Sexual Dysfunction Flashcards
What is the key neurotransmitter for creating erections?
Nitric oxide
What is the key intracellular molecule that leads to erection?
cGMP
What kinds of physical activity is equivalent to sexual activity?
Climbing 2 flights of stairs in 10 seconds or walking a mile in 20 mins
What are common SEs of PDE-5i?
Headaches, Facial flushing, nasal congestion, visual changes
What are the different half-lives of the PDE-5is?
Sildenafil - Viagra - Tmax 1 hr - T1/2 - 4 hrs
Vardenafil - Levitra - Tmax 1 hr - T1/2 - 4 hrs
Tadalafil - Cialis - Tmax 2 hrs - T1/2 - 18 hrs
Side effects of alprostadil?
penile pain
Which is the only FDA-approved monotherapy for ICI?
Alprostadil
What does phentolamine do in ICI?
It potentiates the effect of the other medications which increase cyclic AMP. It is commonly used with papaverine as Bimix (which cases less penile pain than trimix because there is no alprostadil)
Medical management of stuttering priapism?
Lupron, biclutamide, ketoconazole with corticosteroid.
In adolescents can use Sudafed and tech them phenylephrine injections at home
What components of evaluation are required for Peyronie’s disease?
Careful history and physical focusing on the deformity, the psychological distress caused by it, any functional issues related to it including a reptile function, as well as intra- cavernosal injection in the office.
What are options for treatment of men with Peyronie’s disease in the active phase?
Nonsteroidal anti-inflammatory medication, intra-lesional verapamil. No other oral therapy’s should be recommended.
What medication must be inquired about prior to initiating ICI or in a pt with priapism?
MAOIs because MAOI+phenylephrine can cause severe hypertension
How is the diagnosis of low testosterone made of?
Two separate morning testosterones. Levels below 300 would be considered low testosterone.The guidelines say you have to check it twice.
In men who are found to have To low testosterone levels, what other additional tests are warranted?
Luteinizing hormone in order to determine if the pituitary is involved. If this is low or normal, prolactin should be measured. If replacement therapy is being considered a hematocrit as well as a PSA should be checked.
What are the risks associated with testosterone replacement?
- Infertility
- Erythrocytosis
- Gynecomastia
- Voiding difficulties
- Obstructive sleep apnea
- Increased risk of stroke, DVT, PE, MI (Although this is somewhat controversial)
For men with ED, What are the components of the initial a valuation?
- Medical, psychosocial, sexual history
- Validated questionnaires
- Counseling that ED may be a marker of other systemic disease
- Morning total testosterone
In men who have undergone radical prostatectomy, what should they be counseled about regarding early use of phosphodiesterase inhibitor’s?
Early use of phosphodiesterase inhibitor’s may not improve spontaneous erection recovery according to the AUA guidelines
What are the two classes of BP meds most likely to cause ED?
Thiazides and Beta blockers
Which BP meds are less likely to cause ED?
ACE-Inhibitors
ARBs (spironolactone)
Calcium channel blockers
Does alprostadil need to be administered in the office as a test dose? If so, why?
Yes, because there is 3% risk of hypotension
What is important to consider when using a vacuum erection device?
Needs to be used with a limited to avoid damaging the penis?
What are the WHO parameters for semen volume, concentration, motility, morphology?
Volume >1.5cc
Concentration 15 million/mL
Morphology <4%
Motility 40%
What are the criteria for performing a varicocelectomy for infertility
Male with semen abnormalities, a palpable varicocele, and infertility (with normal female evaluation)
What is appropriate follow-up for patients who are started on PDE-5is?
See them at 3 months to evaluate for efficacy and side effects. Then every 6-12 months to ensure they haven’t been started on nitrates
