Erectile Dysfunction (Final)

Question 1

true or false: erectile dysfunction may be an indicator of CV disease

Answer 1

true

Question 2

explain the normal physiology of an erection

Answer 2

1. starts with the nervous system
   - sensory stimulation causes acetylcholine to be released which works with cGMP and cAMP to produce an erection
2. erections are primarily a vascular event
   - corpus cavernosum and spongiosum fill with blood causing swelling and elongation.

Question 3

during the initiation of an erection, is the arterial blood flow or the venous blood flow affected

Answer 3

increase in arterial blood flow - results in filling of sinuses

Question 4

in order to prolong an erection, is the arterial blood flow or venous blood flow affected

Answer 4

decrease in venous OUTflow

Question 5

an increase in arterial blood flow is mediated through acetylcholine induced (vasoconstriction/vasodilation)

Answer 5

vasodilation

Question 6

erections require libido and _____ stimulates libido

Answer 6

testosterone

Question 7

true or false: ED only occurs when there is an abnormality in the hormonal system

Answer 7

false - can occur if there is an abnormality in the nervous, vascular or hormonal system

Question 8

what are the medications that can cause ED

Answer 8

• anticholinergics (decrease flow of blood therefore ED)
• dopamine antagonists (affects CNS/neuronal therefore ED)
• estrogens (opp. of testosterone therefore ED)
• antifungals (lower testosterone therefore ED)
• antiandrogens (lower testosterone therefore ED)
• antihypertensives (decreases blood flow therefore ED)
• CNS depressants (affects CNS/neuronal therefore ED)

Question 9

treatment of this type of cancer can also cause ED as treatment consists of surgery, radiation and hormonal treatments which can affect the normal mechanisms

Answer 9

prostate cancer

Question 10

what are some medical conditions/lifestyle factors that can reduce the blood flow to the corpora therefore induce ED

Answer 10

• peripheral vascular disease
• atherosclerosis
• smoking
• sedentary lifestyle
• penile trauma or surgery

Question 11

what are some medical conditions/lifestyle factor that can affect nerve conduction therefore induce ED

Answer 11

• spinal cord injury
• stroke
• DM
• MS
• dementia
• penile trauma or surgery

Question 12

what are some medical conditions/lifestyle factors related to endocrine disorders therefore induce ED

Answer 12

• hypogonadism
• thyroid disorders
• prolactinoma

Question 13

if erections with partner ARE NOT better than erections alone or sleep, what is the first step to addressing this issue?

Answer 13

address psychosocial issues

Question 14

if erections with partner are better than erections alone or sleep, what is the first step to addressing this issue, and the patient is not taking any alpha-blockers or nitrates?

Answer 14

PDE5 inhibitors

Question 15

if erections with partner are better than erections alone or sleep, what is the first step to addressing this issue, and the patient is taking alpha-blockers or nitrates?

Answer 15

Alprostadil VDE (vaccuum device)

Question 16

what are some nonpharm treatments for ED

Answer 16

• smoking cessation
• weight loss
• avoidance of recreational drugs
• stress management
• exercise
• address sexual avoidance
• address lack of sexual arousal
• vaccuum erection devices (VED)

Question 16

this is the first line treatment option for ED. cGMP is responsible for decreasing calcium levels and therefore produce an erection. This medication inhibits the conversion of cGMP to inactive GMP, therefore driving the pathway towards that of producing an erection

Answer 16

PDE5 inhibitors

Question 17

true or false: it is safe for patients that do not have ED to use PDE5 inhibitors

Answer 17

false - can lead to priaprism (prolonged erection)

Question 18

what are the 3 available PDE5 inhibitors

Answer 18

1. sildenafil (Viagra)
2. vardenafil (Levitra)
3. tadalafil (Cialis)

Question 19

true or false: sildenafil should be taken 30-60 mins prior to sexual activity with food

Answer 19

false - 30-60 mins prior ON AN EMPTY STOMACH

Question 20

true or false: vardenafil should be taken 30-60 mins prior to sexual activity with food

Answer 20

false - 30-60 mins prior ON AN EMPTY STOMACH

Question 21

true or false: tadalafil should be taken 1 hr prior to sexual activity without regard to food

Answer 21

true

Question 22

true or false: the duration of action of sildenafil is ~4 hours but can be up to 12 hours

Answer 22

true

Question 23

true or false: the duration of action of vardenafil is ~4 hours but can be up to 12 hours

Answer 23

true

Question 24

true or false: the duration of action of tadalafil is ~4 hours but can be up to 12 hours

Answer 24

false - 36 hours

Question 25

what are the most common s/e of PDE5 inhhibitors

Answer 25

- facial flushing - h/a - dyspepsia - nasal congestion - dizziness

Question 26

what are some rare s/e of PDE5 inhibitors

Answer 26

- hearing loss - priaprism

Question 27

what is a s/e specific to sildenafil and vardenafil

Answer 27

- blue vision

Question 28

what is a s/e specific to vardenafil

Answer 28

- QT prolongation

Question 29

what are s/e specific to tadalafil

Answer 29

- myalgia - back pain

Question 30

PDE5-inhibitors are metabolized by this enzyme therefore need to be mindful of inducers (carbamazepine) and inhibitors (clarithromycin and ketoconazole)

Answer 30

CYP 3A4

Question 31

how long should sildenafil and vardenafil be spaced from taking nitrates

Answer 31

24 hours

Question 32

how long should tadalafil be spaced from taking nitrates

Answer 32

48 hours

Question 33

this medication should spaced from PDE5 inhibitors by 4 hours

Answer 33

alpha blockers

Question 34

this is considered a second line option for ED. comprised of a pump, cylinder and constriction band. the cylinder is poushed up against the abdomen, the vaccuum is activated, removing air and creating pressure that draws blood toward the gland of the penis. to prolong erection the band is placed at the base of the penis

Answer 34

vaccuum erection device (VED)

Question 35

what is the maximum time period the constriction band should be left on

Answer 35

30 mins

Question 36

what are some advantages of VEDs

Answer 36

- non-invasive - effective

Question 37

what are some diadvantages of VEDs

Answer 37

- not discrete - patients may fail to ejaculate - caution in patients taking OACs

Question 38

this is considered 2nd or 3rd line Tx for ED. it stimulates adenylyl cyclase which increases cAMP, which decreases calcium therefore causes an erection. this is delieverd directly to the corpus cavernosum. is useful in patients with problems with nerve conduction

Answer 38

intracavernosal injections

Question 39

what is the onset of action of intracavernosal injections

Answer 39

5-15 mins

Question 40

what is the duration of action of intracavernosal injections

Answer 40

~ 1 hr

Question 41

what are some common a/e associated with intracavernosal injections

Answer 41

- penile pain (burning, ache) - fibrosis (scarring of tissue) - hematoma (bad bruise)

Question 42

what are some rare a/e of intracavernosal injections

Answer 42

- priaprism - infections

Question 43

what is the max amount if intracavernosal injections that should be used per week

Answer 43

3/week

Question 44

who should intracavernosal injections not be used in

Answer 44

patients who are at high risk of poor injection technique (RA, obese, psych conditions)

Question 45

this is another option for ED. it is moderately effective, and less invasive than intercavernosal injections. it has the same MOA as intracavernosal injections and is also delievered directly to the corpus cavernosum

Answer 45

urethral inserts

Question 46

what are some common a/e in urethral inserts

Answer 46

- urethral pain - urethral injury - priaprism

Question 47

which treatment option has a risk of vaginal burning and itch in female partners

Answer 47

urethral inserts

Question 48

when should urethral inserts be used prior to sex

Answer 48

10-30 mins