410.2 📚 國考版醫垫國考 / PGY OSCE

410.2.0.1 📌 Cram Sheet

410.2.0.1.1 🔥 高 yield 10
  1. Female SD: HSDD, arousal, orgasmic, genito-pelvic pain
  2. Male ED causes: vascular > neurogenic > hormonal > drug > psychogenic
  3. ED + DM/CV common; ED precedes MI by 3-5 yr
  4. PDE5 inhibitor 1st: sildenafil, tadalafil (long), vardenafil, avanafil
  5. Nitrate + PDE5 = 犁忌 (severe hypotension)
  6. PE treatment: SSRI/paroxetine (off-label), dapoxetine (EU), topical, behavioral
  7. Female libido drugs: flibanserin (premenop), bremelanotide
  8. GSM treatment: vaginal estrogen / ospemifene / DHEA
  9. Drug-induced ED: SSRI, β-blocker, thiazide, anti-androgen, opioid
  10. Sex therapy / CBT important adjunct
410.2.0.1.2 🔢 必背
項目 æ•žå­—
Sildenafil duration 4-6 hr
Tadalafil duration 36 hr
Tadalafil daily dose 2.5-5 mg
Sildenafil dose 50-100 mg PRN
ED prevalence 40-70 50%
Flibanserin 100 mg HS

410.2.0.2 ⭐ 高 yield

410.2.0.2.1 PDE5 Inhibitor Comparison
Drug Onset Peak Duration
Sildenafil 30-60 min 1 hr 4-6 hr
Tadalafil 30 min 2 hr 36 hr
Vardenafil 25 min 1 hr 4-5 hr
Avanafil 15 min 30 min 6 hr
410.2.0.2.2 PDE5 Side Effects
  • Headache, flushing
  • Dyspepsia, back pain
  • Nasal congestion
  • Visual changes (blue tint — sildenafil)
  • NAION (rare)
  • Priapism (rare)
410.2.0.2.3 Female Libido Drugs
Drug Mechanism Use
Flibanserin 5HT1A agonist + 5HT2A antagonist Premenop HSDD; nightly
Bremelanotide Melanocortin agonist Premenop HSDD; on-demand SC
Testosterone (off-label) Direct Post-menop HSDD (controversial)
410.2.0.2.4 Drugs Causing Sexual Dysfunction
  • SSRI/SNRI (30-70% sexual SE)
  • Antipsychotic (esp. risperidone, haloperidol)
  • β-blocker (older > newer)
  • Thiazide
  • Anti-androgen: spironolactone, finasteride, abiraterone
  • GnRH agonist: leuprolide
  • Opioid
  • Antiepileptic (some)
  • Hormonal contraception (some women)

410.2.0.3 🎯 自我檢枬

  1. ED #1 cause? → Vascular
  2. PDE5 1st line? → Sildenafil etc
  3. PDE5 + nitrate? → 犁忌
  4. Tadalafil duration? → 36 hr
  5. PE first-line drug? → SSRI (paroxetine, off-label)
  6. Flibanserin? → HSDD premenop
  7. Female sexual dysfunction 4? → HSDD, arousal, orgasmic, genito-pelvic
  8. Male ED 5 cause? → Vascular, neuro, hormonal, drug, psychogenic
  9. SSRI sexual SE? → 30-70%
  10. ED workup? → T, glucose, lipid, drug review
  11. Postmenopausal libido drug? → Testosterone (off-label, controversial)
  12. Peyronie’s drug? → Collagenase (Xiaflex)
  13. Vacuum device? → Mechanical ED treatment
  14. Penile prosthesis? → Refractory ED
  15. Sex therapy? → Adjunct for most SD

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