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30 Cards in this Set
- Front
- Back
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What are the 3 main disturbances of male sexual function?
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1. Loss of libido
2. Impotence 3. Ejaculatory Failure |
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Neural control of sexual function originates where?
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Forebrain Limbic system
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What is "failure to attain an erection of sufficient strength to carry out sexual intercourse - 25% of the time"?
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Impotence
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Is impotence common?
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Yes, especially in older men
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Centran limbic system initiation in an erection leads to what physiologic response?
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1. Increase in parasympathetic outflow
AND 2. Decrease of sympathetic outflow |
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What 2 items get relax during an erection?
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1. Helicine arteries in corpus cavernosa
2. Smooth muscle of trabeculae of the corpus cavernosa |
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What is impeded during an erection?
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Venous drainage as a result of compression by the engorged corpus cavernosa
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What is responsible for ejaculation?
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Sacral efferents
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The changes in blood flow during an erection are mediated by the release of what?
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Nitrous Oxide
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NO is released from where?
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Post-synaptic parasympathetic neurons and endothelial cells
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NO stimulates what and causes increase of what?
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Guanylate cyclase in trabecular and arterial smooth muscle cells
Causing increase in GMP!! |
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What is one of the main causes of impotence?
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Drug induced impotence
Ex: B Blockers, SSRI's |
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Most of the time, how is a diagnosis of erectile dysfunction obtained?
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Via history alone
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What testing can be done to confirm erectile dysfunction?
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REM sleep study
See if patient gets erections during REM sleep |
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What are 4 broad treatment strategies in ED?
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1. Counseling if psychogenic
2. Surgery if local genital abnormality 3. Adjust drug regimen - if drug induced 4. Testosterone - if androgen deficient |
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Penile implants are very successful for what subset of patients?
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Trauma - especially military
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What is the most common form of ED treatment?
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Vasodilators, specifically Oral PDE 5 inhibitors
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What are the 3 main PDE 5 inhibitors?
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1. Sildenafil (viagra)
2. Vardenafil (levitra) 3. Tadalafil (cialis) |
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What is the MOA of PDE 5 inhibitors?
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Incraese levels of cGMP by inhibiting PDE 5, a specific breakdown enzyme of cGMP
Work by MAINTAINING the vasodilatory response |
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What is the time of onset of PDE 5 inhibitors?
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Quickly
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PDE 5 inhibitors are metabolized by what to an active metabolite?
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CYP3A4
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In which 4 paitient populations must you be careful about dosing?
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1. Elderly
2. Patients with hepatic dysfunction 3. Patients with renal dysfunction 4. Patients on CYP3A4 inhibitors |
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What OTC med can complicate PDE 5 inhibitors?
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Cimetidine (for heart burn) - can cause priopism (very engorged penis)
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What are the 2 primary indications for PDE 5 inhibitors?
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1. ED
2. Primary Pulmonary Hypertension |
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What are the 4 groups of adverse effects with PDE 5 inhibitors?
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1. Vasodilation (headache, flusing, rhinitis)
2. Cardiovascular (hypotension, platelet inhibition) 3. GI (dyspepsia due to esphogeal sphyncter relaxation) 4. Visual Abnormalities |
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PDE 5 inhibitors are contraindicated in men taking what?
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Nitrates for hypertension
Combination can cause hypotension and fatal events |
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How many hours must elapse between taking PDE 5 inhibitors and taking nitrates?
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>6 hours
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Is the initial stimulatory response necessary for clinical response in PDE 5 inhibitors?
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YES
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What are the 3 theories as to the cause of female sexual dysfunction?
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1. Vascular Theory
2. Hormone Theory 3. Dissatisfaction Theory |
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What are the 3 main types of treatment for female sexual dysfunction?
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1. Educational
2. Hormone Replacement Therapy (estrogen and/or testosterone) 3. Vascular Treatment (PDE 5 inhibitors, Eros) |
