Download testosterone buccal system, mucoadhesive - DavisPlus

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Use Cautiously in: Pre-existing cardiac, renal, or liver disease; Sleep apnea; Obe-
testosterone buccal system, mucoadhesive
(tess-toss-te-rone buhk-uhl)
sity; Chronic lung disease; Geriatric patients (qrisk of prostatic hyperplasia/carcinoma); Males ⬍18 yr (safety and effectiveness not established).
Adverse Reactions/Side Effects
CNS: anxiety, fatigue, headache. CV: edema. GI: abdominal cramps, bitter taste,
Striant
Classification
Therapeutic: hormones
Pharmacologic: androgens
Schedule III
Pregnancy Category X
gingivitis, gum edema, gum tenderness, liver function test elevation, nausea, taste
perversion, vomiting. GU: priapism, prostatic enlargement. Endo: acne, gynecomastia, hypercholesterolemia.
Interactions
Drug-Drug: Mayqaction of oral hypoglycemic agents andinsulin. Concurrent
use with corticosteroids mayqrisk of edema formation.
Indications
Route/Dosage
Hypogonadism in androgen-deficient men.
Buccal (Adults): Replacement therapy— 30 mg (one system) applied to gum region twice daily (in morning and evening, spaced 12 hr apart).
Action
Responsible for the normal growth and development of male sex organs. Maintenance of male secondary sex characteristics: Growth and maturation of the prostate,
seminal vesicles, penis, scrotum, Development of male hair distribution, Vocal cord
thickening, Alterations in body musculature and fat distribution. Therapeutic Effects: Correction of hormone deficiency in male hypogonadism.
NURSING IMPLICATIONS
Assessment
● Monitor intake and output ratios, weigh patient twice weekly, and assess patient
for edema. Report significant changes indicative of fluid retention.
● Monitor for breast enlargement, persistent erections, and increased urge to uri-
nate in men. Monitor for difficulty urinating in elderly men, because prostate enlargement may occur.
Lab Test Considerations: Monitor hemoglobin and hematocrit periodically
during therapy; may cause polycythemia.
Monitor hepatic function tests, prostate specific antigen, and serum cholesterol
levels periodically during therapy. Mayqserum AST, ALT, and bilirubin,qcholesterol levels, and suppress clotting factors II, V, VII, and X.
Monitor blood glucose closely in patients with diabetes who are receiving oral hypoglycemic agents or insulin.
Monitor serum testosterone concentrations 4– 12 wk after starting therapy.
Pharmacokinetics
Absorption: Well absorbed through buccal mucosa.
Distribution: Crosses the placenta.
Protein Binding: 98%.
Metabolism and Excretion: Metabolized by the liver. Absorption from buccal
●
mucosa bypasses initial liver metabolism. 90% eliminated in urine as metabolites.
Half-life: 10– 100 min.
TIME/ACTION PROFILE (androgenic effects†)
●
ROUTE
DURATION
●
12 hr
Potential Nursing Diagnoses
ONSET
PEAK
Buccal
unknown
10–12 hr
†Response is highly variable among individuals; may take months
Sexual dysfunction (Indications) (Side Effects)
Contraindications/Precautions
Contraindicated in: Hypersensitivity; OB: Pregnancy and lactation; Male patients
with breast or prostate cancer; Women.
⫽ Canadian drug name.
●
Implementation
● Buccal: Apply to gum region twice daily (about 12 hr apart), rotating sides with
each dose.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Patient/Family Teaching
● Advise patient to report the following signs and symptoms promptly: priapism
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(sustained and often painful erections), difficulty urinating, breathing problems,
gynecomastia, edema (unexpected weight gain, swelling of feet), hepatitis (yellowing of skin or eyes and abdominal pain), or unusual bleeding or bruising.
Explain rationale for prohibiting use of testosterone for increasing athletic performance. Testosterone is neither safe nor effective for this use and has a potential
risk of serious side effects.
Advise diabetic patients to monitor blood closely for alterations in blood glucose
concentrations.
Emphasize the importance of regular follow-up physical exams and lab tests to
monitor progress.
Buccal: Instruct patient to place the rounded side surface of the buccal system in a
comfortable position against the gum just above incisor tooth. Hold the system
firmly in place with a finger over the lip and against the product for 30 seconds to
ensure adhesion. Buccal system is designed to stay in position until removed. If it
fails to adhere to the gum or falls off within the first 8 hr after application, remove
original system and apply a new one (this counts as replacing the first dose; apply
the next system 12 hr after the original system was applied). If the buccal system
falls off after 8 hr but before 12 hr, replace the original system (this replacement
can serve as the second dose for that day).
Advise patient to avoid dislodging buccal system and to check on placement after
toothbrushing, use of mouthwash, eating or drinking. Do not chew or swallow
buccal system. To remove, slide system downwards from gum toward tooth to
avoid scratching the gum.
Evaluation/Desired Outcomes
● Resolution of the signs of androgen deficiency without side effects.
Why was this drug prescribed for your patient?
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