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ED Flashcards

1
Q

Physiology of an erection

A

neurovascular event

  • autonomic/somatic nerve supply
  • Arterial blood flow via cavernosal arteries
  • smooth/striated musculature of corpora cevernosa/pelvic floor
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2
Q

Neurotransmitters sustaining/initiating erection

A

Primary - nitrous oxide

Others - Ach, PGs, Vasoactive intestinal peptide

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3
Q

Erection caused and maintained by?

A

Increased arterial flow and venous resistance

Smooth muscle relaxation w/in corpora cavernosa

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4
Q

Increased erection rigidity is due to

A

Bulbocavernosus/ischiocavernosus muscle contraction

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5
Q

ED dysfx def?

A

Consistent inability to attain/maintain a sufficient erection for sexual performance

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6
Q

ED dysfx MC pop?

A

40-70 - >50%

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7
Q

ED dysfx etiologies?

A

Organic or psychogenic (freq overlap)

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8
Q

ED dysfx psychogenic occurs in what pop?

A

Young men

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9
Q

ED dysfx psychogenic will have what versus organic issues?

A

Normal - Nocturnal/morning erections

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10
Q

Two types of psycogenic ED dysfx?

A

Generalized (unresponsive and inhibition)

Situational (Partner, performance, psych/adujstment)

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11
Q

ED dysfx psychogenic generalized unresponsive -

A

Lack sexual arousability

Age related decline in arousability

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12
Q

ED dysfx psychogenic - generalized inhibition -

A

Chronic D/O of sexual intimacy

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13
Q

ED dysfx psychogenic - situational partner related -

A

Lack in specific relationship
Lack due to to sexual object preference
High central inhibition due to partner conflict/threat

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14
Q

ED dysfx psychogenic - situational performance related -

A

Ass/w other sexual dysfx (premature ejack)

Situational performance anxiety (fear of failure)

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15
Q

ED dysfx psychogenic - situational psych/adjustment -

A

Ass/w negative mood - depression or major life stress

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16
Q

Organic ED dysfx types?

A

Arterial/venous
Hormonal
Neurogenic
Rx-induced

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17
Q

Which type of ED dysfx is characterized w/ nocturnal erections?

A

Psychogenic only (Not organic)

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18
Q

Organic - Vascular reasons

A

CV Dz - HTN, DM, Hyperlipidemia, Tob

Major surgery/radiotherapy - Radical prostatectomy

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19
Q

Organic - Neurogenic reasons

A

Injuries to brain/spinal cord
Parkinsons/Alzheimers Dz
Multiple Sclerosis
Stroke

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20
Q

Organic - Cavernous reasons

A

Peyronies Dz
Cavernous fibrosis
Penile Fx

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21
Q

Organic - Hormonal reasons

A

Hypogonadism
Hyperprolactinemia
Thyroidism’s
Cortisolism’s

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22
Q

Organic - Rx-induced reasons

A

Anti-Htn
Anti-depressants
Opiods
Recreation Rx

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23
Q

Organic - Pyschogenic reasons

A

Performance-related anxiety
Traumatic past experiences
Relationship issues
Anxiety/depression/stress

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24
Q

RFs of males

A 
>40yo, fat (ETOH, Tob, Illict)
DM, HTN, Dyslipidemia, CAD/PAD
Psych (depression, anxiety, stress)
Neurologic Dz
CKD
Hx prostate cancer TXT
Pelvic (trauma/surgery/irradation)
Endocrine D/O
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25
ED dysfx Hx
``` Other sexual Dysfx -Loss libido (androgen deficits) -Loss of seminal emission (anejaculation) > -Anorgasmia -Premature ejaculation Chronic vs Occasional vs Situational Attaining vs maintaining PMHx/PSHx Illicits, ETOH, Tob ```
26
What may make Hx taking easier/more comfortable for the patient?
Self administered - International Index of Erectile Fx (IIEF)
27
Rx induced ED dysfx meds
Anti-HTN (BB, Thiazides, Spironolactone, Clonidine) Antidepressants Opioids Prostate agents (Doxazosin/terazosin)
28
Rapid onset finding causes
``` Pyschogenic GU trauma (prostatectomy) ```
29
Nonsustained erection finding causes
Anxiety | Venous leak
30
Complete loss of nocturnal Erections
Vascular/neurologic Dz
31
ED dysfx PE
Vascular/neurosensory exam Genitalia exam (scarring/plaques) or (testicular size) Prostate exam Note secondary sex characteristics (gynecomastia)
32
ED dysfx labs
Lipid panel Glucose Testosterone/PRL TSH
33
If testosterone or PRL ABNL reflex?
Free testosterone and LH = differentiates hypothalamic-pituitary dysfx vs testicular failure
34
To differentiate organic vs psychogenic test with?
Nocturnal penile tumescemce testing device
35
Special test - trial of (PO) PDE-5 inhibitors
Inadequate response to (PO) > directly inject vasoactive substances > erection = intact vascular system (no further eval)
36
Direct injection of vasoactive substances?
PG E1 Papaverine Phentolamine
37
Failure to achieve erections after (PO/INJ) reflex?
Penile duplex doppler U/S Penile cavernosography Pudendal arteriography
38
Psychogenic ED dysf TXT
Sexual health therapy/counseling
39
ED dysfx TXT
``` Lifestyle mods and decrease CV risk PDE-5 Inhibitors Vasoactive Rx (Alprostadil (PG E2) (INJ/Suppository) Hormonal replacement Adjunct Devices Surgical ```
40
MOA of PDE-5 Inhibitors?
inhibits phosphodiesterase type 5 > allowing cGMP to fx unopposed = more blood flow into erect penis
41
PDE-5 Inhibitors Rx
Vardenafil Avandafil Sildenafil Tadalafil
42
Adverse SEs PDE-5 Inhibitors
HOTN - (caution if patient is on Alpha Blks for lower urinary tract S/S - titrate carefully) Priapism - rare
43
PDE-5 Inhibitors Rx CI's?
``` Nitroglycerin/nitrates > excess preload reduction/HOTN CYP450 - 3A4 inhibitors -erythromycin -cimetidine -ketoconazole -intraconazole -Grapefruit juice ```
44
PDE-5 Inhibitors relative CI's?
``` Active coronary ischemia in men not on nitrates HF Borderline HOTN or multiple HTN Rx's CYP450 - 3A4 inhibitors -erythromycin -cimetidine -ketoconazole -intraconazole -Grapefruit juice ```
45
PDE-5 Inhibitors - Sildenafil attributes
Viagra - 1hr prior to sex - lasts 4hrs 50-100mg (empty stomach - high fat meal = delays)
46
All PDE-5 Inhibitors requires what for effective use?
Stimulation
47
PDE-5 Inhibitors - Vardenafil attributes
Levitra - 1hr prior sex - onset/duration similar to sildenafil 20mg PO (1/day max)
48
PDE-5 Inhibitors - Tadalafil attributes
Cialis - 1hr prior sex - 30-60m onset lasting 3 days* 10-20mg PO (no more than 1 Q2 days)
49
Which PDE-5 Inhibitors is FDA approved for BPH ED?
Tadalafil (cialis) | -2.5mg and 5mg daily dosing
50
PDE-5 Inhibitors - Avanafil attributes
Stendra - 15m prior sex* - similar duration to sildenafil 100-200mg
51
Vasoactive therapy Rx?
Alprostadil (PG E2)
52
MOA of Alprostadil (PG E2)?
Stimulates adenyl cyclade to increase intracellular cAMP levels > smooth muscle relaxation and V-dil
53
Alprostadil routes?
Injectable | Urethral Suppository
54
Direct injection of alprostadil notes
Use tuberculin syringe | Inject at base/lateral aspect (avoid superficial BVs/nerves)
55
Urethral Suppository of alprostadil notes
``` Small pellet (MUSE) inserted w/ applicator 3x1 mm pellet is inserted 3cm into urethra - Absorbs from urethra > corpus spongiosum > corpora cavernosa ```
56
ED dysf - hormonal replacement TXT?
If - documented androgen deficits | Testosterone injections/topical patches (androderm)
57
What must be performed prior to hormonal replacement?
R/O prostate cancer 1st
58
Vacuum Erection Device
Best for patients w/ venous D/O of penis and fail to achieve erection w/ vasoactive substance injection
59
Vasoactive substance injection failure + venous D/O reflex?
Vacuum erection device
60
Vacuum erection device - methodology?
``` creates negative pressure around penis > blood drawn into corpora cavernosa > tumescence/erection achieved > place elastic constriction band around penile base > PVTs loss of erection ```
61
ED dysfx surgical options?
Inflatable penile implant Flexible rod penile implant Vascular reconstruction - last resort
62
Vascular reconstruction of penis is indicated for?
Vascular D/O - Trauma-induced focal arterial occlusion - Congenital venous occlusion
63
Vascular reconstruction success rate?
Many will still fail to achieve rigid erection

Urology (7 decks)

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