Drugs for Men’s Health and Reproductive Disorders Chapter 57 Drugs for Men’s Health and Reproductive Disorders Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Substances Related to Male Reproductive Disorders Androgens Testosterone, main androgen  Administration IM, well-absorbed Indications Hypogonadism Delayed puberty in adolescents Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Androgens Testosterone Drug interactions Lab interactions Anticoagulants, barbiturates, phenytoin, corticosteroids Lab interactions Decreases blood glucose in diabetics; increases cholesterol, thyroid, liver function, hematocrit Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Androgens (Cont.) Testosterone Side effects Pripiasm Gynecomastia Spermatogenesis halted Oligospermia Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Androgens (Cont.) Adverse reactions Hypercalcemia Virilization Teratogenic effects Hepatic carcinoma Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Androgens (Cont.) Contraindications Pregnancy Nephrosis or nephrotic phase of nephritis Hypercalcemia Pituitary insufficiency Hepatic dysfunction BPH Prostate cancer History of myocardial infarction Men with breast cancer Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Androgens (Cont.) Caution Hypertension Hypercholesterolemia CAD Renal disease Seizure disorder Infants Prepubertal children Older men Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Anabolic Steroids Also called anabolic-androgenic steroids (AAS) Class of steroid hormones related to the hormone testosterone They increase protein synthesis within cells, which results in the buildup of cellular tissue (anabolism), especially in muscles. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Testosterone Precursors Androstenediol Androstenedione Dehydroepiandrosterone (DHEA) Available as nutritional supplements Health risks from long-term use: increased LDL, decreased HDL, acne, high blood pressure, liver damage, and dangerous changes in the structure of the left ventricle of the heart Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Other Steroids Gonadotropin (hCG, Pregnyl, Novarel, Ovidrel) Tetrahydrogestrinone (THG) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Androgens Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Antiandrogens Leuprolide, ketoconazole, flutamide (Eulexin) Use: Treatment of benign prostatic hypertrophy, advanced prostatic cancer, and as hormonal therapy in the treatment of endometriosis Other uses: Treatment of male pattern baldness, acne, hirsutism, virilization syndrome in women, and precocious puberty in boys Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drugs Used in Other Male Reproductive Disorders Developmental disorders Undescended testes Associated with infertility, testicular cancer Delayed puberty Given Gn-RH, LH, or FSH therapy Pituitary, thyroid, adrenal disorders Given LH or FSH therapy Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drugs Used in Other Male Reproductive Disorders (Cont.) Sexual dysfunction Phosphodiesterase inhibitors Sildenafil citrate (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Natural Products Herbs used for sexual performance Yohimbine Ginseng Damiana Ginkgo biloba Saw palmetto Muira puama Tribulus terrestris Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drugs for Treatment of BPH 5-alpha reductase inhibitors Finasteride (Proscar, Propecia) Dutasteride (Avodart, Duagen) Alpha-adrenergic blocking agents Tamsulosin (Flomax) Doxazosin (Cardura) Terazosin (Hytrin) Alfuzosin (Uroxatrel) Silodosin (Rapaflo) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 The nurse teaches a patient that sildenafil is contraindicated for patients taking which category of medications? Sulfonylureas Beta blockers Nitrates Proton pump inhibitors Answer: C Rationale: Nitroglycerin and other nitrate medications used to treat heart disease can cause a significant decrease in blood pressure when taken with PDE-5 inhibitors. Therefore, this class of drugs is contraindicated for use by any patient using organic nitrates in any form. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 A patient is receiving androgen therapy for hypogonadism. The nurse teaches the patient to observe for common side effects of the drug, including which of the following? Abdominal pain and hives at injection site Dry mouth and dizziness Weight gain and blurred vision Generalized rash Answer: A Rationale: Some side effects of androgen therapy include abdominal pain, nausea, insomnia, diarrhea or constipation, hives or redness at the injection site, increased salivation, mouth soreness, and increased or decreased sexual desire. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 The nurse should inform a woman undergoing androgen therapy that she may develop which symptom? Impaired bone growth Gynecomastia Vocal changes Priapism Answer: C Rationale: Vocal changes to a deeper voice may occur. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #4 Which drug used in the treatment of benign prostatic hypertrophy is most likely to cause postural hypotension? Alfuzosin (Uroxatral) Dutasteride (Avodart) Finasteride (Propecia) Tadalafil (Cialis) Answer: A Rationale: Alfuzosin is an alpha-adrenergic blocking agent, which is also used to control blood pressure and can cause postural hypotension. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #5 Before administering androgen therapy, it is most important for the nurse to assess the patient for chronic obstructive pulmonary disease. diabetes mellitus. pregnancy. a serum calcium of 8.0. Answer: C Rationale: Androgen therapy is contraindicated during pregnancy. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.