Hi. Welcome to our video series on men's health. Now, I bet you're kind of wondering why I'm
whispering because this topic is really personal. We're talking about erectile dysfunction and
BPH. Now, if I talk the whole video like that, what kind of conversation would we have? I'm
trying to make the point that this topic is really uncomfortable for most men to talk to you about.
So you have to approach it like it's no big deal. Just like the first time you learned how to do
catheter care or other personal interactions with your male patients. You just have to approach
this very matter of fact, this is a problem, many people have it, and we can deal with it. So now
let's go into talking about the video on erectile dysfunction and BPH, benign prostatic hypertrophy.
Okay, so we can't go forward until we define what it is. When we say ED, we mean erectile
dysfunction. That means the inability of a man to maintain an erection sufficient enough for some
sexual activity. Okay, so starting there now you know exactly what we're talking about. Erectile
dysfunction, it's the inability of a man to maintain an erection sufficient enough for sexual
activity. That's it. So, lots of men experience this. That can be because of chronic illness like
diabetes, high blood pressure or even depression. There are also some medications that put our men
at risk for erectile dysfunction and as you age this becomes more difficult. So, when you start
to think about the potential patients this might encompass, there's a significant group of men
that may be dealing with this. They just might be too uncomfortable to talk to you about it. So
remember as a nurse, our job is to help patients feel comfortable and to feel safe talking about
things that are kind of uncomfortable. Okay, now you can imagine we had a hard time coming up with
an appropriate picture for this question but I want to see what do you already know about PDE5s and
how they treat erectile dysfunction. So, take just a minute, see what you know, maybe what you've
even learned from watching those crazy commercials on TV, and write to yourself some notes on what
you know about this treatment. Okay, now let me clear up how they actually work. We got some visuals
for you that are very appropriate and very clinical. PDE5 is an enzyme and it converts where it
breaks down cGMP. Okay. Let's talk about why do we care that that converts or breaks down cGMP.
Well, cGMP is an enzyme that's responsible for helping the penis become engorged and that's
what makes it larger and stiff. So, when you have PDE5 it breaks down cGMP. So if you break
that down then I'm going to have less of an erection and not be able to maintain sexual activity.
So, a PDE5, which is a phosphodiesterase 5 inhibitor, we use it to treat erectile dysfunction.
Okay, take a look at those pictures in case my words have kind of like "whoahh that's a lot to
____ right away." Look at the picture on the top. See, there is a vessel with PDE5 the
vessel narrows but look if we have less PDE5 then we'll have more cGMP and the vessels remain
dilated and full of volume. Okay, so why do we want that? Because in order for a man to maintain
an erection for sexual activity they need to remain engorged, those vessels need to stay dilated.
So I have a less of the PDE5 that breaks down that cGMP, we'll be able to maintain an erection
that's sufficient and longer. Okay, so that's what the first step is, when we're talking about
treating erectile dysfunction is understanding what does PDE5 do, what does cGMP do, and why do PDE5
inhibitors help us. So we've walk to that together but I'd like you to pause the video for just a
second and make sure you're very clear on what PDE5 does, cGMP does, and why a PDE5 inhibitor will
help treat erectile dysfunction. Okay, good work. Now the time you take with your brain to
stop, pause, recall and write something down, those mental gymnastics that your brain uses to
decide what you're going to write down on your notes really helps you recall that information
later and believe me you're going to see a lot of patients that are taking these medications. So,
let's help you remember what these medication names are. They end in "afils." Right? See that's
a-f-i-l-s. We've got sildenafil, tadalafil, vardenafil, and avanafil. Okay, so when you see those
endings, you want to start thinking about a PDE5 inhibitor treatment for erectile dysfunction.
Now, this is where it gets a little tricky, okay, because there are some of those timing issues.
You're in the mood, you need the medication so you've got to have some pretty classic timing things
going on here. We've got up there in that red bar for you, mind the delay. Let me explain. See,
the dose timing ranges from 15-60 minutes before sexual activity. So you can see how that would
be a little problematic if you are ready for sexual activity but you've got to stop and take a pill
and wait that period of time for it to become effective. So, it's kind of inconvenient and you'll
have to have an understanding partner and an educated patient to know that it's not necessarily an
instantaneous response. Now, that's the big selling factor for tadalafil which kind of cracks me
up, right, "tada." Okay, so there's no timing issue with that. You can take it daily so you don't
have to coordinate, "Is it gonna happen tonight?" "Not gonna happen tonight?" You don't have
to mess with the medication, they just take it once a day and it's available to them when they
are ready. Now, a couple of things you need to know about not doing. You don't want to take
grapefruit juice with these medications and that's true about statins too. But grapefruit juice is
not a good idea with these medications so educate your patients that they shouldn't take grapefruit
juice and these medications at the same time. Now here's another side note. For sildenafil, the
response is delayed as long as 60 extra minutes if they eat a big fat meal with the medication.
So, your patients need to know, "Hey, lay off the grapefruit juice, not a good idea to eat a big
high fat meal with it particularly with sildenafil, and pay attention to the timing that's required
by your particular medication."