Chapter 35 Men’s Health Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc

Chapter 35

Men’s Health Drugs

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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

Androgens

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

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

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)

Androgens (cont’d)


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

Androgens:Mechanism of Action


5-Alpha-reductase inhibitors Alpha1-adrenergic blockers Androgen receptor blockers Gonadotropin-releasing hormone (Gn-RH)

analogs

Androgen 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)

5-Alpha-Reductase Inhibitors


Used for symptomatic relief of obstruction caused by BPH

doxazosin (Cardura) tamsulosin (Flomax) terazosin (Hytrin) alfuzosin (Uroxatral) silodosin (Rapaflo)

Alpha1-Adrenergic Blockers


Block the activity of androgen hormones at target tissue (prostate) receptors

flutamide (Eulexin) nilutamide (Nilandron) bicalutamide (Casodex)

Androgen Receptor Blockers


Used to treat prostate cancer goserelin (Zoladex) leuprolide (Lupron) triptorelin (Trelstar)

Gn-RH Analogs


sildenafil (Viagra) First oral drug for treatment of ED

vardenafil (Levitra) tadalafil (Cialis) alprostadil (Caverject)

Drugs to Treat Erectile Dysfunction


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 nitroglycerinB. HydrochlorothiazideC. PotassiumD. Multivitamin with iron


Primary use: replacement therapy Other uses vary with the specific drug

Men’s Health Drugs: Indications


Androgens cause fluid retention Anabolic steroids

Peliosis of the liver, other severe hepatic effects Many other effects

Men’s Health Drugs:Adverse Effects



When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review?A. Hemoglobin A1CB. TriglyceridesC. PotassiumD. Lactate dehydrogenase (LDH)


5-Alpha-reductase inhibitors Loss of libido, loss of erection, ejaculatory

dysfunction, other effects May cause PSA concentrations to decrease

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

Men’s Health Drugs:Adverse Effects (cont’d)


Serenoa repens, Sabal serrulata Used for treatment of BPH and alopecia Adverse effects

GI upset Headache Back pain Dysuria

Herbal Products:Saw Palmetto



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 DB. acetaminophen (Tylenol)C. St. John’s wortD. ibuprofen (Motrin)


Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications

Obtain baseline vital signs, weight, height, serum electrolyte levels

Nursing Implications


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

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



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



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Chapter 35 Men’s Health Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc