men’s health drugs

7/30/2019 Mens Health Drugs

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Mens Health Drugs

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Androgens

Produced by the testes, ovaries, and

adrenal cortex

Group of male sex hormones Major endogenous androgen is

testosterone

Primary clinical application is

management of androgen deficiency in

males

Principal adverse effects are virilization

and hepatotoxicity 2


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Androgens

Testosterone

Responsible for normal development and

maintenance of primary and secondarymale sex characteristics

Development of bone and muscle tissue

Inhibition of protein catabolism (metabolic

breakdown)

Retention of various electrolytes

Erythropoietic effect

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Androgens & other Drugs

Several synthetic derivatives of

testosterone

Oral forms have a high first-pass effect Transdermal forms available

Patches and gel

Injectible: testosterone cypionate [Depo-testosterone]

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Testosterone

Biosynthesis and secretion Males: testosterone

Females: preandrogens Effects on sex characteristics in males

Pubertal transformation

Spermatogenesis

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Testosterone

Effects on sex characteristics in females Clitoral growth

Anabolic effects Skeletal muscle

Erythropoietic effects Synthesis of erythropoietin

Men have greater hematocrit than women

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Androgens

Anabolic steroids

Synthetic derivatives of testosterone

Anabolic activity: synthesis of tissue andincreasing tissue formation

Schedule III, great potential for misuse by

athletes

Abuse by athletes: growing problem Dosage up to 30 therapeutic dose

Serious and some irreversible side effects

Use banned by all major athletic associations7


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Androgen [Anabolic Steroid]

Abuse by Athletes Many athletes use to enhance athletic performance

Significant risks

Hypertension, suppression of release of LH and

FSH, testicular shrinkage, sterility, gynecomastia,acne, reduction in HDL and increase in LDL

Hepatotoxicity with 17-alpha-alkylated compounds

Renal damage

Psychologic effects Mentally healthy: minimal impact

Psychologically unbalanced: could intensify

aggression

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Anabolic Steroids: End -lone

oxymetholone (Anadrol-50)

oxandrolone (Oxandrin)

nandrolone (Deca-Durabolin)

stanozolol (Winstrol)

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Indications

Approved

Anemia

Hereditary

angioedema Metastatic breast

cancer

Male hypogonadism

Replacementtherapy

Delayed puberty

Replacement

therapy in

menopausal women

Unlabeled [non-FDA

approved]

HIV-associated

wasting syndrome

[oxandrolone]

Alcoholic hepatitis

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Androgens:

Mechanism of Action Effects are similar to the bodys

endogenous androgens

Stimulation of normal growth anddevelopment of the male sex organs

Development and maintenance of malesecondary sex characteristics

Stimulate increased synthesis of bodyproteins, aiding in the formation ofmuscular and skeletal proteins

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Drugs for Treatment of BPH-

Androgen Inhibitors 5-alpha reductase inhibitors: end -

ride

Finasteride (Proscar)-Prototype Dutasteride (Avodart, Duagen)

Alpha-adrenergic blocking agents:

end losin/zosin Tamsulosin (Flomax)

Doxazosin (Cardura)

Terazosin (Hytrin)

Alfuzosin (Uroxatrel)

Silodosin [Rapaflo] 13


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5-Alpha-Reductase Inhibitors

Finasteride and dutasteride Block the effects of endogenous androgens

Inhibits enzyme 5-alpha reductase which

converts testosterone to 5-alphadihydrotestosterone

Used to treat benign prostatic hyperplasia(BPH)

Lowers prostatic DHT concentrations:Reduce size of prostate and results inalleviation of symptoms of BPH

Easierpassage of urine 14


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5-Alpha-Reductase Inhibitors:

Finasteride [Proscar]Prevents thinning of hair-Increased hair

growth noted [treat male-pattern baldness

as Propecia]-Male onlyWomen: teratogenic [pregnancy] & not

recommended for any age

Women must wear gloves when handling

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Drug Therapy

Antiandrogen agents (5-alpha-

reductase inhibitors (5-ARI) : finasteride

(Proscar), dutaseride (Avodart) Lower level of dihydrotesterone (DHT)

Take for 6 months before improvement

noted S/E: ED, decreased libido, gynecomastia,

flushing

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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]- Preg. B

Clinical effects of prostate shrinkage

immediately

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Drug Therapy

Alpha-adrenergic blockers Relax smooth muscle of bladder neck

sphincter/prostate

tamulosin (Flomax), alfuzosin (Uroxatral): Constricts prostate gland: reduces uretheal

pressure & improves urine flow

terazosin (Hytrin), doxazosin (Cardura):

used for pt w/BPH & HTN ALPHA BLOCKERS: **MUST MONITOR BP

(INPATIENT SETTING)

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Androgen Receptor Blockers

Block the activity of androgen hormones

at target tissue (prostate) receptors

Use: prostate Ca

Agents: endmide/tamide

flutamide [Eulexin, Apo-flutaminde]-Preg D

nilutamide [Nilandron]

Bicalutamide [Casodex]

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Gn-RH Analogs

Gonadotropin-releasing hormone

analogs

Action: inhibits secretion of primary

gonadotropin which leads to decreasein testosterone production

Used to treat prostate cancer

Agents

Goserelin [Zoladex]

Leuprolide [Lupron]

Triptorelin [Trelstar] 20


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Drugs Used to Treat Erectile

Dysfunction [ED]

Pharmacologic agents for sexual

dysfunction

Phosphodiesterase inhibitors: endnafil/fil

Sildenafil citrate (Viagra)-prototype

Vardenafil (Levitra)

Tadalafil (Cialis) Others used:

Apomorphine (Uprima)

Phentolamine (Vasomax)

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Mechanism of Action

Inhibiting the action of the enzyme

phosphodiesterase

Cialis & Levitra have similar action &longer duration of action

Tadalafil [Cialis]- The Weekender

Do not eat fatty foods

No Etoh in excess

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Pharmacologic Therapy

Sildenafil (Viagra) PO Take 1 hour before sex & no more than once

Vardenafil (Levitra) PO Take 1 hour before intercourse

Peak action: 30 to 120 minutes

Recommended frequency: 10 mg in 24 hrs

Tadalafil(Cialis) The WeekenderPO Take before sexual activity

Effect peaks at 30 min to 6 hours

May last 36 hrs.23


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Recommended Administration

Sexual stimulation is required for an

erection to occur.

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Other Pharmacologic Measures

Injecting vasoactive agents

directly into penis: alprostadil

(Caverject), papaverine,phentolamine (Vasomax)

Complications:

Priapism

Fibrotic plaques at injection sites

Alprostadil suppository

Gel pellet inserted into urethra to

create an erection 25


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Other Options

intraurethral inserts:Tablets (Muse)

self-injection of theerectile tissues with amedication thatimproves penile bloodflow, such as

Pros tagland in E-1:alprostadil (Caverjector Edex).

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Contraindication [HH]

Do not take if you are taking nitrate

medications such as nitroglycerine (eg,

Nitrobid) or isosorbide mononitrate (eg,

Imdur).Do not take if you have high uncontrolled

blood pressure, coronary artery disease, or

have had a heart attack within the past 6

months.

Do not take if you have been diagnosed

with a cardiac dysrhythmia or kidney or

liver dysfunction. 27


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Adverse Effects

Drugs for erectile dysfunction

Headache, flushing, dyspepsia, chest pain

hypotension Priapism

Unexplained visual loss

In men with preexisting cardiovasculardisease, especially those taking nitrates

Lower BP substantially

May cause serious adverse effects

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Interactions

Androgens: oral anticoagulants, oral

hypoglycemics [enhance effect]

ED: severe hypotension [nitrate use]

Alpha-blockers: additive effect

hypotension with other BP lowering

drugs

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Herbal Products:

Saw Palmetto

Serenoa repens, sabal serrulata

Used for treatment of BPH and alopecia

Must check with HCP before taking

Can interfere with prescription medications

Cannot use w i th medicat ions conta in ing estrogen

(saw palmetto)

Adverse effects

GI upset

Headache

Back pain

Dysuria 30


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Nursing Implications

Assessment should include complete

history, including medication history,

urinary elimination problems, potentialcontraindications

Obtain baseline vital signs, weight,

height, serum electrolyte levels

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Assess renal and liver function

Assess PSA level and perform digital

rectal exam (DRE) before beginning anydrugs for treatment of prostate disease

Assess current medications for potential

interactions

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IM testosterone should be givendeeplychoose landmarks carefully

Follow exact instructions for SL, buccal,

and PO forms Transdermal Testoderm patches are

applied to the scrotal skin

Transdermal Androderm patches areapplied to the skin on the body, neverto

scrotal skin

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Pregnant women should not handle

crushed or broken finasteride tablets

Establish baseline LFTs w/finasteride Educate patients on proper

administration techniques for each drug

Monitor for therapeutic responses

Monitor for adverse effects

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Patient Teaching

Finesteride-Protect from light or heat

Instruct about potential side effects if on

an ED drug: dizziness, heartburn &

hypotension esp. on a nitrate

Instruct with ED drugs that they are not

effective if no sexual stimulation occurs

Reinforce f/u appt. if on testosterone

Instruct to seek immediate attention if

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Patient Teaching

Instruct that testosterone should not be

abruptly stopped-must be weaned over

several weeks

Testoderm patch: place on clean, dry

scrotal skin that has been shaved;

replace every 22-24 hours as ordered

Androderm patch: place on clean, dry

skin on back, abd, upper arms or thighs.

AVOID scrotal or bony areas. Change

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