Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 35 Men’s Health Drugs

2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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)  stanozolol (Winstrol)  oxandrolone (Oxandrin)  nandrolone (Deca-Durabolin)

5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Androgen Inhibitors  5-Alpha-reductase inhibitors  Alpha 1 -adrenergic blockers  Androgen receptor blockers  Gonadotropin-releasing hormone (Gn-RH) analogs

7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 5-Alpha-Reductase Inhibitors  Finasteride and dutasteride  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)

8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Alpha 1 -Adrenergic Blockers  Used for symptomatic relief of obstruction caused by BPH  doxazosin (Cardura)  tamsulosin (Flomax)  terazosin (Hytrin)  alfuzosin (Uroxatral)

9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Androgen Receptor Blockers  Block the activity of androgen hormones at target tissue (prostate) receptors  flutamide  nilutamide  bicalutamide

10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Gn-RH Analogs  Gonadotropin-releasing hormone analogs  Used to treat prostate cancer  Goserelin  Leuprolide  Triptorelin

11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drugs to Treat Erectile Dysfunction  sildenafil (Viagra)  First oral drug for treatment of ED  vardenafil (Levitra)  tadalafil (Cialis)

12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Men’s Health Drugs: Indications  Primary use: replacement therapy  Other uses vary with the specific drug

13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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 Lower BP substantially May cause serious adverse effects May cause serious adverse effects

16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Assess renal and liver function  Assess PSA level and perform digital rectal exam (DRE) before beginning any drugs for treatment of prostate disease  Assess current medications for potential interactions

19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Pregnant women should not handle crushed or broken finasteride tablets  Educate patients on proper administration techniques for each drug  Monitor for therapeutic responses  Monitor for adverse effects