Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

Chapter 35
Men’s Health Drugs
Copyright © 2014 by Mosby, an imprint 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
Stimulates the production of blood cells
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Androgens (cont’d)




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
Transdermal forms available

Patches and gel
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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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)
 oxandrolone (Oxandrin)
 nandrolone (Deca-Durabolin)
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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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Androgen Inhibitors




5-Alpha-reductase inhibitors
Alpha1-adrenergic blockers
Androgen receptor blockers
Gonadotropin-releasing hormone (Gn-RH)
analogs
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5-Alpha-Reductase Inhibitors




Finasteride (Proscar) and dutasteride (Avodart)
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)
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Alpha1-Adrenergic Blockers






Used for symptomatic relief of obstruction
caused by BPH
doxazosin (Cardura)
tamsulosin (Flomax)
terazosin (Hytrin)
alfuzosin (Uroxatral)
silodosin (Rapaflo)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Androgen Receptor Blockers




Block the activity of androgen hormones at
target tissue (prostate) receptors
flutamide (Eulexin)
nilutamide (Nilandron)
bicalutamide (Casodex)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Gn-RH Analogs




Used to treat prostate cancer
goserelin (Zoladex)
leuprolide (Lupron)
triptorelin (Trelstar)
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10
Drugs to Treat Erectile Dysfunction

sildenafil (Viagra)




First oral drug for treatment of ED
vardenafil (Levitra)
tadalafil (Cialis)
alprostadil (Caverject)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
11
Classroom Response 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?
A.
Transdermal nitroglycerin
B.
Hydrochlorothiazide
C.
Potassium
D.
Multivitamin with iron
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Men’s Health Drugs: Indications


Primary use: replacement therapy
Other uses vary with the specific drug
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Men’s Health Drugs:
Adverse Effects


Androgens cause fluid retention
Anabolic steroids


Peliosis of the liver, other severe hepatic effects
Many other effects
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Classroom Response Question
When assessing a patient taking testosterone,
which laboratory value is most important for the
nurse to review?
A.
Hemoglobin A1C
B.
Triglycerides
C.
Potassium
D.
Lactate dehydrogenase (LDH)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
15
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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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
• May cause serious adverse effects
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Herbal Products:
Saw Palmetto



Serenoa repens, Sabal serrulata
Used for treatment of BPH and alopecia
Adverse effects




GI upset
Headache
Back pain
Dysuria
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Classroom Response 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?
A. Calcium with vitamin D
B. acetaminophen (Tylenol)
C. St. John’s wort
D. ibuprofen (Motrin)
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Nursing Implications


Assessment should include complete history,
including medication history, urinary elimination
problems, potential contraindications
Obtain baseline vital signs, weight, height,
serum electrolyte levels
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Nursing Implications (cont’d)



Assess renal and liver function
Assess PSA level and perform digital rectal
examination (DRE) before beginning any drugs
for treatment of prostate disease
Assess current medications for potential
interactions
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Nursing Implications (cont’d)



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
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Nursing Implications (cont’d)




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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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