NSG 533 ADVANCED PHARMACOLOGY 4
COMPREHENSIVE EXAM SCRIPT 2026 SOLVED
QUESTIONS WITH CORRECT ANSWERS
◉ Before initiating treatment for ED. Answer: a physical examination
and thorough medical, social, and medication histories with
emphasis on cardiac disease must be taken to assess for ability to
safely perform sexual activity and to assess for possible drug
interactions
Diagnosis should include PE (including a check for signs of
hypogonadism), medication review, Hx, and labs ( HbA1C, PSA, FLP,
testosterone)
◉ ED treatment should include. Answer: Non-pharmacological
interventions
Reduce fat and cholesterol in diet
Decrease or limit alcohol consumption
Eliminate tobacco use and substance abuse
Weight loss if appropriate
Regular exercise
Co-morbidity (DM, HTN, etc.) management - including (if possible)
removal of causal medications
,◉ If a medication is removed, consider that it probably will have to
be replaced with a reasonable alternative. Answer: Examples:
SSRIs are a potential cause of ED. A reasonable replacement might
be bupropion (assuming no contraindications)
Dutasteride (for BPH) is a common cause of ED. Tardenafil as a
replacement for or in combination with a 5-alpha reductase might
be reasonable (assuming no contraindications)
◉ ED Note:. Answer: There are occasions where an offending
medication can NOT be discontinued because of a compelling
indication and / or lack of a reasonable alternative (eg Beta-blockers
in heart failure or SIHD).
◉ PDE5Is - Often considered drug of choice when pharmacotherapy
is necessary. There is no convincing evidence that one agent in this
class is superior to another. Choice may be based on patient
preference, cost, and formularies. Answer: There is no drug effect
without some type of sexual stimulation because these drugs do not
cause penile erections; they only provide the ability of the penis to
respond to sexual stimulation.
Varying duration of action (most 4-5 h, tadalafil 36h).
Headache and flushing most common ADRs. Serious cardiac events
possible
, ◉ Significant DIs exist. Answer: +) nitrates - severe hypotensionIn
an emergent situation, a patient who has taken sildenafil may be
given a nitrate after 24 hours; for tadalafil, after 48 hours.
Vardenafil does not have a suggested time interval, but blood
pressure and heart rate did not change when the drug was taken 24
hours before nitrate administration. These suggested intervals are a
direct correlation to half-life and duration of action
Prolonging of QT interval
Serious cardiovascular events have been associated with PDE5
inhibitors; therefore, they should not be used in patients in whom
sexual intercourse is inadvisable because of poor cardiac status.
◉ Testosterone replacement (Low-T). Answer: Testosterone
replacement regimens should never be administered to men with
normal serum testosterone levels, or in patients with isolated
erectile dysfunction as the only sign of hypogonadism.
Before initiating any testosterone replacement regimen in patients
40 years and older, patients should be screened for breast cancer,
benign prostatic hyperplasia, and prostate cancer. All are
testosterone-dependent conditions and theoretically could be
worsened by exogenous administration of testosterone
◉ Alprostadil - PgE1 analog administered by intracavernosal
injection & intraurethral inserts. Answer: Because PGs bypass many
steps in the erectile cascade, they are quite effective at producing an
erection, even in cases where PDE5 inhibitors cannot do so.
COMPREHENSIVE EXAM SCRIPT 2026 SOLVED
QUESTIONS WITH CORRECT ANSWERS
◉ Before initiating treatment for ED. Answer: a physical examination
and thorough medical, social, and medication histories with
emphasis on cardiac disease must be taken to assess for ability to
safely perform sexual activity and to assess for possible drug
interactions
Diagnosis should include PE (including a check for signs of
hypogonadism), medication review, Hx, and labs ( HbA1C, PSA, FLP,
testosterone)
◉ ED treatment should include. Answer: Non-pharmacological
interventions
Reduce fat and cholesterol in diet
Decrease or limit alcohol consumption
Eliminate tobacco use and substance abuse
Weight loss if appropriate
Regular exercise
Co-morbidity (DM, HTN, etc.) management - including (if possible)
removal of causal medications
,◉ If a medication is removed, consider that it probably will have to
be replaced with a reasonable alternative. Answer: Examples:
SSRIs are a potential cause of ED. A reasonable replacement might
be bupropion (assuming no contraindications)
Dutasteride (for BPH) is a common cause of ED. Tardenafil as a
replacement for or in combination with a 5-alpha reductase might
be reasonable (assuming no contraindications)
◉ ED Note:. Answer: There are occasions where an offending
medication can NOT be discontinued because of a compelling
indication and / or lack of a reasonable alternative (eg Beta-blockers
in heart failure or SIHD).
◉ PDE5Is - Often considered drug of choice when pharmacotherapy
is necessary. There is no convincing evidence that one agent in this
class is superior to another. Choice may be based on patient
preference, cost, and formularies. Answer: There is no drug effect
without some type of sexual stimulation because these drugs do not
cause penile erections; they only provide the ability of the penis to
respond to sexual stimulation.
Varying duration of action (most 4-5 h, tadalafil 36h).
Headache and flushing most common ADRs. Serious cardiac events
possible
, ◉ Significant DIs exist. Answer: +) nitrates - severe hypotensionIn
an emergent situation, a patient who has taken sildenafil may be
given a nitrate after 24 hours; for tadalafil, after 48 hours.
Vardenafil does not have a suggested time interval, but blood
pressure and heart rate did not change when the drug was taken 24
hours before nitrate administration. These suggested intervals are a
direct correlation to half-life and duration of action
Prolonging of QT interval
Serious cardiovascular events have been associated with PDE5
inhibitors; therefore, they should not be used in patients in whom
sexual intercourse is inadvisable because of poor cardiac status.
◉ Testosterone replacement (Low-T). Answer: Testosterone
replacement regimens should never be administered to men with
normal serum testosterone levels, or in patients with isolated
erectile dysfunction as the only sign of hypogonadism.
Before initiating any testosterone replacement regimen in patients
40 years and older, patients should be screened for breast cancer,
benign prostatic hyperplasia, and prostate cancer. All are
testosterone-dependent conditions and theoretically could be
worsened by exogenous administration of testosterone
◉ Alprostadil - PgE1 analog administered by intracavernosal
injection & intraurethral inserts. Answer: Because PGs bypass many
steps in the erectile cascade, they are quite effective at producing an
erection, even in cases where PDE5 inhibitors cannot do so.
