Erectile dysfunction Flashcards
(33 cards)
organic causes of ed
spinal injury
neurologic
prostate surgery
vascular
psychogenic causes of ed
stress
relationship issues
how can you determine if cause is psychogenic
happens acutely
ask if spotaneous or nocturnal erections bc then you know vasculature works
drug causes of ed
high dose HCTZ CCB alpha blockers - terazosin central alpha 2 agonist - clonidine chronic opioids antidepressants antiandrogen - finasteride, corticosteroid alcohol smoking
medical conditions causing ed
diabetes hypertension dyslipidemia hypogonadism - test testosterone levels CKD hypo/hyperthyroidism stroke radiation of pelvis anxiety, depression hyperprolactinemia decreases testosterone petronies disease
what is peyronies disease
scar tissue build up in penis causes a curved erect penis
pathyphysiology of an erection
require sexual stimulation to release ach which then activates inositol triphosphate which then coverts l arginine into nitric oxide
cavernous nerve also secretes nitric oxide
NO convert GTP into cGMP
cGMP causese decreased Ca and therefore smooth muscle relaxation and improved arteriole blood flow
PDE5i MOA
work by preventing the breakdown of cGMP
requires sexual stimulation to start the cascade to make cGMP
reason for drug interaction between nitrates and viagra
nitrates increase cGMP and viagra prevents the breakdown so get lots of cGMP and severe hypotension
must separate by 24hr
prostaglandin E pathway
prostagland E through G protein stimulates adenyl cyclase to convert ATP into cAMP which causes smooth muscle relaxation and improved blood flow
papaverine MOA
prevents cAMP breakdown by inhibiting PDE2,3,4
inhibition of PDE 6 causes
vision loss
blue green distrubance
inhibited by sildenafil
inhibition of PDE 11 causes
myalgia presented as back pain
causes by cialis
dose of sildenafil
50mg start increase to 100mg
25mg in renal impairment
max 1dose/day
admin of sildenafil
empty stomach
30min before
moderate alcohol
efficacy of sildenafil
30% dont response
considered first line
peaks in 1hr and lasts 4
adverse effects of sildenafil
flushing headache nasal congestion dyspepsia visual disturbance rare sudden visual or hearing loss NAIO
PDE5i drug interactions
nitrates - seprate by 24 hr, 48 in cialis
grapefruit juice and other cyp3a4 inhibitors
alpha blockers - wait until stabilized , space 4 hr
side effect of all ED drugs
pripasm - erection for more than 4 hours is a medical emergency bc lose oxygen in the blood
tadalafil dose
10-20mg max1/day but should only need 1 every 48hours
max 3/wk in renal dysfunction
daily dosing of 2.5 or 5mg but not in crcl <30
AE of cialis
back pain
vardenafil dosing
10-20mg
no dose adjustment in renal failure
vardenafil AE
QT prolongation
alpostadil MOA
prostaglandin E so increases cAMP
