ppt chapter 41
TRANSCRIPT
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Drugs Affecting the Male Reproductive System
Drugs Affecting the Male Reproductive System
Chapter 41
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drugs Used to Affect the Male Reproductive System
Drugs Used to Affect the Male Reproductive System
• Male Steroid Hormones or Androgens
– Act like testosterone
– Development of male sexual characteristics
• Male Sex Hormone or Anabolic Steroids
– Synthetic testosterone preparations that have more anabolic effects than androgenic effects
– Tissue building
• Drugs to Improve Penile Dysfunction
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Sites of Action for Drugs Affecting the Male Reproductive System
Sites of Action for Drugs Affecting the Male Reproductive System
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Signs and Symptoms of Adverse Effects of Androgens/Anabolic Steroids
Signs and Symptoms of Adverse Effects of Androgens/Anabolic Steroids
• Swelling in fingers or legs
• Continual erection
• Uncontrollable sex drive
• Yellowing skin
• Fever, chills, or rash
• Chest pain or difficulty breathing
• Hoarseness
• Loss of hair or growth of facial hair in women
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Androgens and Their IndicationsAndrogens and Their Indications
• Testosterone (Duratest, Testoderm, others)
– Hypogonadism; breast cancer
• Danazol (Danocrine)
– Block the release of FSH and LH in women
• Fluoxymesterone (Halotestin)
– Hypogonadism; breast cancer
• Testolactone (Teslac)
– Breast cancers
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AndrogensAndrogens
• Actions
– Increase the retention of nitrogen, sodium, potassium
– Decrease the urinary excretion of calcium
– Increase protein anabolism
– Decrease protein catabolism
– Increase the production of red blood cells
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Androgens (cont.)Androgens (cont.)
• Pharmacokinetics
– Well absorbed and widely distributed throughout the body
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy
– Pregnancy and lactation
– Prostate or breast cancer in men
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Androgens (cont.)Androgens (cont.)• Caution
– Liver dysfunction or cardiovascular disease
• Indications
– Replacement therapy in hypogonadism and delayed puberty in males
– Inoperable breast cancer
– Prevention of ovulation to treat endometriosis
• Adverse Effects
– Acne, edema, hirsutism
– Deepening of the voice, oily skin and hair, weight gain, decreased breast size, testicular atrophy
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Androgens (cont.)Androgens (cont.)
• Adverse Effects (cont.)
– Flushing sweating, vaginitis, nervousness, and emotional labiality
– Headache, dizziness, sleep disorders, and altered electrolytes
• Drug Laboratory Test
– Thyroid function
– Creatinine
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Alternative Therapies Used to Enhance Athletic Performance
Alternative Therapies Used to Enhance Athletic Performance
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QuestionQuestion
Please answer the following statement as true or false.
Androgens are male sex hormones and include testosterone produced in the testes, and the androgens
which are produced in the posterior pituitary gland.
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AnswerAnswer
False
Rationale: Androgens are male sex hormones and include testosterone produced in the testes, and the androgens
produced in the adrenal glands.
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Anabolic Steroids and Their IndicationsAnabolic Steroids and Their Indications
• Oxandrolone (Oxandrin)
– Promote weight gain in debilitated patients
– Increase protein anabolism
– Treat certain cancers
• Oxymetholone (Anadrol-50)
– Treat various anemias
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Anabolic SteroidsAnabolic Steroids• Actions
– Promote body tissue-building processes
– Reverse catabolic or tissue-destroying processes
– Increase hemoglobin and red blood cell mass
• Indications
– Indications vary with each drug
– Treatment of anemias, certain cancers, and angioedema
– Promote weight gain and tissue repair
– Protein anabolism
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Anabolic Steroids (cont.)Anabolic Steroids (cont.)
• Pharmacokinetics
– Well absorbed and widely distributed throughout the body
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy and liver dysfunction
– Pregnancy and lactation
– Coronary disease
– Prostate or breast cancer in males
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Anabolic Steroids (cont.)Anabolic Steroids (cont.)
• Adverse Effects
– Cardiomyopathy
– Hepatic carcinoma
– Personality changes
– Sexual dysfunction
– Virilization
– Inhibition or testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido
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Anabolic Steroids (cont.)Anabolic Steroids (cont.)
• Drug-to-Drug Interactions
– Oral anticoagulants
– Antidiabetic medications
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Drugs Approved for the Treatment of Penile Erectile Dysfunction
Drugs Approved for the Treatment of Penile Erectile Dysfunction
• Alprostadil (Caverject, MUSE)
– Prostaglandin that relaxes vascular smooth muscle and allows filling of the corpus cavernosum when it is injected directly into the cavernosum
• Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra)
– Selectively inhibits phosphodiesterase type 5 receptors (PDE5) and increases nitrous oxide levels, allowing blood to flow into the corpus cavernosum
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Drugs for Treatment of Penile Erectile Dysfunction
Drugs for Treatment of Penile Erectile Dysfunction
• Actions
– Alprostadil: Injected and acts locally to relax vascular smooth muscle and promote blood flow into the corpus cavernosum causing penile erection.
– Inhibits PDE5 receptors, leading to a release of nitrous oxide, which activates cGMP to cause a prolonged smooth muscle relaxation, allowing the flow of blood into the corpus cavernosum and facilitating erection.
• Indications
– Treatment of erectile dysfunction in the presence of sexual stimulation
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Drugs for Treatment of Penile Erectile Dysfunction (cont.)
Drugs for Treatment of Penile Erectile Dysfunction (cont.)
• Pharmacokinetics
– Well absorbed, metabolized in the liver and excreted in the urine
• Contraindications
– Condition that might predispose to priapism
– Penile implants
– Use in women
• Caution
– Bleeding disorders, coronary artery disease, active peptic ulcer, retinitis pigmentosa, hypotension or severe hypertension, congenital prolonged Q T interval, or severe hepatic or renal disorders
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Drugs for Treatment of Penile Erectile Dysfunction (cont.)
Drugs for Treatment of Penile Erectile Dysfunction (cont.)
• Adverse Effects
– Edema, headache, dizziness, syncope, angina, dyspnea
• Drug-to-Drug Interactions
– PDE5 inhibitors combined with organic nitrates or alpha blockers
• Can cause dangerous cardiovascular effects, including death
• Careful patient teaching is essential
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QuestionQuestion
After six months of use what is the mean dose of Caverject?
A. 2.5 mcg
B. 10.3 mcg
C. 15.9 mcg
D. 20.7 mcg
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AnswerAnswer
D. 20.7 mcg
Rationale: Alprostadil (Caverject, MUSE): 2.5 mcg injected intracavernously, titrate the dose to one that will allow a satisfactory erection that is maintained no longer than 1 hr; mean dose after 6 mo is reported to be 20.7 mcg.
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Use of Drugs Affecting the Male Reproductive System Across the Lifespan
Use of Drugs Affecting the Male Reproductive System Across the Lifespan
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Prototype AndrogenPrototype Androgen
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Prototype Androgen (Continued)Prototype Androgen (Continued)
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Prototype Anabolic Steroids Prototype Anabolic Steroids
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Prototype Drugs for Treatment of Erectile Dysfunction
Prototype Drugs for Treatment of Erectile Dysfunction
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Nursing Considerations for AndrogensNursing Considerations for Androgens
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Nursing Considerations for Anabolic Steroids
Nursing Considerations for Anabolic Steroids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Nursing Considerations for Drugs Used in the Treatment of Erectile Dysfunction
Nursing Considerations for Drugs Used in the Treatment of Erectile Dysfunction
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation