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443-SRH and MSK > erectile dysfunction > Flashcards

erectile dysfunction Flashcards

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1
Q

interpersonal relationship among 2 people in romantic relationship, who may or may not be actively engaged in sexual relations

A

intimacy

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2
Q

experience of pleasure from one’s senses leading to an increased awareness of an appreciation for one’s own body

A

sensuality

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3
Q

any combination of sexual behaviour, sensual activity, emotional intimacy, or sense of sexual identity (a bio-psyco-social process + cultural and interpersonal factors)

A

sexuality

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4
Q

consistent or recurrent inability of male to attain and maintain an erection of the penis sufficient to permit satisfactory sexual intercourse

A

ED

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5
Q

inability of male to perform sexual act

A

impotence

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6
Q

dick changes with aging

A

Arousal becomes delayed, less rigidity in erection
Weaker, shorter orgasms
Prolonged plateau and diminished urge to ejaculate
More rapid detumescence with a prolonged refractory period

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7
Q

physiology of a flaccid penis

A

SNS
arterial and smooth muscle contracted

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8
Q

physiology of an erect penis

A

PNS
NO primary mediator
vasodilation + decrease in peripheral vascular resistance

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9
Q

pulmonary RF for ED

A

COPD, OSA

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10
Q

endocrine RF for ED

A

hypogonadism (meh), DM, obesity

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11
Q

CV RF for ED

A

HPTN, hypercholesterolemia, vascular disease, strole

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12
Q

why is a man with ED a cardiac pt until proven otherwise

A

endothelial dysfunction leads to ED leads to early death

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13
Q

lfiestyle RF for ED

A

obesity
sedetary lifestyle
bike riding
smoking, alcohol
shift work
poor diet

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14
Q

COVID can cause ED through mechs like

A

endothelial dysfxn, psyc distress, impaired pulmonary hemodynamics, exacerbation of CV diseases, impact on T levels, sensory loss

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15
Q

what Anti-HPTN drugs worsen ED? which would be chosen instead

A

worsen: BB, thiazides, aldosterone antagonists, centrally acting
better: CCB, ARB, ACEi

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16
Q

what hormone affecting drugs worsen/ cause ED

A

antiandrogens: spironolactone, cimetidine
CS, E, P, GnRH agonists, 5alpha reductase inhibitors

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17
Q

which psyc meds worsen ED

A

SSRIs, SNRIs, TCAs, MAOi, 1st gen neuroleptics, risperidone

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18
Q

which psyc meds are preferred for ED

A

buproprion, mirtazapine, quetiapine, olanzapine, aripiprazole

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19
Q

list 3 assessment tools for ED

A

SQoL assessment, self esteem and relationship questionnaire (SEAR), erectile dysfunction inventory of tx satisfaction (EDITS), # of events (penetration, attempts), international index of erectile function (IIEF)

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20
Q

what are first line ED tx

A

PDE5i, psychotherapy

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21
Q

what are second line ED tx

A

IV inj, intraurethral suppositories, vacuum erection device

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22
Q

nonpharm ED tx

A

Counseling of both partners
Lifestyle: smoking cessation, avoid EtOH, substance misuse, healthy diet, exercise, adequate sleep

