Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

40 Cards in this Set

  • Front
  • Back
How do you define erectile dysfunction?
Inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance.
Whats the prevalence of ED?
-in 5% of men @ age 40, w/ prevalence increasing to 15-25% by age 65.
What are the #1 & #2 causes of erectile dysfunction?
1) Diabetes
2) Hypertension
Normal erectile dysfunction is a complex interaction b/w what factors?
1) Psychological fxn: STRESS is major factory b/c sympathetics kick in and men won't be able to erect.
2) Hormonal fxn: dec testosterone, hypogonadal
3) vascular fxn: surgery, dz
4) neurologic fxn.
Describe the movement of blood in a flaccid & in an erect penis.
1) Flaccid: blood going in = blood going out.
2) amt of blood going in is more than amt of blood going out. You stretch the lacunar bodies that closed off & hold blood in at all full erection there & no blood is going in & out.
What are the 3 neuroeffector systems that control smooth muscle relaxation & penile blood flow?
1) Adrenergic fibers, 2) Cholinergic fibers, 3) Nonadrenergic-noncholinergic fibers.
Vasodilation of the arteries in the penis is mediated by what?
Nitric oxide & cGMP following activation of cholingeric & nonadrenergic noncholinergic fibers.
What causes relaxation of the corpus cavernosum?
Prostaglandin E1 (smooth muscle dilator)
What are the causes of ED?
Vascular Dz, Neuropathy (ex. DM-pudendal N-->erection), iatrogenic factors (radical prostatectomy), congenital abnormalities, peyronie's dz, psychological processes, drugs
When doing a Hx & PE, what are some risk factors for ED?
HTN, Hyperlipidemia, Hypogonadism, Endocrine d/o's, endocrine disorders, smoking, alcohol abuse, drug abuse (alcohol, estrogens, antiandrogens, H2 receptor blockers, anticholinergics, ketoconazole (tx for prostate cancer b/c blocks testosterone production), antidepressants, marijuaa, anti-HTN, narcotics, beta blockers, psychotropics, cigarettes, cocaine, spironolactone, lipid-lowering agents, NSAIDs, cytotoxic drugs, diuretics)
In diagnosis of ED, what should be done in PE?
1. Assessment of secondary male sexual characteristics
2. Femoral & lower extremity pulses
3. Focused neuro exam (perianal sensation, sphincter tone, bulbocavernosus reflex, PBI-biothesiometry when neuropathy is suspected)
4. Eval of prostate size by DRE
5. Detection of Peyronie's plaques.
What are the lab tests done for a patient who comes in with erectile dysfxn?
1. morning testosterone specimen
2. serum prolactin
3. Tests for other systemic dz
-CBC, urinalysis, serum creatinine, glucose, lipid profile (pts w/ hyperlipidemia have good chance of having vascular insufficiency)
-thyroid fxn tests.
What are the special tests indicated for pts coming in for ED diagnosis?
1. Vasoactive agent injection - prostaglandin E used b/c its a potent smooth muscle dilator (diagnostic tool & tx),
2. Nocturnal penile tumescence (screens for psychogenic vs organic ED)
3. Duplex ultrasonography.
5. Pharmacoarteriography.
What are the tx options for ED?
-psychosexual counseling
-hormone replacement
-vacuum pumps & constriction devices
-penile implants
-vascular surgery --not done anymore
-injectable meds (for those who can't take oral)
-oral meds.
When is psychotherapy and/or behavioral therapy alone effect for ED?
when no organic cause of ED is evident
When is individual or couples therapy for ED helpful?
Individual therapy--primary ED.
Couples therapy--secondary ED
In which ED patients will androgenic steroids be helpful?
-in ED pts w/ hypogonadism;
Does exogenous testosterone cause prostate CA?
NO, but it will make it more aggressive. It may just increase the risk of prostate hypertrophy & CA.
How does it exogenous testosterone effect sexual fxn?
-It can suppress remaining endogenous androgen production; may be metabolized to estradiol w/ potentially detrimental effects on sexual fxn (dec)
What's the most commonly used device for ED?
Vacuum constriction devices; It creates a negative P that sucks blood into cavernous tissues. High success rate, pt satisfaction. No tests req'd beyong initial eval.
What are the adverse effects of the vacuum constriction devices?
-Hematoma, eccymosis, petechiae;
-Pain, numbness of penis; blocked &/or painful ejaculation; pulling of scrotal tissue into vacuum cylinder.
What ED device ALWAYS works? What are the 2 types?
Penile implants; Types: semirigid & multicomponent inflatable;
-Avg life of prostheses: 7-10 yrs.
-Good in pts who fail or refuse tx's
-Needs pt/partner screening & education.
What are the complications of penile implants?
Perioperative infection (2%), device malfunction (4%), repeat surgery (9%)
What is the only erectile tissue in the penis?
Corpus cavernosum
What is the biggest problem w/ using a vasoactive intracavernosal injection like alprostadil oor phentolamine (basically injection of prostaglandin E)?
Priapism (injection > 4 hrs)D

(self-injection-->always midshaft, never 6 or 12 o'clock;
What are the disadvantages of using vasoactive intracavernosal drugs?
-Poor long term tolerability: many stop during 1st yr;
-Adverse effects: bruising, prolonged erection, pain, induration, plaque, nodule, curvature of penis, superficial infection, dizziness
Do viagra or levitra cause priapism?
No b/c they're just vasodilators.
In the transurethral version of aprostadil, 35.7% of men reported what adverse sx even though this did not cause them to discontinue drug usage?
Penile pain --the had no priapism or penile fibrosis)
What are the 3 types of existing oral therapies for ED?
1. Yohimbine-very old drug, not very effective.
2. Trazodone -psych drug w/ SE of priapism;
3. L-arginine;
What are the 2 drugs now under investigation for ED (oral)? What is the 1st FDA approved agent?
Apomorphine & Phentolamine;
FDA approved: Sildenafil
Whats the MOA for Sildenafil?
-Selective & potent PDE V inhibitor; Phosphodiesterase breaks down cGMP; Inhibition gives more cGMP thus more vasodilation. NO acts thru 2nd messenge, cGMP, in nl development of erections;
Whats the predominant PDE enzyme in the corpus cavernosum?
PDE type V
Whats the important side effect of Sildenafil?
Blue haze b/c of vasodilation due to PDE in eye.
Does Sildenafil show effectiveness in all groups of patients including those w/ DM, spinal cord injury, radical prostatectomy, pts w/ ED of psychogenic origin (confidence builder)?
If patient goes to the hospital w/ chest pain, why is it important that they tell their doctor that they're on viagra?
B/c they'll be put on a nitrous drop for the chest pain and get severe vasodilation and thus hypotension leading to shock & death!
Whereas 79% of patients w/ ED use an oral med like trazodone or yohimbine, their satisfaction rate is only 16%. However, 2% of ED pts use surgery & whats their satisfaction rate?
What is the usual basis of erectile dysfunction?
Organic basis
Best treatments of ED involve who?
your sexual partner
What is the first step in treating ED?
Recongition--PCPs need to discuss sexual health & fxn w/ their patients.
Are there effective treatments available for all types of ED?