Introduction to Clinical Pharmacology Chapter 47 Menopause and Andropause Drugs

Aging Urinary and Reproductive Changes Menopause makes changes for women very pronounced because fertility stops For men change is not as overt. Hormonal and urinary changes may be more subtle and are referred to as andropause

Aging Female Genitourinary System Vaginal walls become thinner, shorten, and lose some of their elasticity The vagina produces less lubrication and at a slower rate during sexual arousal The pH environment changes, making the vagina more susceptible to yeast infections Pelvic floor muscles weaken and lead to stress incontinence

Estrogens Relief of moderate to severe vasomotor symptoms of menopause (flushing, sweating) Treatment of atrophic vaginitis Treatment of osteoporosis in women past menopause Palliative treatment of advanced prostatic carcinoma (in men) Selected cases of advanced breast carcinoma

Estrogens: Adverse Reactions Central nervous system reactions Headache, migraine Dizziness, mental depression Dermatologic reactions Dermatitis, pruritus Chloasma (pigmentation of the skin) or melasma (discoloration of the skin), which may continue when use of the drug is discontinued

Estrogens: Adverse Reactions (cont.) Genitourinary reactions Breakthrough bleeding, withdrawal bleeding, spotting, changes in menstrual flow Dysmenorrhea, premenstrual-like syndrome, amenorrhea Vaginal candidiasis, cervical erosion, vaginitis Local reactions Pain at injection site or sterile abscess with parenteral form of the drug Redness and irritation at the application site with transdermal system

Estrogen: Adverse Reactions (cont.) Ophthalmic reactions Steepening of corneal curvature Intolerance to contact lenses Miscellaneous reactions Edema, rhinitis, changes in libido Breast pain, enlargement, and tenderness Reduced carbohydrate tolerance Venous thromboembolism, pulmonary embolism Weight gain or loss Generalized and skeletal pain

Estrogens: Interactions Interacting drug Common use Effect of interaction Oral anticoagulants Blood thinners Decreased anticoagulant effect Tricyclic antidepressants Treatment of depression Increased effectiveness of antidepressant Rifampin Anti-infective Increased risk of breakthrough bleeding Hydantoins Seizure control Increased risk of breakthrough bleeding and pregnancy

Antispasmodics: Actions and Uses Cholinergic blocking drugs: Inhibit bladder contractions, delay urge to void Relieve symptoms of dysuria, urinary urgency, nocturia, suprapubic pain and frequency, urge incontinence Treat bladder instability caused by neurogenic bladder

Antispasmodics: Adverse Reactions Dry mouth, drowsiness, constipation or diarrhea, decreased production of tears, decreased sweating, GI disturbances, dim vision, urinary hesitancy Nausea and vomiting, nervousness, vertigo, headache, rash, mental confusion Discolors urine

Antispasmodics: Contraindications and Precautions Contraindicated in patients: With hypersensitivity to drug, glaucoma Used cautiously in patients: With GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic or renal disease, hypertension

Interactions: Antispasmodics Interactant drug Effect of interaction Antibiotics/antifungals Decreased effectiveness of anti-infective drug Meperidine, flurazepam, phenothiazines Increased effect of antispasmodic Tricyclic antidepressants Haloperidol Decreased effectiveness of antipsychotic drug Digoxin Increased serum levels of digoxin

Drugs to Treat BPH Treatment for BPH includes monitoring, medications, or invasive procedures Drugs are used for mild to moderate symptoms of BPH (e.g., frequency, reduced flow, nocturia, and dysuria) and include androgen inhibitors and adrenergic blockers. The most widely used drugs to treat BPH are the alpha (α)-adrenergic blockers

BPH Drug Adverse Reactions Adverse reactions usually are mild and do not require discontinuing use of the drug Some of the adverse reactions seen with the administration of alpha-adrenergic blockers are as follows: weight gain, fatigue, dizziness, and transient orthostatic hypotension

BPH Drug Interactions Interacting Drug Common Use Effect of Interaction Antibiotics/antifung als Fight infection Decreased effectiveness of anti-infective drug Beta blockers Hypertension Increased hypotension Phosphodiesterase type 5 inhibitors Erectile dysfunction