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23
Q

pharm classes for ED

A

PDE1
prostaglandin E1
MUSE
injections
trazodone

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24
Q

PDEi response for ED is ____ in diabetics

A

lower

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25
PDEi response is ______ dependent
dose
26
PDEi SEs
flushing, headache, dyspepsia, nasal congestion, visual disturbances (more with sildenafil)
27
PDE5i may increase risk of
malignant malenoma or basal cell carcinoma
28
PDEi eye safety
nonarteritic anterior ischemic optic neuropathy (NAION) new/ worsening glaucoma change in colour perception
29
how do PDEi change colour perception
PDE6 interacts with sildenafil in retina for blue tinged vision
30
what is NAION
Non-arteritic anterior ischemic optic neuropathy (NAION): acute ischemia of optic nerve, infarct may result, visual field defect or vision loss may occur Counsel pt to inform MD if experiencing vision loss
31
what is an absolute contraindication for PDE5i
nitrates
32
CV effects of sildenafil may be potentially hazardous in include (5)
active coronary ischemia (not on nitrateS) CHF and boarderline low BP boarderline low volume status complicated, multidrug AHA regimen meds that can prolong half life (P450 3A4i, 2C9i)
33
PDEi should monitor for dizziness with
alpha antagonists
34
how long to trial PDEi
4 mths
35
what is the only PDEi you can use on demand
tadalafil 20mg
36
how long before sex to take sildenafil
30min-4hrs
37
how long before sex to take tadalafil
stat = 20mg (max 3x/wk) 15min-36h if 5mg daily
38
how long before sex should you take vardenafil
15min-4hrs
39
which PDEi have their Cmax decreased with high fat meal
sildenafil, verdenafil
40
which PDEi is most associated with visual disturbances
sildenafil
41
prostaglandin E MOA
↑ cAMP = SM relaxation, vaso occlusion, erection (endogenous NO not required)
42
how long before sex to inject Prostaglandin E1
<1hr, erection can occur within 5min
43
max usage of sildenafil
1dose/d
44
max use of vardenafil
1dose/day
45
max use of tadalafil
3 on demand 20mg doses/ week one 5mg/day
46
max use of PGE1
1 dose/24h, 3 doses/wk
47
when are PGE1s used
when systemic therapies are CI - inject into area instead
48
PGE1 AEs
penile pain, priapism
49
PGE1 contraindications
any condition that increases the risk of priapism (sick cell anemia, multiple myeloma, leukemia, anatomical penile deformity)
50
MUSE is
alprostadil- a PGE1
51
what should you use for ED pts who refuse injections + failed on PDEi
MUSE
52
aloprostil AEs (MUSE)
penile pain, urethral burring, vaginal irritation for partner
53
which meds are used for ED injections
papaverine phentolamine PGE1
54
what is triple therapy for ED
papaverine phentolamine PGE1
55
papaverine is a _____ with MOA ______
nonspec PDEi ↑cAMP and cGMP in penile erectile tissue
56
papaverine SEs
penile fibrosis, potential hepatotoxicity
57
phentolamine is a ___________ and blocks ___________
alpha 1,2 selective antagonist blocks sympathetic receptors that controls tone
58
drawbacks of injections for ED include
nonspontaneous, manual dexterity, eyesight, priapism, fibrosis, dropout/ adherence
59
trazodone MOA for ED
facilitates 5HT and DA pathways
60
trazodone SEs
priapism, sedation
61
which NHPs are used for ED
yohimbine panax gingseng butea superba L-arginine
62
Yohimbine MOA
a2-antagonist, acts at brain center to control libido, penile erection
63
yohimbine is used for ____ ED with evidence of ____
psychogenic ED mixed evidence but superior to placebo
64
panex gingseng MOA
increase cGMP + relaxation of corpus cavernosum
65
role of panax ginseng
psyc ED
66
which NHP is not recommended rn for ED 1. yohimbine 2. panax ginseng 3. butea superba 4. L0arginine
3
67
L-arginine MO for ED
NO production
68
role of L arginine in ED
use with PDE5i if resistant
69
most effective tx for ED 1. PDEi 2. penile devices 3. penile prosthesis 4. NHPs like yohimbine
2
70
how to monitor for efficacy of ED tx
dose required, number and quality of erections after taking meds internationl index of erectile function secual encounter profile
71
what is classified as priapism
Unwanted erection lasting >4hrs + not associated with sexual desire
72
what is the danger with priapism
if >36hrs = permanent ED better chances if restoring normal fxn if ER fast
73
what is the most common type of priapism
low flow
74
tx of priapism
early stage = ice packs and cold showers analgesia decompression (remove at least 5ml) intracavernosaal sympathomimetics oral sympathomimetics shunt surgery
75
what re some Intracavernosal sympathomimetics you can use in priapism
phenylephrine for rapid vasoconstriction
76
what oral sympathomimetics can be given for priapism
terbutaline po 5-10mg, pseudoephedrine po caution CV risk

443-SRH and MSK (24 decks)

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