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Chapter 35
Men’s Health Drugs
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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
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Androgens (Cont.)
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
Methyltestosterone (Android)
Fluoxymesterone (Halotestin)
Transdermal forms available
Patches and gel
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Androgens (Cont.)
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)
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Androgens (Cont.)
Anabolic steroids: approved indications
Adjunctive therapy to promote weight gain after extensive surgery, trauma, chronic diseases, anemia, hereditary angioedema, and metastatic breast cancer
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Androgens (Cont.)
Anabolic steroids: great potential for misuse
Bodybuilders and weightlifters
Muscle-building properties
Serious consequences: sterility, cardiovascular diseases, and liver cancer
Schedule III controlled substances by the U.S. Drug Enforcement Administration
Misuse of these drugs can lead to psychological or physical dependence or both.
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Androgens (Cont.)
Danazol (Danocrine)
Synthetic androgen is danazol (Danocrine).
Use: treatment of hereditary angioedema, and, in women, endometriosis and fibrocystic breast disease.
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8. Androgens: Mechanism of Action
Effects are similar to the body’s endogenous androgens
Stimulate 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
Enhanced erythropoiesis
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Androgen Inhibitors
Block the effects of naturally occurring (endogenous) androgens
5-Alpha reductase inhibitors
Benign prostatic hyperplasia (BPH) treatment
Finasteride
Dutasteride
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10. Finasteride (Propicia)
Inhibition of 5-alpha reductase prevents the thinning of hair caused by increased levels of DHT
Male pattern baldness
Women
Not for treatment of female baldness
Teratogenic in pregnant women
Use in women of any age (pregnant or not) is not recommended.
Women need to wear gloves when handling finasteride.
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11. Alpha1-Adrenergic Blockers
Used for symptomatic relief of obstruction caused by BPH
Doxazosin (Cardura)
Tamsulosin (Flomax)
Terazosin (Hytrin)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)
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12. Alpha1-Adrenergic Blockers (Cont.)
These drugs have clinical effects of prostate shrinkage immediately.
5-Alpha reductase inhibitors may take up to 6 months of continual therapy for clinical effects of prostate shrinkage.
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13. Androgen Receptor Blockers
Block the activity of androgen hormones at target tissue (prostate) receptors
Used in the treatment of prostate cancer
Flutamide (Eulexin)
Nilutamide (Nilandron)
Bicalutamide (Casodex)
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14. Gonadotropin-Releasing Hormone Analogs
Used to treat prostate cancer
Action: inhibit the secretion of pituitary gonadotropin, which eventually leads to a decrease in testosterone production
Goserelin (Zoladex)
Leuprolide (Lupron)
Triptorelin (Trelstar)
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15. Drugs to Treat Erectile Dysfunction
Phosphodiesterase (PDE) inhibitors are used in the treatment of erectile dysfunction (ED).
Sildenafil (Viagra)
First oral drug for treatment of ED
Causes relaxation of the smooth muscle in the corpora cavernosa (erectile tubes) of the penis and permits the inflow of blood
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16. Drugs to Treat Erectile Dysfunction (Cont.)
Vardenafil (Levitra)
Tadalafil (Cialis)
Similar to sildenafil (Viagra) but longer duration of action
Sildenafil and tadalafil are also used to treat pulmonary hypertension.
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17. Drugs to Treat Erectile Dysfunction (Cont.)
Avanagil (Stendra): newest PDE inhibitor approved for ED
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18. Drugs to Treat Erectile Dysfunction (Cont.)
Alprostadil (Caverject)
Prostaglandin
Administered by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra
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19. Audience Response System 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 such as sildenafil with nitrates may lead to dangerous hypotensive episodes.
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20. Men’s Health Drugs: Indications
Primary use: replacement therapy
Other uses vary with the specific drug
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21. Men’s Health Drugs: Contraindications
Known androgen-responsive tumors
Sildenafil, vardenafil, tadalafil and avanafil: contraindicated in men with major cardiovascular disorders, especially if they use nitrate medications such as nitroglycerin
Use of finasteride is contraindicated in women (especially pregnant women) and children.
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22. Men’s Health Drugs: Adverse Effects
Androgens cause fluid retention.
Anabolic steroids
Peliosis of the liver
Hepatic neoplasms (liver cancer)
Cholestatic hepatitis
Jaundice
Abnormal liver function
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23. Men’s Health Drugs: Adverse Effects (Cont.)
Priapism: abnormally prolonged penile erection
Relatively uncommon
Possible adverse effect of both the ED drugs and the androgens
Medical emergency that warrants urgent medical attention
Caused by an excessive therapeutic drug response
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24. Men’s Health Drugs: Adverse Effects (Cont.)
PDE inhibitors: can cause unexplained visual loss.
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25. Men’s Health Drugs: Adverse Effects (Cont.)
Finasteride: loss of libido, loss of erection, ejaculatory dysfunction, hypersensitivity reactions, gynecomastia, severe myopathy, and a 50% decrease in prostate-specific antigen (PSA) concentrations
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26. Audience Response System 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.
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Interactions
Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity.
Androgens with cyclosporine increases the risk of cyclosporine toxicity.
Sildenafil, vardenafil, tadalafil, and avanafil may cause severe hypotension when given together with nitrates such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate.
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Interactions (Cont.)
Alpha blockers: additive hypotension when given with other drugs that lower blood pressure
Effects of tamsulosin may be increased when it is taken with azole antifungal drugs, erythromycin and clarithromycin, cardiac drugs such as propranolol and verapamil, and protease inhibitors.
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29. Herbal Products: Saw Palmetto
Serenoa repens, Sabal serrulata
Used for treatment of BPH and alopecia
Adverse effects
Gastrointestinal upset
Headache
Back pain
Dysuria
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30. Audience Response System 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 nonsteroidal antiinflammatory drug ibuprofen (Motrin) because of the potential for drug interactions.
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Nursing Implications
Assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications.
Obtain baseline vital signs, weight, height, and serum electrolyte levels.
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32. Nursing Implications (Cont.)
Assess renal and liver function.
Assess PSA level and perform digital rectal examination before beginning any drugs for treatment of prostate disease.
Assess current medications for potential interactions.
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33. Nursing Implications (Cont.)
Follow exact instructions for sublingual, buccal, and oral 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.
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34. Audience Response System Question
A patient has been prescribed Testoderm transdermal patches for hypogonadism. The nurse should teach the patient to
apply the patch to the upper arm.
apply the patch to clean, dry scrotal skin that has been shaved for optimal skin contact.
shave the skin of the calf and apply the patch.
discontinue use of the patch if the skin is uncomfortable.
Correct answer: B
Rationale: Testoderm transdermal patches for the treatment of hypogonadism should be applied to clean, dry scrotal skin that has been shaved for optimal skin contact. Patients should not be advised to discontinue any medication without consulting the prescriber.
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35. Nursing Implications (Cont.)
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.
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36. Audience Response System Question
A patient has been prescribed AndroGel. When providing patient teaching, the nurse will instruct the patient that the gel may be applied to all of the following areas EXCEPT the
abdomen.
shoulders.
arms.
thighs.
Correct answer: D
Rationale: AndroGel is to be applied to the shoulders, arms, or abdominal skin as ordered.
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