Pharmacology in Nursing Men’s Health Drugs

Androgens Testosterone Responsible for normal development and maintenance of the primary and secondary male sex characteristics Development of bone and muscle tissue Inhibition of protein catabolism (metabolic breakdown) Retention of various electrolytes Pg 525 Besides having androgenic activity testosterone is also involved in the development of bone and muscle tissue, inhibition of protein catabolism and retention of nitrogen, phosphorus, potassium and sodium. These functions contribute to its anabolic activity The hormones initiated the synthesis of specific proteins needed for androgenic and anabolic activity by binding to areas of DNA in the nuclei of interstitial cells. Also testosterone appears to have erythropoietic effect in that it stimulates the production of RBC.

Androgens (cont’d) Several synthetic derivatives of testosterone 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

Androgens (cont’d) Anabolic steroids Anabolic activity: synthesis of tissue and increasing tissue formation Schedule III, great potential for misuse by athletes oxymetholone stanozolol oxandrolone nandrolone

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

Androgen Inhibitors 5-α-reductase inhibitors α1-adrenergic blockers Androgen receptor blockers Gonadotropin-releasing hormone (Gn- RH) analogs

Androgen Inhibitors (cont’d) 5-α-reductase inhibitors: finasteride (Proscar) and dutasteride (Avodart) Block the effects of endogenous androgens Used to treat benign prostatic hypertrophy (BPH) Results in alleviation of symptoms of BPH Easier passage of urine May also be used for treatment of male-pattern baldness Pregnancy category X teratogenic to pregnancy Works by inhibiting the enzyme that normally converts testosterone to 5-a-dihydrotestosterone DHT it is actually a somewhat more potent type of testosterone and is the principal androgen responsible for stimulating prostatic growth as well as other make primary and secondary sex characteristics.

BPH What is the most common problem it causes???? Difficulty vioding

α1-Adrenergic Blockers Used for symptomatic relief of obstruction due to BPH doxazosin (Cardura) tamsulosin (Flomax) terazosin (Hytrin) Flomax seems to have great effect specifically for the a1-receptors in the prostate and this may cause less hypotension. Relaxes that bladder and sphincter to aid in the urinary flow

Androgen Receptor Blockers Block the activity of androgen hormones at the target tissue (prostate) receptors flutamide nilutamide bicalutamide Primarily used in the treatment of prostate cancer

Gn-RH Analogs Gonadotropin-releasing hormone analogs Used to treat prostate cancer goserelin leuprolide triptorelin

Drugs to Treat Erectile Dysfunction sildenafil (Viagra) First oral drug for treatment of ED vardenafil (Levitra) tadalafil (Cialis) Works similar to nitrates and causes vasodilatation to the penis allowing and erection to occur. It inhibits the action of the enzyme phosphodiesterase. This in turn allows the build up in the penis of the chemical cyclic guanosine monophosphate. Which causes the relaxation of smooth muscle in the corpora cavernosa (erectile tubes) of the penis and permits the inflow of blood. How do you think your patients feel about this????????

Remember to be very sensitive, respectful, and non judgmental.

Sex is a health part of every persons life and relationship

Men’s Health Drugs: Indications Primary use: hormone replacement therapy Other uses vary with the specific drug

Men’s Health Drugs: Adverse Effects Androgens cause fluid retention Anabolic steroids Peliosis of the liver, other severe hepatic effects “Roid rage” is an uncommon vascular condition characterized by randomly distributed multiple blood-filled cavities throughout liver

Men’s Health Drugs: Adverse Effects (cont’d) 5-α-reductase inhibitors Loss of libido, loss of erection, ejaculatory dysfunction, other effects

Men’s Health Drugs: Adverse Effects (cont’d) minoxidil Oral form: tachycardia, dizziness, angina, severe fluid retention Topical form: same but less severe adverse effects, local irritation, itching, dryness, redness

Men’s Health Drugs: Adverse Effects (cont’d) Drugs for erectile dysfunction Headache, flushing, dyspepsia, nasal congestion, chest pain hyper/hypotension Priapism, unexplained visual loss In men with preexisting cardiovascular disease, especially those taking nitrates Lower BP substantially May cause serious adverse effects

Nursing Implications Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications Obtain baseline vital signs, weight, height, serum electrolyte levels

Nursing Implications (cont’d) Assess renal and liver function Assess PSA level before beginning any drugs for treatment of prostate disease Assess current medications for potential interactions

Nursing Implications (cont’d) IM testosterone should be given deeply—choose landmarks carefully 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

Nursing Implications (cont’d) Pregnant women should not handle crushed or broken finasteride tablets Educate patient on proper administration techniques for each drug Monitor for therapeutic responses Monitor for adverse effects