Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Chapter 35 Men’s Health Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Androgens Testosterone Responsible for normal development and maintenance of primary and secondary male sex characteristics Development of bone and muscle tissue Inhibition of protein catabolism (metabolic breakdown) Retention of various electrolytes Stimulates the production of blood cells Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Androgens (cont’d) Several synthetic derivatives of testosterone are available Long-term dosage forms can last from 2 to 3 days to 2 to 4 weeks Oral forms have a high first-pass effect Transdermal forms available Patches and gel Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Androgens (cont’d) Anabolic steroids Anabolic activity: synthesis of tissue and increasing tissue formation Schedule III, great potential for misuse by athletes oxymetholone (Anadrol-50) oxandrolone (Oxandrin) nandrolone (Deca-Durabolin) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Androgens: Mechanism of Action Effects are similar to the body’s endogenous androgens Stimulation of normal growth and development of the male sex organs Development and maintenance of male secondary sex characteristics Stimulate increased synthesis of body proteins, aiding in the formation of muscular and skeletal proteins Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Androgen Inhibitors 5-Alpha-reductase inhibitors Alpha1-adrenergic blockers Androgen receptor blockers Gonadotropin-releasing hormone (Gn-RH) analogs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

5-Alpha-Reductase Inhibitors Finasteride (Proscar) and dutasteride (Avodart) Block the effects of endogenous androgens Used to treat benign prostatic hyperplasia (BPH) Results in alleviation of symptoms of BPH Easier passage of urine May also be used for treatment of male-pattern baldness (minoxidil) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Alpha1-Adrenergic Blockers Used for symptomatic relief of obstruction caused by BPH doxazosin (Cardura) tamsulosin (Flomax) terazosin (Hytrin) alfuzosin (Uroxatral) silodosin (Rapaflo) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Androgen Receptor Blockers Block the activity of androgen hormones at target tissue (prostate) receptors flutamide (Eulexin) nilutamide (Nilandron) bicalutamide (Casodex) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Gn-RH Analogs Used to treat prostate cancer goserelin (Zoladex) leuprolide (Lupron) triptorelin (Trelstar) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Drugs to Treat Erectile Dysfunction sildenafil (Viagra) First oral drug for treatment of ED vardenafil (Levitra) tadalafil (Cialis) alprostadil (Caverject) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? Transdermal nitroglycerin Hydrochlorothiazide Potassium Multivitamin with iron Correct answer: A Rationale: Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Men’s Health Drugs: Indications Primary use: replacement therapy Other uses vary with the specific drug Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Men’s Health Drugs: Adverse Effects Androgens cause fluid retention Anabolic steroids Peliosis of the liver, other severe hepatic effects Many other effects Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review? Hemoglobin A1C Triglycerides Potassium Lactate dehydrogenase (LDH) Correct answer: D Rationale: Assess the patient for liver disease because formation of blood-filled cavities may occur. This condition, also called peliosis, is associated with long-term therapy and may be life-threatening. Perform liver function studies (e.g., LDH, CPK, and bilirubin levels) as ordered to monitor for the possible adverse effect of abnormal liver function and jaundice. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Men’s Health Drugs: Adverse Effects (cont’d) 5-Alpha-reductase inhibitors Loss of libido, loss of erection, ejaculatory dysfunction, other effects May cause PSA concentrations to decrease Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Men’s Health Drugs: Adverse Effects (cont’d) Drugs for erectile dysfunction Headache, flushing, dyspepsia, chest pain, hypotension Priapism Unexplained visual loss In men with preexisting cardiovascular disease, especially those taking nitrates Lower BP substantially May cause serious adverse effects Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Herbal Products: Saw Palmetto Serenoa repens, Sabal serrulata Used for treatment of BPH and alopecia Adverse effects GI upset Headache Back pain Dysuria Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse? Calcium with vitamin D acetaminophen (Tylenol) St. John’s wort ibuprofen (Motrin) Correct answer: D Rationale: The nurse should be most concerned about concurrent use of saw palmetto with the NSAID ibuprofen (Motrin) because of the potential for drug interactions. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Nursing Implications Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications Obtain baseline vital signs, weight, height, serum electrolyte levels Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Assess renal and liver function Assess PSA level and perform digital rectal examination (DRE) before beginning any drugs for treatment of prostate disease Assess current medications for potential interactions Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Follow exact instructions for SL, buccal, and PO forms Transdermal Testoderm patches are applied to the scrotal skin Transdermal Androderm patches are applied to the skin on the body, never to scrotal skin Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Pregnant women should not touch crushed or broken hormone drugs Educate patients on proper administration techniques for each drug Monitor for therapeutic responses Monitor for adverse effects Copyright © 2014 by Mosby, an imprint of Elsevier Inc.