title: Optimizing treatment outcomes with phosphodiesterase type 5 inhibitors for erectile dysfunction: opening windows to enhanced sexual function and overall health.
abstract: OBJECTIVE
  Phosphodiesterase type 5 (PDE5) inhibitors have proved to be efficacious, safe, and well tolerated, in clinical trials and practice, for men with erectile dysfunction (ED). However, many patients are not satisfied with treatment and discontinue it prematurely. This review discusses evidence-based strategies that nurse practitioners (NPs) can use to improve diagnosis of ED, optimize patient outcomes, and identify opportunities to detect other potentially serious comorbid conditions.
  
  
  METHODS
  This article was based on a previously published review, which involved a PubMed-MEDLINE search of the clinical literature from January 1, 1998 (year of sildenafil's approval in many markets), through August 30, 2008 (date of search).
  
  
  CONCLUSIONS
  Strategies to optimize responses to PDE5 therapy are summarized by the mnemonic "EPOCH": Evaluating and educating to ensure realistic expectations of therapy; Prescribing a treatment individualized to the couple's needs and preferences; Optimizing drug dose/regimen and revisiting key educational messages at follow-up visits; Controlling comorbidities via lifestyle counseling, medications, and/or referrals; and Helping patients and their partners to seek other forms of therapy if they have decided not to use a PDE5 inhibitor.
  
  
  CONCLUSIONS
  The "EPOCH" mnemonic may remind NPs of steps to optimize treatment outcomes with PDE5 inhibitors.
authors.affiliation: State University of New York Health Science Center at Brooklyn (SUNY Downstate Medical Center) and Kings County Hospital Center, Brooklyn, New York, USA. rsadovsk@aol.com
authors.forename: Richard
authors.initials: R
authors.lastname: Sadovsky
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Brock
authors.forename: Mikel
authors.initials: M
authors.lastname: Gray
authors.forename: Penny Kaye
authors.initials: PK
authors.lastname: Jensen
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Gutkin
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sorsaburu
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases; D003863:Depression; D004522:Educational Status; D006304:Health Status; D006801:Humans; D018783:Impotence, Vasculogenic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011471:Prostatic Neoplasms; D011687:Purines / Q000627:therapeutic use; D012307:Risk Factors; D019529:Sexuality; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate