Urology- ED Flashcards
Physiology of an erection
Dilation of arterial inflow → relaxation of corpora cavernosa smooth muscle → constriction of venous outflow
Dilation of arterial inflow is mediated by what?
NO, cGMP-mediated smooth muscle relaxation
What degrades cGMP?
PDE5
ED treatment
PDE5is
PDE5i drugs
Sildenafil, vardenafil, tadalafil, avanafil
Onset of action for Viagra
30-60 minutes
Duration of Viagra
2-4 hours
Wait time for nitrates for Viagra
24 hours
Vardenafil onset of action
60 minutes
Duration of vardenafil
4-6 hours
Wait time for nitrates for vardenafil
24 hours
Onset of tadalafil
30-45 minutes
Duration of tadalafil
24-36 hours
Wait time for nitrates for tadalafil
48 hours
Onset of action for tadalafil
30-45 minutes
Avanafil onset of action
15 minutes
Duration of avanafil
4-6 hours
Wait time for nitrates for avanafil
12-24 hours
How many doses should the patient try of a PDE5i before it’s considered ineffective?
7-8 doses
PDE5is only give patients an erection with what?
Sexual stimulation
PDE5is CI
Nitrates
PDE5is are a major substrate of what enzyme?
3A4; dose reduction is necessary
Step 1 of the ED treatment algorithm
Treat underlying disease(s)
D/C medications that can contribute
Remove risk factors
Hypogonadism- testosterone supplements
ED treatment algorithm: what to do if the PDE5 doesn’t work
Vacuum erection device, intraurethral alprostadil
CV risk for PDE5is: high risk
Unstable or refractory angina with treatment
Uncontrolled HTN
Severe CHF
Recent MI or stroke within the past 2 weeks
Mod-severe valvular heart disease
High-risk cardiac arrhythmias
Obstructive hypertrophic cardiomyopathy
PDE5s ARE CI’ED!
CV risk for PDE5is: intermediate risk
Has ≥3 risk factors for CVD
Mild-moderate stable angina
Recent MI or stroke within the past 2-8 weeks
Moderate CHF (NYHA Class III)
Hx of stroke, TIA, PAD
Undergo complete CV workup and treadmill stress test before starting, then recategorize between low and high risk
CV risk for PDE5is: low risk
Controlled HTN
Asymptomatic CVD with <3 risk factors for CVD
Mild CHF (NHYA Class I and II)
Mild valvular heart disease
MI >8 weeks ago
Medications affecting ED
Thiazide diuretics and beta-blockers EXCEPT NEBIVOLOL may adversely influence ED
Dose and duration of opioid use, as well as age, comorbidity, depression, and use of sedative-hypnotics, were associated with evidence of ED.
Regular NSAID use is associated with ED beyond what would be expected due to age and comorbidity.
