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6 Cards in this Set

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WD is a 60 year old white male who presents to his primary care provider for a routine check up. WD has a past medical history significant for coronary artery disease, diabetes mellitus, hypertension and erectile dysfunction (ED). WD’s physician renews the following medications: lisinopril 20mg, glyburide 5mg, and isosorbide mononitrate 60mg. At the end of the visit, WD mentions that he would like to take something for erectile dysfunction. Which of the following agents is the best choice to use in treating WD’s erectile dysfunction?
a. Viagra (sildenafil) 50mg
b. Enzyte
c. Muse (alprostadil) 125 mcg
d. Levitra (vardenafil) 10mg
c.
WD is on chronic nitrate therapy, and a PDE 5 inhibitor is contraindicated; therefore sildenafil and vardenafil are wrong. Enzyte is an herbal product that has not been studied or approved by the FDA. This question is abstracted from Objective 2.
BC is a 45 year old African American male who has difficulty maintaining an erection during intercourse. Past Medical History includes: diabetes mellitus, hyperlipidemia, and hypertension. Drug list includes: aspirin, metformin, and HCTZ. All labs, including testosterone, are within normal limits. Which of the following is the best initial therapy for this patient’s ED?
a. Testosterone patch
b. Viagra (sildenafil) 50mg
c. Zocor (simvastatin) 20mg
d. Prinivil (lisinopril) 5mg
b.
Although it may be argued that patient could benefit from addition of statin and ACE, this question specifies ED. Assuming that pt has normal testosterone, as stated, it does not make sense to replace testosterone to treat ED. As such, Viagra is the most appropriate choice
In considering an agent for patients who drink more than 2 alcoholic beverages per
day, which of the following agents would NOT be the first choice to treat ED?
a. Cialis (tadalafil)
b. Levitra (vardenafil)
c. Viagra (sildenafil)
d. Muse (alprostadil)
a.
Cialis is the only agent that carries a warning about alcohol
consumption. Although it could be argued that perhaps all agents in this class should
carry the same warning, Cialis is the only one that does, and therefore would not be an
option.
Risk factors for developing erectile dysfunction include all of the following EXCEPT:
a. Diabetes
b. Hypertension
c. Advanced Age
d. Gastroesophageal Reflux Diseasem
d.
Diabetes, HTN and advanced age are all associated with
developing ED.
BV is a 60 yo WM with a PMH of angina, HTN, and hyperlipidemia. He arrives at your pharmacy with a new prescription for Viagra (sildenafil). Before filling the patient’s prescription, he asks you to check for any problems with his drugs, considering the medications he has on file at your store. His profile lists the following medications:
Lisinopril 10mg daily, Lipitor (atorvastatin) 40mg at bedtime, NTG 0.4mg SL PRN, warfarin (Coumadin) 5mg daily, and Zetia (ezetimibe) 10mg daily.

What is your main concern, upon doing a review of this patient’s medications?
a. Lisinopril may be at suboptimal dose to control HTN in this high-risk cardiac
patient.
b. Zetia should be taken at bedtime for optimal LDL lowering.
c. Viagra is contraindicated with use of nitrates.
d. Vytorin may be a more suitable option for this patient, as it may lower the
patient’s prescription cost.
c.
Phosphodiesterase 5 inhibitors are contraindicated with the use of
nitrates
BV asks you to explain some alternatives for treating ED. He is not sure that he wants to
take Viagra, and he wonders what options are available to him. Which of the following
would be most appropriate for this patient at this time?
a. Vacuum Erection Devices (VEDs) are safe to use and would be a suitable
alternative for this patient.
b. With proper education, pt may benefit from using a MUSE suppository to treat
ED.
c. Enzyte is an herbal supplement available over the counter, and is likely to be safe when taken with patient’s other medications.
d. Patient may need to visit his urologist to determine if he is a candidate for penile
prosthesis.
b.
A vacuum erection device is not suitable for this patient, who is on warfarin; VED can cause painful bruising. MUSE is a successful alternative, if provided to patient with proper education. Enzyte is not approved by the FDA and is therefore not properly studied. Penile prosthesis is a last resort, and patient would benefit from a trial of MUSE first, before being considered for surgery.