Exam 3 lecture 6

Question 1

define ED

Answer 1

inability to maintain erection sufficient for penetration to permit satisfactory sex

Question 2

decreased libido

Answer 2

decreased sexual drive or desire

Question 3

increased libido

Answer 3

precocious puberty; inappropriate and excessive sexual drive or desire

Question 4

delayed ejaculation

Answer 4

aka “dry sex”; ejaculation is delayed or absent

Question 5

retrograde ejaculation

Answer 5

ejaculate passes retrograde into the bladder instead of toward the anterior urethra (antegrade) & out of the penis

Question 6

infertility

Answer 6

insufficient # of sperm, abnormal morphology or have inadequate motility & fail to fertilize the ovum

Question 7

psychogenic cause of ED

Answer 7

• not as receptive to sexual stimuli
• age-related decline in arousability
• situational: partner related, performance related
• psychological distress

Question 8

organic cause of ED

Answer 8

• neurogenic:(innervation issue- stroke, dimentia, tumor, DM, chronic ETOH)
• vascular: (impaired blood flow)- PVD, HTN, trauma, atherosclerosis
• hormonal: decr. test, hyperprolactinemia, hypothyroidism, hyperthyroidism
• medication induced

Question 9

medications that can cause ED

Answer 9

anticholinergics, antidepresssants/antipsycotics, DA antagonists, estrogens/antiandrogens, CNS depressants, HTN drugs, other (cigarettes & alcohol)

Question 10

international index of erectile function (IIEF)

Answer 10

pt questionare to objectively measure symptoms.

• includes: erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction
• classifies: severe- no ED

Question 11

pharmacologic therapies to treat iodiopathic ED

Answer 11

• PDE5 inhibitors

- synthetic prostaglandin E1 analog

Question 12

first line therapy for management of ED

Answer 12

PDE5 inhibitors

Question 13

Pros of PDE5 inhibitors

Answer 13

• effectivness, route of administration, low side effects, discreet

Question 14

PDE5 inhibitor MOA

Answer 14

• blocks PDE5 -> NO breakdown of cGMP-> NO increase in Ca-> smooth muscle RELAXATION-> incr. blood flow-> erection prolonged

Question 15

dutumenscence

Answer 15

return of penis to relaxed state

Question 16

PDE5 selective

Answer 16

-genital tissue, tracheal smooth muscle, platelets- bleeding

Question 17

PDE6 selective

Answer 17

(Sildenafl»vardenafil)

- photoreceptors in the retina- incr. sensitivity to light, blurred vision, loss of blue-green color discrimination

Question 18

PDE11 selective

Answer 18

(Tadalafil»>all others)

- skeletal muscle- back & muscle pain

Question 19

PDE5 inhibitor contraindications

Answer 19

concurrent use of regular or intermittent nitrates

Question 20

PDE5 inhibitor side effects

Answer 20

• common: HA, dizziness, flushing dyspepsia
• severe(rare): priapism, hearing impairment, visual disturbances, myalgias/back pain, nonarteritic anterior ischemic optic neuropathy (NAION)

Question 21

priapism

Answer 21

erection lasting >4hours

Question 22

nonarteritic anterior ischemic optic neuropathy (NAION)

Answer 22

• blood flow blocked to the optic nerve
• rapid onset of painless, unilateral vision loss
• risk factors: glaucoma, etc

Question 23

PDE5 inhibitor drug interaction

Answer 23

• nitrates
• CYP3A4 inhibitors (macrolides & azoles)
• antihypertensives (alpha 1- blockers)
• alcohol

Question 24

which drugs do you need to take on an empty stomach or low fat meal?

Answer 24

sildenafil & vardenafil

Question 25

synthetic prostaglandin E1analog

Answer 25

alprostadil

Question 26

alprostadil MOA

Answer 26

increases production of cCAMP-> muscle relaxation

Question 27

pros of alprostadil

Answer 27

- efficacy | - good for multiple ED etiologies

Question 28

cons of alprostadil

Answer 28

- inconvenient administration- injection/suppository - unnatural erection - needle phobia - cost of therapy

Question 29

duration of erection is directly related to the dose for what drug?

Answer 29

alprostadil

Question 30

alprostadil injection dose

Answer 30

- vasculogenic, pyschogenic: 2.5mcg; 60mcg max - neurogenic: 1.25mcg; range 1.25-20) - max 3 doses/wk with >24 hours inbetween

Question 31

alprostadil (Caverject or Edex) counseling points

Answer 31

- store at RT - reconstitute prior to use - inject 5-10 minutes prior - erection will last ~1 hour

Question 32

alprostadil (MUSE) counseling points

Answer 32

- intraurethral suppository - store in fridge - empty bladder before use - sit, stand or walk around while erection develops- improve erection quality

Question 33

erections with alprostadil shouldn't last longer than

Answer 33

1 hour

Question 34

3 parts of a vacuum erection device (VED)

Answer 34

pump, cylinder and tubing

Question 35

VED MOA

Answer 35

vacuum pressure draws blood into the corpora cavernosa - onset of action: 0.5 hours - better response in combo with alprostadil

Question 36

what is first line in patients in monogamous relationships?

Answer 36

VED

Question 37

secondary erectile dysfunction due to

Answer 37

hypogonadism- use hormone replacement therapy (HRT)

Question 38

signs/symptoms of low testosterone

Answer 38

- decreased libido - decreased muscle strength - depressed mood - normal levels: 300-1100

Question 39

supplemental testosterone does not

Answer 39

directly treat ED, but improves libido

Question 40

formulations that testosterone comes in

Answer 40

PO, buccal, IM, patch, gel, implant

Question 41

testosterone therapy side effects

Answer 41

- cardio: edema, flushing, HTN, < HDL - CNS: aggrssion, anxiety, excitation - derm: acne, hirsutism, dry skin - endo: hypoglycemia, gynecomastia, weight gain, Na retention - worsening sleep apnea, increased Hct

Question 42

topical testosterone patch is applied when and where?

Answer 42

at night. Scrotum, arms, buttocks or back

Question 43

topical testosterone gel is applied when and where?

Answer 43

in the morning, shoulders, upper arms, abdomen

Question 44

hebal ED treatment

Answer 44

- yohimbine - aphrodisiac - central alpha 2 antagonist - not recommended