Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
IOS 9 Exam 2
Erectile Dysfunction
| Question | Answer |
|---|---|
| Pathophysiology of ED | Sexual stimulation leads to NO release and relaxation of smooth muscle and arteries of corpora cavernosa, increasing blood floow and causing venoocclusion of sinusodial spaces leading to intracavernous pressures and penil rigidity |
| Etiologies of ED | Libido, Ejaculation, Erectile function, or a combination |
| Patient assessment involves what 6 steps | Medical history, sexual history, IIEF, psychocial history, PE, cardiovascular assessment |
| SHIM score of <11 indicates | Severe Cardiovascular status |
| SHIM score of 17-21 indicates | Mild to moderate cardiovascular status |
| What are the modifiable risk factors for erectile dysfunction | Alocholism, BPH, DM, Depression, Drugs, drug abuse, dyslipidemia, endocrine disfunction, Liver problems, obesity, smoking |
| Low cardiovascular assessment risks include | Stable andina, post-successful CABG, uncomplicated past MI, controlled HTN, mild valvular disease |
| Moderate risk cardiovascular risks include | Moderate stable angina, recent MI (2-6 weeks), noncardio sequella of atherosclerosis (TIA), requires special testing |
| High cardiovascular risks include | Recent MI (<2weeks), high risk arrhythmias, hypertrophic cardiomyopathy, mod-severe valvular disease- Refer to specialist |
| Lifestyle modifications of ED | Alcoholis, BPH, drugs, drug abuse, depression, dyslipidemia, endocrine regulation, hormone replacement |
| Drugs that cause dysfunctional libido | B-Blockers, Spironolactone, Phenothiazines, Cimetidine, ketoconazoles |
| Drugs that cause dysfunctional ejaculation | Alpha blockers,(tamsulosin), labetolol, TCA's, phenothiazines, typical antipsychotics |
| Drugs that cause increase in prolactin or decrease in testosterone | Finasteride, ketoconazole, B-blockers, Digoxin, verapamil, SSRI's, Anticovulsants, metoclopropamide |
| Drugs that cause anti-androgen effects | Spironolactone, Phenothiazines, Cimetidine |
| 5HT stimulation causes inhibition of | Orgasm and ejaculation |
| If patient is taking thiazides or spironolactone suggest | Loop diuretic |
| If patient is taking a B-blocker, clonidine, methyldopa suggest | ACE, ARB |
| If patient is taking verapamil suggest | diltiazim |
| If patient is taking TCA's or SSRI suggest | Trazadine, burprioion, mirtazepine |
| If patient is taking lithium suggest | Valprotic acid` |
| If patient is taking finasteride or tamsulosin suggest | Doxazosin |
| First line therapy if patient has low testosterone | Testerone- IM, patch, gel, buccal |
| Contradidications of testosterone | Prostrate cancer, increased PSA, peripheral edema, liver dysfunction, sleep apnea, polycythemia |
| Side effects of testosterone | Acne, HA, increase in PSA, LFT, CHolesterol, Hgb, HCT, decrease in HDL |
| Testerone Gel administration issues | Can transfer to partner, avoid washing or removal for 4-6 hours |
| Sidenafil-Dose duration, food, ETOH, dose adjustments needed | 25,50 (start),100 mg, onset 30-60m, food decreases, dur-4hr, start low for >65, renal, hepatic, 3A4 |
| Vardenafil-Dose duration, food, ETOH, dose adjustments needed | 5,10 (start),20 Onset 30-60 min, food decreases,dur-4hr, low dose- >65, renal -Avoid if on QT drugs |
| Tadalafil-Dose duration, food, ETOH, dose adjustments needed | 5,10 (start) ,20 gOnset 30-4 hrs, duration 24-36hrs, ETOH > 5 hypotension, Low dose for >65, hepatic, 3A4 meds |
| Side effects of PDE inhibitors | HA, flushing, rhinitis, dyspsia, back/limb pain, rare-vision changes (increased with risk factors) |
| Contraindications of PDE inhibitors | Cannot take nitrate 24hours-sildenafil/vardenafil and 48 tadalafil |
| Caution with PDE inhibitors include | Drugs metabolized via 3A4 pathway, alpha blockers should be seperated by 4 hours |
| OTC ED treatment | Vacuum pump- |
| Side effects of vacuum pump | Penile numbness, brusing, delayed ejaculation |
| Vacuum pump contraindications | Sickle cell anemia |
| Vasodialators:intraurethral suppository & intracavermosal | Alprostadil |
| Side effects of Alprostadil intraurethral suppositories & Intracavemosal | IU- penile pain, burning IC- penile pain, cavernosal fibrosis/scaring, hematoma, priapism (continous errection) |
| Alternative Agents used for ED | Sublingual apomorphine (DA agonist-mexico), oral phentolamine (Mexico), Yohimbine (OTC- alpha 2 antagonist) |
| Administration of Alprostadil Suppository involves | Insertion of medicated pellet 5-10 minutes before sexual intercourse, and penis should be rubbed to allow pellet to dissolve |
| Intravacermosal alprostadil | Patient must injection into the corpora cavernosa at a 10-20 angle |
Created by:
liza001
Popular Pharmacology sets