erectile dysfunction

Question 1

ED treatment

Answer 1

lifestyle changes - smoking cessation, reduce alcohol

1st line - phosphodiesterase type 5 inhibitor
- increases blood flow to penis - still requires sexual stimulation

short acting: sildenafil, avanafil, vardenafil - occasional use PRN

long acting: tadalafil - use PRN or as regular lower daily dose to allow for spontaneous sexual activity

Pt should have 6 doses at max dose (with sexual stimulation) before being classified as non-responder

2nd line - alprostadil (intracavernosal, intraurethral or topical) under careful medical supervision

Question 2

phosphodiesterase T5 inhibitor - imp points

Answer 2

SE’s:
flushing
dizziness
nasal congestion
migraine

C/I:
hypotension, stroke,
taking nitrates
unstable angina
have angina during intercourse
should’t have sexual activity

PRIAPISM - erection lasts > 4 hours - seek medical attention

interactions - nitrates, alpha blockers - hypotension

alprostadil - wear condom if partner is of childbearing age, pregnant or lactating