Trigger - Male sexual dysfunction Flashcards
what contracts during ejaculation
epididymis
vas deferens
seminal vesicles
prostate
bulbocavernosus and ischiocavernoso
norepinephrine and endothelin play what role in male sexual function
mediates detumescence (smooth muscle contraction increasing venous outflow, restoring flaccid state)
failure to initiate erection can be due to what kind of cause
psychogenic, endocrinologic, neurogenic
failure to fill penile tissue is d/t what kind of cause
arteriogenic
what disease decreases NO synthesis?
DM
also causes vascular disease and neuropathy. basically kills erections from all three directions
this etiology results in inhibition of reflexogenic responses and/or increases in smooth muscle tone
psychogenic
relaxation of what allows increased blood flow into the penis and therefore erection
corpora cavernosa
what compresses venous return during an erection
trabecular smooth muscle
if a patient has no response to direct injection of vasoactive medication, what is suggested and what tests should be done to follow up
- respone = non-intact vasculature
should do duplex US, cavernosography, and arteriography
a patient with unstable CHF and untreated OSA is not eligible for what type of ED treatement
testosterone therapy
also not eligible:
- prolatinomas
- erythrocytosis
- any conditions suggesting prostate cancer or BPH
- breast cancer
which testosterone replacement therapy is expensive
topical cream
injectable is NOT the expensive type
which testosterone replacement therapy causes fluctuations in serum levels of testosterone
testosterone injections
spermatogenesis suppression is a SE of what ED treatment
testosterone replacement therapy
steroids, GnRH agnonists/antagonists and warfarin are all DDI for what ED med
testosterone replacement therapy
what medications MOA is to inhibit the degradation cGMP which allows sustained blood flow to the penis
PDE-5 inhibitors
longest acting PDE5 inhibitor
tadalafil - 36 hrs
what is the shortest onset of action PDE 5 inhibitor
avanafil - 30 min
which med has a SE for anterior optic neuropathy, hearling loss, and vision changes
PDE 5 inhibitors
literally for these just think HEENT
Head - headache, flushing
Ears - hearing loss
Eyes - vision chnages, anterior optic neuropathy
Nose - congestion or rhinitis
Throat - dyspepsia
then add hypotension and priapism
what medication is CI for NTG or nitrates of any form AS WELL AS CV disease with risk for CV event with sex
PDE-5 inhibitors
DDI for antifungals and alpha blockers
PDE5 inhibitors
also nitrates
SE of this med include dizziness, fibrosis, infection, bruising, and pain
and of course… priapism
injectable prostaglandins
what ED treatment inhibits ejaculation
Vacuum devices
what are surgical procedures that are completed on the proximal artery of the penis
endarterectomy and balloon dilation
what are surgeries that are done on the distal artery of the penis
arterial bypass
what part of the penis are penile prosthesis implanted into
corpora cavernosa
paroxetine is 1st line treatment for what disorder
premature ejaculation
what is the most effective treatemnt for premature ejaculation
combo of pharm + counseling
imipramine, chlorpheniramine and pseudophedrine are used in the treatment of what disorder
retrograde ejaculation
only treated if fertility is desired!
