Episode Details

Episode 40: Erectile Dysfunction Basics. 

Erectile dysfunction fundamentals, allergy to penicillin label removal, jokes

Today is February 5, 2021.

Question of the month: Diabetes management

This is a reminder of our question for this month. Please answer before Feb 15, 2021. The best answer will receive a prize. Question: What is the first treatment approach for type 2 DM? For example, for a patient who had polydipsia, polyuria for a few weeks and at your office had a random BG of 210.

Send your answer to RBresidency@clinicasierravista.org. Don’t miss this chance to win.

Penicillin Allergy Study: How many times have you heard a patient say that they are allergic to penicillin? Exactly, a lot! Skin allergy testing continues to be the best test to diagnose penicillin allergy. All patients who have a negative penicillin allergy skin test should be challenged with penicillin in a medical setting for 1-2 hours to ensure that immediate reaction does not occur. Many patients labeled as “allergic to penicillin” may not be truly allergic. We recognize that true penicillin allergy exists, and allergic reactions range from mild rash to life-threatening anaphylaxis, but many patients needing penicillin may not get it because of a wrong diagnosis of penicillin allergy. 

Up to 15% of the US population are labeled as “allergic to penicillin”. The American Journal of Respiratory and Critical Care Medicine published in February 2020 a way to remove low-risk penicillin allergy labels in an ICU. The investigators created a risk-stratification tool after evaluating 318 patients in an allergy clinic. Low risk indicators include urticaria to penicillin >5 years ago, a self-limited rash, GI symptoms only, a remote childhood history, a family history only, avoidance from fear of allergy only, a known tolerance to penicillin since the reported reaction, or non-allergic symptoms. 

Using that tool, 216 patients admitted to the MICU labeled as “allergic to penicillin” were evaluated. 68 patients qualified as “low risk.” 54 patients agreed to be challenged with a single oral dose of 250 mg amoxicillin and observed for 1 hour. None of the challenged patients had any immediate or delayed reaction. Their penicillin allergy label was removed. Later, 41 of the 54 challenged patients received multiple doses of either penicillin’s (17 patients) or cephalosporins (24 patients) without any reaction. This tool has not been validated to be used in an outpatient setting yet, but it sets the foundation for further investigation in this matter.

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

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Erectile Dysfunction. 

Arreaza: Today our guest is Dr. John Ihejirika.  

Ihejirika: My name is Dr. John Ihejirika. I am one of the third/Final-year residents at the Rio Bravo Family Medicine residency program, here in Bakersfield, California.  I am glad to be back on the podcast and thanks for having me again.

Arreaza: What topic are you discussing today?

Today I will be talking about Erectile dysfunction.

Arreaza: What is Erectile dysfunction?

Ihejirika: Erectile dysfunction [ED] can be defined as the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. 

It is very common, affecting at least 12 million men in the United States. The condition can be caused by vascular, neurologic, psychological, medications and hormonal factors.