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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Differentiate between organic and psychogenic erectile dysfunction (ED) with regard to etiology and pathophysiology

  • Identify the drug classes most likely to contribute to ED

  • Define the essential components of history, physical examination, and laboratory data needed to evaluate the patient presenting with ED

  • Describe current nonpharmacologic and pharmacologic options for ED treatment to determine an appropriate first-line therapy for a specific patient

  • Compare and contrast the benefits and risks for current phosphodiesterase inhibitors

  • Recommend an appropriate treatment approach for patients with ED and significant cardiovascular risk factors

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PATIENT PRESENTATION

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Chief Complaint

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"I am having trouble in the bedroom."

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History of Present Illness

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JM is a 67-year-old African American male who comes to your medication management clinic complaining about "not getting it up." He has a new girlfriend, and he is frustrated that they cannot be intimate. He has not been sexually active for at least 10 years, yet really wants to get back "on the horse," but needs help. He wants to know if he can get one of those pills he saw on television. In terms of his other medications, he admits to not taking his depression medication regularly as well as his cholesterol medication.

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Past Medical History

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HTN × 25 years

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Angina × 10 years

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Hyperlipidemia × 20 years

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Depression × 5 years

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Family History

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Father died at age 75 from lung cancer. Mother died at age 70 from complications of diabetes. He has one brother who is healthy (age 61) and one sister who has diabetes and HTN (age 56). He has two sons (ages 42 and 27) who both have HTN and diabetes.

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Social/Work History

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The patient retired from the real estate business to take care of his wife about 10 years ago. For the last 3 years, he has been living in an apartment within a retirement community. Prior to this transition, he was living in his own home; however, he was lonely due to his wife's death 7 years ago from cancer. He has completed a few years of college but was unable to graduate. Now, he has a new girlfriend in his building.

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Tobacco/Alcohol/Substance Use

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He has a history of smoking about ½ to 1 ppd for the last 50 years. He admits he is trying to cut back. Currently, he regularly drinks about two cans of beer per night and occasionally more during "Happy Hours" at the facility on Friday.

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Allergy/Intolerance/Adverse Event History

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No known drug allergies

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Medications (Current)

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HCTZ 25 mg PO q 24 h (for the past 6 years)

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