Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
12 Cards in this Set
- Front
- Back
|
Describe the treatment algorithm of someone with ED?
|
1) First try oral phosphodiesterases
2) Intracavernosal Injection 3) Intraurethral suppository 4) Penile Prosthesis |
|
|
What are risk factors for ED?
|
DM
Dyslipidemia Smoking Medications (Beta-blockers, Furosemide) |
|
|
When putting someone on a phosphodiesterase inhibitor, what medications would you be concerned about?
|
Nitrates
Alpha blockers (within 4 hours) |
|
|
What else are you concerned about?
|
The patients blood pressure (and it becoming too low)
|
|
|
What phosphodiesterase inhibitors do you have to choose from and what are their doses?
|
Sildenafil 25-100 mg 1 hour before intercourse
Vardenafil 5-10 mg 1 hour before intercourse Tadalafil 5-20 mg before intercourse |
|
|
What do you do if the agent you chose doesn't work?
|
Tell the patient to continue trying several times as rates of success increase with sequential administration.
|
|
|
What if treatment failure occurs with one PDE inhibitor?
|
Switch to another - Sometimes another agent in the same class will work better for someone
|
|
|
What are the major contraindications to phosphodiesterase therapy?
|
Unstable or symptomatic angina
Uncontrolled Hypertension Class III/IV CHF Recent MI Moderate - Severe valvular heart disease High risk cardiac arrhythmias Hypertropic cardiomyopathy |
|
|
How do you want to counsel someone taking a PDE inhibitor?
|
It may take 4-5 doses to work
An erection lasting longer than 4 hours is a medical emergency Wait 30-60 min before starting any sexual activity (2 hours with tadalafil) Sildenafil - a fatty meal will delay effect up to 2 hours Do not take more than 1 dose per day Sildenafil (vision changes) Tadalafil (muscle pain) May need to try another agent if one fails |
|
|
What is the intra-cavernosal injection product?
|
Caverject (intracavernosal alprostadil)
|
|
|
How would you counsel someone on this product?
|
No more than 1 injection per day or 3 per week
Use aseptic technique to prevent infection Hold penis against leg Inject at a 90 degree angle into the later part of the penis Do not inject into the dorsal or ventral portion to avoid systemic absorption Massage penis after injection to spread drug Rotate injection sites Adverse effects = Plaques or Fibrosis, Pain, Burning sensation, bruising, Dizziness/hypotension at large doses |
|
|
How would you counsel someone using an intraurethral suppository?
|
Administere 5-10 minutes before sexual activity
No more than 2 administrations per day Empty bladder before administration Hold penis and insert applicator 1/2 inch into penis Massage penis to allow for drug distribution |
