ED Flashcards
(39 cards)
What is ED
Inability to attain or maintain an erection sufficient for sexual performance
Affects 52% of men 40+
How does a normal erection occur
Relaxation of smooth muscle in cavernosal artery= increased inflow of blood into corpus carvernosa
Increased venous outflow resistance= decreased outflow
What is the physiology behind attaining a normal erection
PNS releases nitric oxide Increased cGMP/cAMP Decreased intracellular calcium smooth muscle relaxation/ vasodilation greater inflow of blood into cavernosa
(very similar to what B3 agonists do in UUI!)
What is the physiology behind maintaining a normal erection
High inflow into cavernosa causes expansion= compression of venous sinuses
Decreased outflow of blood via venous system
What are vasculogenic causes of ED (MCC)
Arterial inflow problem
Venous outflow problem
What are neurogenic causes of ED
Prostatectomy (2 nerves run very close to the prostate and can be damaged in surgery)
What are psychogenic causes of ED
Depression, stress, anxiety, psych d/o
What are endocrine causes of ED
Hyperprolactinemia (PRL suppresses testosterone)
Thyroid d/o
Hypogonadism (sex hormone binding globulin)
What medications can cause ED
Anti-HTN (BB, thiazide, clonidine, methyldopa)
Antidepressants/psychotics (TCA, MAOI, lithium, phenothiazine)
Sedatives, anticholinergics, Phenytoin, alcohol, tobacco
What medications can reduce testosterone and secondarily cause ED
Cimetidine, spironalactone, ketoconazole, LHRH agonists (leuprolide), non steroidal anti androgens (flutamide, biclumatide), Estrogens
What disease states can cause ED
chronic renal insufficiency
DM
chronic hepatic disease
Neurologic, atherosclerotic, endocrine dz
What trauma can cause ED
Pelvic Fx Penile Fx (tunica vaginalis can snap 2/2 stiffness when erect)
What sexual history is important to ask with a CC of ED
onset, rigidity, duration Morning erections (reflex- when the bladder gets full, erection) Libido Relationship PReformance anxiety/stress Curvature (Peyronie's) IIEF scale
On PE for ED complaint it is important to assess
Circulaiton
Gynecomastia, galactorrhea, visual field deficit
External genitalia exam (penis and testes)
What labs could you check with a CC of ED
Testosterone (if decreased libido, check total and bioavailable testosterone between 7-11 AM)
PRL if indicated
Nocturnal penile tumescence (BP cuff around penis that measurea how many times per night the penis gets erect; normal is a few)
What is Penile duplex doppler sonography
test for ARTERY insufficiency
inject vasoactive med into cavernosa to measure arterial flow and diameter
What is Cavernosometry
test for VENOUS leak
inject vasoactive med into cavernosa- then use needle for inflow of saline and measure rate of inflow of saline required to maintain erection
General Tx of ED can include (before meds, etc.)
Is CV status appropriate for sex? Smoking cessation weight control alcohol change meds if needed treat medical conditions
Other Tx for ED include
Yohimbine PDE5 inhibitors VED MUSE (medicated urethral system for erection) Penile injection constriction ring penile splint penile prosthesis penile revascularization
PDE5-I are contraindicated with
Nitrate use!
can cause severe orthostatic hypotension
*Use caution with alpha blockers (tamulosin, alfuzosin); use lowest dose of each and separate doses
What is the normal role of PDE5
PDE5 decreases amount of cGMP= decreased blood flow to penis= Detumescence
What is the MOA of PDE5-Inhibitors
Block PDE5= cGMP can continue to have vasodilatory effect
Erection is prolonged
ADE of PDE5-I include
Nasal congestion facial flushing HA dyspepsia back pain/myalgias visual changes (blue halo) Non-arteritic ischeimc optic neuropathy priapism
What are the PDE5 inhibitors
Sildenafil (viagra)
Tadalafil (cialis)
Vardenafil
Avanafil