Drugs for Erectile Dysfunction Sexual stimulation causes a series of steps where chemicals are released and the smooth muscles of the penis (corpus cavernosum) become engorged with blood Erectile dysfunction results from a failure of the penis to become engorged, preventing sexual intercourse Phosphodiesterase type 5 inhibitors are oral drugs that facilitate the enzyme that allows blood flow into the penis, resulting in an erection

Erectile Dysfunction Drugs Adverse Reactions The most common adverse reactions include headache, flushing, GI upset, nausea, and runny nose or congestion Drugs for ED should not be taken by men who use nitrates (e.g., for angina pain) Because these drugs affect smooth muscle, patients with pre-existing cardiac problems, especially those using drugs to lower blood pressure, should discuss use with their primary health care provider before using the drug

Erectile Dysfunction Drug Interactions Interacting drug Common use Effect of interaction Antiretrovirals Viral infection Increased effectiveness of ED drug Antihypertensiv es Reduce blood pressure Increased effectiveness of antihypertensive

Nursing Process: Baseline Assessment Complete patient health history Menstrual history BPH Overactive bladder Incontinence Thrombophlebitis Smoking history Liver disease Vital signs

Nursing Process: Ongoing Assessment Vital signs Adverse drug reactions

Nursing Process: Diagnoses Deficient Knowledge related to diagnosis, use of ERT, or other factors Impaired Oral Mucous Membranes related to dry mouth from anticholinergic Risk for Injury related to drowsiness, dizziness, or hypotension Acute Pain related to priapism

Nursing Process: Planning Optimal response to drug therapy Support of patient needs related to the management of adverse reactions Confidence in an understanding of the medication regimen

Nursing Process: Implementation Estrogens and progestins Carefully read the patient package insert available with the drug. If there are any questions about this information, discuss them with the primary health care provider If GI upset occurs, take the drug with food

Nursing Process: Implementation (cont.) Notify the primary health care provider if any of the following occurs: Pain in the legs or groin area; sharp chest pain or sudden shortness of breath; lumps in the breast; sudden severe headache; dizziness or fainting; vision or speech disturbances; weakness or numbness in the arms, face, or legs; severe abdominal pain; depression; or yellowing of the skin or eyes If pregnancy is suspected or abnormal vaginal bleeding occurs, stop taking the drug and contact the primary health care provider immediately

Nursing Process: Implementation (cont.) Patient with diabetes: Check the blood glucose daily, or more often. Contact the primary health care provider if the blood glucose is elevated. An elevated blood glucose level may require a change in diabetic therapy (insulin, oral antidiabetic drug) or diet; these changes must be made by the primary health care provider

Nursing Process: Implementation (cont.) Androgen hormone inhibitors Inform the primary health care provider immediately if sexual partner is or may become pregnant, because additional measures, such as discontinuing the drug or use of a condom, may be necessary Women who are or who may become pregnant should not handle this medication Do not donate blood for at least 6 months after stopping medication due to potential effects on pregnant women who may receive the blood product

Nursing Process: Evaluation Therapeutic effect is achieved and urinary or reproductive symptoms are relieved Adverse reactions are identified, reported to the primary health care provider, and managed successfully through appropriate nursing interventions Knowledge level is enhanced Mucous membranes are moist and intact No injury is evident Patient is free of pain Patient and family express confidence and demonstrate an understanding of the drug regimen

Question Is the following statement true or false? During menopause, the hormone estrogen diminishes and the menstrual cycle can become irregular until it stops.

Answer True This period is also called the female climacteric.

Question Is the following statement true or false? The number of urinary system disorders decreases as people age.

Answer False The number of urinary system disorders increases as people age. Renal function can be reduced to 50% and the urine becomes more dilute. Strength, flexibility, and capacity of the bladder decrease.

Question Is the following statement true or false? Urinary issues can be a sign of prostate enlargement.

Answer True Urinary issues can be a sign of prostate enlargement. BPH symptoms such as frequency, reduced flow, nocturia, and dysuria are treated with antiadrenergic or male hormone inhibitors. A frequent adverse reaction to these medications or a medical condition such as diabetes or BPH is erectile dysfunction. Medications used to reduce these symptoms are similar to others used to dilate circulatory vessels. Similar adverse reactions can present such as hypotension.