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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize risk factors associated with development of erectile dysfunction (ED).

  • Provide brief descriptions of the advantages and disadvantages of the common therapies available for treating ED.

  • Compare and contrast the benefits and risks of the available PDE-5 inhibitors.

  • Provide appropriate patient education on administration and expected side effects of selected treatment modalities for ED.

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PATIENT PRESENTATION

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Chief Complaint

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“My sex life just isn’t what it used to be….”

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HPI

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Peter Johnson is a 63-year-old man who presents to his PCP with the above complaint. On questioning, he states that for the last year he has been able to achieve only partial erections that are insufficient for intercourse. He does not notice nocturnal penile tumescence. He feels that the problem is leading to a strained relationship with his wife, and he is interested in trying an herbal product or “nutritional supplement” for help.

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PMH

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  • Type 2 DM × 14 years

  • HTN

  • HF (NYHA class II)

  • Dyslipidemia

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FH

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Father deceased at age 72 of cancer; mother alive with HTN

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SH

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Married for 38 years; no history of marital problems; does not smoke or drink alcohol; walks for 30 minutes 5 days per week

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Meds

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  • Insulin glargine 60 U SC at bedtime

  • Metformin 1000 mg PO BID

  • Lisinopril 40 mg PO once daily

  • Carvedilol 25 mg PO BID

  • Furosemide 20 mg PO every morning

  • Atorvastatin 40 mg PO once daily

  • ASA 81 mg PO once daily

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All

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NKDA

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ROS

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Denies significant life stressors, fatigue, nocturia, urgency, or symptoms of prostatitis. Complains of occasional nocturia, numbness in his feet, and difficulty achieving and maintaining erections. Occasionally has transient edema in his ankles, and many of his toenails are brittle and yellowing.

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Physical Examination

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Gen
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Alert, well-developed, cooperative man in NAD

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VS
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BP 136/78 mm Hg, P 60 bpm, RR 18, T 37.2°C; Wt 120 kg, Ht 5′11″

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Skin
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Warm, dry; no lesions

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HEENT
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NC/AT; EOMI; PERRLA; funduscopic examination shows no arteriolar narrowing, hemorrhages, or exudates

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Neck/Lymph Nodes
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Supple without JVD, lymphadenopathy, masses, or goiter

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Lungs/Chest
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Clear to A & P bilaterally

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CV
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RRR; normal S1 and S2; no MRG

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Abd
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Soft, obese; NTND; normal bowel sounds; no masses ...

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