1. Pharmacology in Nursing Men’s Health Drugs

2. 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.

3. 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. 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

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

7. 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.

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

10. 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

11. 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

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

13. 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????????

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

15. Sex is a health part of every persons life and relationship

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

17. 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

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

19. 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

20. 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

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

22. 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

23. 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

24. 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