He can't maintain ERECTION enought to read thi - triplehelix

[ArchivalUser]

e as all other functions are normal

[ArchivalUser]

c.

[ArchivalUser]

Option C (Prescribe oral phosphodiesterase therapy) is correct.

ED may result from three basic mechanisms: failure to initiate (psychogenic, endocrinologic, or neurologic), failure to fill (arteriologic) and failure to store (veno-occlusive disease). These categories are not mutually exclusive. For treatment of ED not directly attributable to a specific etiology, the first line medical therapy is now a phosphodiesterase inhibitor.

Option A (Initial trial of psychotherapy before consideration of pharmacotherapy) is incorrect. Pure psychogenic erectile dysfunction (ED) is uncommon, but most cases of ED do have a psychogenic component. Unless there is a history suggestive for serious psychopathology such as post-traumatic stress disorder (PTSD) or depression, nonpharmacotherapeutic treatment modalities are unlikely to provide significant benefit. Initial trial of phosphodiesterase inhibitors is recommended first line management.

Option B (Prescribe a testosterone patch) is incorrect. Testosterone replacement is indicative for treatment of ED if the patient has decreased libido and decreased testosterone levels. Neither is the case with this patient. For treatment of ED not directly attributable to a specific etiology, the first line medical therapy is now a phosphodiesterase inhibitor.

Option D (Recommend intraureteral injection of alprostadil) is incorrect. As a second line therapy intraurethral injection of alprostadil can be recommended for treatment of ED not directly attributable to a specific etiology. The first line medical therapy is now a phosphodiesterase inhibitor.

Option E (Wean off metoprolol with a 30 day taper schedule, concurrently replace with an angiotensin converting enzyme [ACE] inhibitor titrated to target BP) is incorrect. About 50% of men aged 40 to 70 would report some degree of ED. ED correlates with the presence of diabetes, heart disease, hypertension, and decreased high-density lipoprotein (HDL) cholesterol levels. ED may result from three basic mechanisms: failure to initiate (psychogenic, endocrinologic or neurologic), failure to fill (arteriologic) and failure to store (veno-occlusive disease). These categories are not mutually exclusive. Beta blockers may cause ED but the patient has been on the medication for years so there is not a strong case for a causal relationship. The first line medical therapy is now a phosphodiesterase inhibitor.

[ArchivalUser]

good

[ArchivalUser]

cc