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PATIENT CARE PROCESS

Patient Care Process for the Management of Erectile Dysfunction

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Collect

  • Patient characteristics (e.g., age, race)

  • Patient history (past medical history, marital/partner status, family history, social—sexual history, situations in which erectile dysfunction occurs; tobacco, recreational drug, or alcohol use)

  • Administer International Index of Erectile Function screening questionnaire if feasible (see Diagnosis section)

  • Current and past medications, including prescription and nonprescription medications, or nonpharmacologic interventions for erectile dysfunction (see Table 83-4)

  • If patient is not responding to a phosphodiesterase type 5 inhibitor, details on how and when patient is using the medication (see Phosphodiesterase Type 5 Inhibitor Efficacy section)

  • Current psychologic status (emotional stressors, depression, performance anxiety) (see Clinical Presentation box)

  • Objective data (see Diagnosis section)

    • Blood pressure, heart rate, height, weight, and BMI

    • Physical examination to rule out hypogonadism and prostate dysfunction

    • Labs (e.g., blood/serum glucose, lipids, testosterone)

    • Cardiovascular risk assessment, if indicated (see Diagnosis section and Table 83-3)

Assess

  • Patient and partner's expectations regarding therapy and costs

  • Patient's physical ability to engage in or contraindications to sexual intercourse

  • Presence contraindications to phosphodiesterase type 5 inhibitors (see Table 83-3)

  • Current use of medications contributing to erectile dysfunction (see Table 83-2)

Plan*

  • Optimize treatment for underlying causes of erectile dysfunction (e.g., hypertension, coronary artery disease, dyslipidemia, diabetes mellitus, smoking, chronic ethanol abuse)

  • Discontinue medications contributing to erectile dysfunction when possible (Table 83-2)

  • Treat hypogonadism when present

  • Psychotherapy for psychogenic causes of erectile dysfunction

  • Drug therapy regimen including specific agent(s), dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Tables 83-4 and 83-5 and Figures 83-2 and 83-5, 83-6, 83-7)

  • Nonpharmacologic or surgical intervention when medications are contraindicated or are not effective (see Figures 83-2 and 83-3)

  • Patient re-education if nonresponsive to phosphodiesterase type 5 inhibitor, if appropriate (see Phosphodiesterase Type 5 Inhibitor Efficacy section)

  • Monitoring parameters including efficacy (e.g., BP, cardiovascular events, kidney health), safety (medication-specific adverse effects), and timeframe (see Tables 83-6 and 83-7)

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Referrals to other providers when appropriate (e.g., physician, urologist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Schedule follow-up for several weeks after therapy initiation

Follow-up: Monitor and Evaluate

  • Patient satisfaction with quality and quantity of penile erections

  • Presence of adverse effects

  • Adjust medication doses or change to alternative agent as clinically indicated

*Collaborate with patient, caregivers, and other health professionals

KEY CONCEPTS

KEY CONCEPTS

  • image The incidence of erectile dysfunction is low in men younger than 40 years of age. The incidence increases as men age likely as a result of concurrent medical conditions that impair the vascular, neurologic, psychogenic, and hormonal systems necessary for a normal penile erection.

  • image Many commonly used drugs have sympatholytic, anticholinergic, sedative, or antiandrogenic effects that may exacerbate or contribute to the development of erectile dysfunction. Clinicians should be familiar ...

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