In the current discussion, a case of a 58-year-old man with a history of a high cholesterol level and hypertension is discussed and analyzed. Erectile dysfunction is the diagnosis of the patient. Erectile dysfunction, unspecified (N52.9), also known as impotence, is an inability to keep erection enough for sexual intercourse that is usually observed in men under 40 (Ludwig & Phillips, 2014).
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Etiology of the Diagnosis
The causes of erectile dysfunction in men vary considerably. The most frequent problems include heart disease, obesity, diabetes, high blood pressure, high cholesterol, sleep disorders, and even treatments for other diseases (Lin et al., 2015; Sanchez, Pastuszak, & Khera, 2017). Besides, there are some psychological factors, like stress or depression. Finally, smoking and overweight men with certain medical treatments, injuries, or drug/alcohol dependence are at risk of having this dysfunction. In this diagnosis, such factors as a high cholesterol level and high blood pressure should be mentioned.
Pathophysiology of the Diagnosis
Erectile dysfunction is characterized by certain problems in the work of psychological (fear of failure), vascular (penile arterial insufficiency), endocrine (the presence of androgens or testosterone deficiency), and neurological (sclerosis, stroke, or pelvic surgeries) systems (Shamloul & Ghanem, 2013). It usually has organic and mixed psychogenic nature. Penile stimulation should promote the secretion of NO (nitric oxide) that results in the relaxation of smooth muscles and the promotion of blood inflow into the corporal tissues (Sanchez et al., 2017).
Epidemiology of the Diagnosis
Erectile dysfunction is a disease that is usually observed in 15% of males between 40 and 50 years, 45% of men in their 60s, and 70% men under 70 (Sanchez et al., 2017). In addition to age, such factors as BMI, blood pressure, and cholesterol may be determined as important risk factors. It is predicted that erectile dysfunction may reach approximately 322 million cases by 2025 (Shamloul & Ghanem, 2013). There are many ways to avoid such health problems for men, and some of them include following a diet, choosing healthy lifestyles, and avoiding harmful environments.
This diagnosis may be confirmed by several tests and examinations. First, it is necessary to obtain a general medical history and sexual history and pose several questions (Shamloul & Ghanem, 2013). Then, a physical examination of a penis and testicles should be used to check all nerves for sensation. Urine and blood tests are also required to prove/disprove such complications as diabetes, testosterone level, or heart disease. Ultrasound can be used to check the condition of blood vessels.
Goals of Drug Therapy
Erectile dysfunction is treated with the help of phosphodiesterase type 5 inhibitors or TRT (Woo & Wynne, 2011). Still, not all patients are allowed to take all prescriptions. Therefore, it is not enough to remove the disease. It is necessary to improve symptoms, prolong a healthy style of life, and reverse the process of aging. Drugs should help the patient stabilize his sexual life and avoid the growth of possible psychological problems and emotional changes.
Mechanism of Action for Medications
Viagra is a type of sildenafil that is available worldwide. Its duration is about 4-8 hours. The principle of its work is the increase in blood flow to a penis with the help of which a man can sustain an erection.
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Watch Outs for Medications
The main positive aspect of taking Viagra is the possibility to achieve observable improvements in a short period of time. The disadvantages of sildenafil are limited to the absence of long-term safety data and the necessity to spend much money to buy it (Shamloul & Ghanem, 2013). Main contraindications include nitrate-containing compounds or cardiovascular problems. Besides, the usage of α-blockers should be mentioned and restricted. No alcohol interaction is required.
Diagnosis and treatment of erectile dysfunction are characterized by a number of serious steps and precautionary measures. Therefore, patient education is crucial. The peculiar feature of this dysfunction is the possibility of embarrassment and the development of a number of psychological and physiological problems. The patient should be informed about possible complications and the role of such factors as blood pressure and cholesterol. It is not enough to follow a healthy lifestyle in order to prevent erectile dysfunction. It is necessary to know that certain actions should be taken in case this disorder bothers a person without any causes and evident symptoms.
Monitoring of Medication Effectiveness
In one week, the patient should take blood and urine tests and check the level of cholesterol. Besides, it is necessary to check the level of blood pressure daily. In case certain negative changes or worsened conditions are observed, the patient should address a doctor. Viagra should be replaced with other vardenafil or tadalafil in case it is not as effective as it is expected.
Clinical Guideline to Support Treatment Decisions
Shamloul and Ghanem (2013) are the authors of the article where the use of sildenafil is proved and developed. In the article by Ludwig and Phillips (2014), attention is also paid to several randomized controlled trials where patients with erectile dysfunction are free to use Viagra as the main medication for treatment.
Lin, H.H., Ho, F.M., Chen, Y.F., Tseng, C.M., Ho, C.C., & Chung, W.S. (2015). Increased risk of erectile dysfunction among patients with sleep disorders: A nationwide population-based cohort study. International Journal of Clinical Practice, 69(8), 846-852.
Ludwig, W., & Phillips, M. (2014). Organic causes of erectile dysfunction in men under 40. Urologia Internationalis, 92(1), 1-6.
Sanchez, E., Pastuszak, A.W., & Khera, M. (2017). Erectile dysfunction, metabolic syndrome, and cardiovascular risks. Translational Andrology and Urology, 6(1), 28-36.
Shamloul, R., & Ghanem, H. (2013). Erectile dysfunction. The Lancet, 381(9861), 153-165.
Woo, T.M., & Wynne, A.L. (2011). Pharmacotherapeutics for nurse practitioner prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company.