WBR0211

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office
Sub Category	SubCategory::Endocrine, SubCategory::Genitourinary
Prompt	[[Prompt::A 66 year old Caucasian male presents to the physicians office with erectile dysfunction that has been over the last few months. He finds difficulty in obtaining erection and also recently noticed a decrease in his nocturnal erections. His past medical history is significant for type 2 diabetes mellitus and benign prostatic hypertrophy. His current medications include glyburide and prazosin. His physical examination is insignificant. His recent HbA1c level measured a week ago was 6.5%. He is asking for a prescription of sildenafil. Which of the following is the best statement concerning the regarding the treatment of erectile dysfunction in this patient?]]
Answer A	AnswerA::Sildenafil should not be combined with glyburide
Answer A Explanation	[[AnswerAExp::Incorrect-The combination of sildenafil and glyburide is safe.]]
Answer B	AnswerB::Sildenafil is not a drug of choice for diabetics with erectile dysfunction
Answer B Explanation	AnswerBExp::'''Incorrect'''-Sildenafil (phosphodiesterase inhibitors) are the first line of drugs in the treatment of erectile dysfunction in diabetic patients.
Answer C	AnswerC::Sildenafil and prazosin should be given with at least 2 hour interval
Answer C Explanation	[[AnswerCExp::Incorrect-Because of the half-life of sildenafil and increased risk of significant hypotension, sildenafil and an alpha-blocker (e.g. prazosin, doxazosin) should be given apart by at least an interval of 4 hour.]]
Answer D	AnswerD::Sildenafil and prazosin should be given with at least 4 hour interval
Answer D Explanation	[[AnswerDExp::Correct-Diabetics have a high risk of erectile dysfunction due to vascular complications and neuropathy. This risk progressively increases with the patient’s age and duration of diabetes. Psychological causes also should not be overlooked in this age group. The first line of treatment is phosphodiesterase inhibitors (e.g. sildenafil). When treating with phosphodiesterase inhibitors, the following should to be considered. 1.Sildenafil while combining with an alpha-blocker, it is essential to give the drugs with at least 4-hour interval to reduce the risk of hypotension since the half-life of sildenafil is about 4 hours. 2.Sildenafil is contraindicated in patients treated with nitrates. 3.Sildenafil should be used with precaution in conditions predisposing to priapism. 4.Concurrent use of drugs that interfere with the metabolism of sildenafil (e.g. erythromycin, cimetidine) may predispose to adverse reactions by prolonging its plasma half-life.]]
Answer E	AnswerE::Tightening of glycemic control improves erectile dysfunction
Answer E Explanation	AnswerEExp::'''Incorrect'''-Tightening of glycemic control has not been shown to improve erectile dysfunction.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Diabetics have a high risk of erectile dysfunction due to vascular complications and neuropathy. This risk progressively increases with the patient’s age and duration of diabetes. Psychological causes also should not be overlooked in this age group. The first line of treatment is phosphodiesterase inhibitors (e.g. sildenafil). When treating with phosphodiesterase inhibitors, the following should to be considered. 1.Sildenafil while combining with an alpha-blocker, it is essential to give the drugs with at least 4-hour interval to reduce the risk of hypotension since the half-life of sildenafil is about 4 hours. 2.Sildenafil is contraindicated in patients treated with nitrates. 3.Sildenafil should be used with precaution in conditions predisposing to priapism. 4.Concurrent use of drugs that interfere with the metabolism of sildenafil (e.g. erythromycin, cimetidine) may predispose to adverse reactions by prolonging its plasma half-life. Educational objective: In treating erectile dysfunction patients with both sildenafil and alpha-blocker, it is important to give the drugs with at least 4-hour interval to reduce the risk of hypotension. Educational Objective: References: ]]
Approved	Approved::Yes
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