Download Chapter 57 Drugs for Mens Health and Reproductive Disorders

Chapter 57
Drugs for Men’s Health and
Reproductive Disorders
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
1
Substances Related to Male
Reproductive Disorders

Androgens


Administration


Testosterone, main androgen
IM, well-absorbed
Indications


Hypogonadism
Delayed puberty in adolescents
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Androgens

Testosterone


Drug interactions
• Anticoagulants, barbiturates, phenytoin, corticosteroids
Lab interactions
• Decreases blood glucose in diabetics; increases
cholesterol, thyroid, liver function, hematocrit
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Androgens (Cont.)

Testosterone

Side effects
• Pripiasm
• Gynecomastia
• Spermatogenesis halted
• Oligospermia
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Androgens (Cont.)

Adverse reactions




Hypercalcemia
Virilization
Teratogenic effects
Hepatic carcinoma
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Androgens (Cont.)

Contraindications









Pregnancy
Nephrosis or nephrotic phase of nephritis
Hypercalcemia
Pituitary insufficiency
Hepatic dysfunction
BPH
Prostate cancer
History of myocardial infarction
Men with breast cancer
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Androgens (Cont.)

Caution








Hypertension
Hypercholesterolemia
CAD
Renal disease
Seizure disorder
Infants
Prepubertal children
Older men
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Anabolic Steroids



Also called anabolic-androgenic steroids
(AAS)
Class of steroid hormones related to the
hormone testosterone
They increase protein synthesis within cells,
which results in the buildup of cellular tissue
(anabolism), especially in muscles.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Testosterone Precursors





Androstenediol
Androstenedione
Dehydroepiandrosterone (DHEA)
Available as nutritional supplements
Health risks from long-term use: increased
LDL, decreased HDL, acne, high blood
pressure, liver damage, and dangerous
changes in the structure of the left ventricle of
the heart
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Other Steroids


Gonadotropin (hCG, Pregnyl, Novarel,
Ovidrel)
Tetrahydrogestrinone (THG)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Nursing Process: Androgens




Assessment
Nursing diagnoses
Planning
Nursing interventions



Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Antiandrogens



Leuprolide, ketoconazole, flutamide (Eulexin)
Use: Treatment of benign prostatic
hypertrophy, advanced prostatic cancer, and
as hormonal therapy in the treatment of
endometriosis
Other uses: Treatment of male pattern
baldness, acne, hirsutism, virilization
syndrome in women, and precocious puberty
in boys
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Drugs Used in Other Male
Reproductive Disorders

Developmental disorders


Delayed puberty


Undescended testes
• Associated with infertility, testicular cancer
Given Gn-RH, LH, or FSH therapy
Pituitary, thyroid, adrenal disorders

Given LH or FSH therapy
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Drugs Used in Other Male
Reproductive Disorders (Cont.)

Sexual dysfunction

Phosphodiesterase inhibitors
• Sildenafil citrate (Viagra)
• Vardenafil (Levitra)
• Tadalafil (Cialis)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Natural Products

Herbs used for sexual performance







Yohimbine
Ginseng
Damiana
Ginkgo biloba
Saw palmetto
Muira puama
Tribulus terrestris
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Drugs for Treatment of BPH

5-alpha reductase inhibitors



Finasteride (Proscar, Propecia)
Dutasteride (Avodart, Duagen)
Alpha-adrenergic blocking agents





Tamsulosin (Flomax)
Doxazosin (Cardura)
Terazosin (Hytrin)
Alfuzosin (Uroxatrel)
Silodosin (Rapaflo)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Practice Question #1
The nurse teaches a patient that sildenafil is
contraindicated for patients taking which
category of medications?
A.
B.
C.
D.
Sulfonylureas
Beta blockers
Nitrates
Proton pump inhibitors
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Practice Question #2
A patient is receiving androgen therapy for
hypogonadism. The nurse teaches the patient
to observe for common side effects of the drug,
including which of the following?
A.
B.
C.
D.
Abdominal pain and hives at injection site
Dry mouth and dizziness
Weight gain and blurred vision
Generalized rash
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Practice Question #3
The nurse should inform a woman undergoing
androgen therapy that she may develop which
symptom?
A.
B.
C.
D.
Impaired bone growth
Gynecomastia
Vocal changes
Priapism
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Practice Question #4
Which drug used in the treatment of benign
prostatic hypertrophy is most likely to cause
postural hypotension?
A.
B.
C.
D.
Alfuzosin (Uroxatral)
Dutasteride (Avodart)
Finasteride (Propecia)
Tadalafil (Cialis)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Practice Question #5
Before administering androgen therapy, it is
most important for the nurse to assess the
patient for
A.
B.
C.
D.
chronic obstructive pulmonary disease.
diabetes mellitus.
pregnancy.
a serum calcium of 8.0.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21