1. Drugs for Disorders and Conditions of the Male Reproductive System

2. Hypothalamus and Pituitary Regulation of Male Reproductive System
Gonadotropin releasing hormone (GRH)
Pituitary:
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)

3. Anabolic Steriods Testosterone-like compounds
Frequently abused by athletes, even though illegal
Schedule III drugs
Can result in serious adverse effects with long-term use
Increased cholesterol levels, low sperm count, impotence, liver damage
Menstrual irregularities and the appearance of male characteristics in women
Aggression, psychological dependence

4. Male Infertility Rule out psychologic etiology
Goal of pharmacology is to increase sperm production
IM injections to increase testosterone secretion and spermatogenesis.

6. Erectile Dysfunction Etiology:
Vascular diseases
Certain medications
Thiazide diuretics, beta blockers, selective serotonin reuptake inhibitors (SSRI)s, antidepressants
Psychogenic causes
Depression, fatigue, guilt, fear of failure
*GOAL –patient and partner achieve satisfactory sexual relationship
Sildenafil (Viagra): does not cause erection; enhances it
Vardenafil (Levitra): faster onset, slightly longer duration than Viagra
Tadalafil (Cialis): acts within 30 minutes and lasts 24–36 hours

8. Benign Prostatic Hyperplasia (BPH)
Enlargement of prostate
Not precursor to cancer
Symptoms:
Increased urinary frequency, urgency
Post void leakage, nocturia, decreased force of urine stream
Incomplete emptying of bladder

9. Finasteride (Proscar)
Prototype Drugs
Testosterone
Sildenafil (Viagra)
Finasteride (Proscar)

10. Testosterone
Primary therapeutic use is for treatment of delayed puberty and hypogonadism in males.
Adverse Effects: masculinity (high concern when being used by women), salt and water retention, edema, acne and skin irritation. Extreme doses in men (anabolic steroid abuse) may cause feminization rather then masculinity because excess testosterone is metabolized to estrogen.

11. Sildenafil (Viagra)
Relaxing smooth muscles in corpora cavernosa, allowing increased blood flow. Onset of action <1 hour, lasting for up to 4 hours.
Adverse Effects: HA, dizziness, flushing, rash, nasal congestion
Most serious: hypotension in patients concurrently taking nitrates for angina and can result in MI and sudden cardiac death. Priapism –erection lasting longer than 6 hours.

12. Finasteride (Proscar)
Inhibits enzyme responsible for converting testosterone to metabolite, causing growth of prostate cells and promotes enlargement of the gland.
Adverse Effects: causes various types of sexual dysfunction including impotence, impaired fertility, diminished libido, and ejaculatory dysfunction.

13. Monitor client’s condition Provide client education
Role of Nurse
Monitor client’s condition
Provide client education
Obtain medical, surgical, drug history
Assess lifestyle and dietary habits
Obtain description of symptomology and current therapies

14. Androgen Therapy for Hypogonadism
Assess impaired sexual functioning and diminished libido
Note physical signs of decreased hormone production
Decreased or absent body hair, small testes, delayed signs of puberty
Monitor emotional status
Monitor lab results, especially liver enzymes
Monitor serum cholesterol, especially with history of MI or angina
Drug can increase this lab value

15. Pharmacotherapy in Erectile Dysfunction Therapy
Obtain physical exam and history
Impaired sexual function
Cardiovascular disease
Presence of emotional disturbances

16. Pharmacotherapy in Erectile Dysfunction Therapy
Obtain testosterone, prolactin, thyroxin levels
Nocturnal penile tumescence and rigidity (NPTR) test may be ordered
A blood-flow test used to determine if sufficient blood flow to penis
Sildenafil, vardenafil, and tadalafil contraindicated with use of organic nitrates and alpha-adrenergic blockers

17. Drug Therapy with Antiprostatic Agents for BPH
Assess for changes in urinary elimination
Urine retention, nocturia, dribbling
Difficulty starting urinary stream, frequency, urgency
Monitor for hypotension (first-dose phenomenon) and throughout treatment
Alpha-blockers should be used cautiously in clients with asthma or heart failure
Cause bradycardia and bronchoconstriction

18. Drug Therapy with Antiprostatic Agents for BPH
Monitor emotional status of clients taking alpha-blockers
Depression common side effect
May take 6–12 months of treatment before maximum benefit achieved
Monitor for impotence, decreased volume of ejaculate, or decreased libido