Urology- ED

Question 1

Physiology of an erection

Answer 1

Dilation of arterial inflow → relaxation of corpora cavernosa smooth muscle → constriction of venous outflow

Question 2

Dilation of arterial inflow is mediated by what?

Answer 2

NO, cGMP-mediated smooth muscle relaxation

Question 3

What degrades cGMP?

Answer 3

PDE5

Question 4

ED treatment

Answer 4

PDE5is

Question 5

PDE5i drugs

Answer 5

Sildenafil, vardenafil, tadalafil, avanafil

Question 6

Onset of action for Viagra

Answer 6

30-60 minutes

Question 7

Duration of Viagra

Answer 7

2-4 hours

Question 8

Wait time for nitrates for Viagra

Answer 8

24 hours

Question 9

Vardenafil onset of action

Answer 9

60 minutes

Question 10

Duration of vardenafil

Answer 10

4-6 hours

Question 11

Wait time for nitrates for vardenafil

Answer 11

24 hours

Question 12

Onset of tadalafil

Answer 12

30-45 minutes

Question 13

Duration of tadalafil

Answer 13

24-36 hours

Question 14

Wait time for nitrates for tadalafil

Answer 14

48 hours

Question 15

Onset of action for tadalafil

Answer 15

30-45 minutes

Question 16

Avanafil onset of action

Answer 16

15 minutes

Question 17

Duration of avanafil

Answer 17

4-6 hours

Question 18

Wait time for nitrates for avanafil

Answer 18

12-24 hours

Question 19

How many doses should the patient try of a PDE5i before it’s considered ineffective?

Answer 19

7-8 doses

Question 20

PDE5is only give patients an erection with what?

Answer 20

Sexual stimulation

Question 21

PDE5is CI

Answer 21

Nitrates

Question 22

PDE5is are a major substrate of what enzyme?

Answer 22

3A4; dose reduction is necessary

Question 23

Step 1 of the ED treatment algorithm

Answer 23

Treat underlying disease(s)
D/C medications that can contribute
Remove risk factors
Hypogonadism- testosterone supplements

Question 24

ED treatment algorithm: what to do if the PDE5 doesn’t work

Answer 24

Vacuum erection device, intraurethral alprostadil

Question 25

CV risk for PDE5is: high risk

Answer 25

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!

Question 26

CV risk for PDE5is: intermediate risk

Answer 26

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

Question 27

CV risk for PDE5is: low risk

Answer 27

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

Question 28

Medications affecting ED

Answer 28

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.