1. Introduction to Clinical Pharmacology Chapter 47 Menopause and Andropause Drugs

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. Nursing Process: Ongoing Assessment
Vital signs
Adverse drug reactions

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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

29. Answer
True
This period is also called the female climacteric.

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

31. 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.

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

33. 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.