CHAPTER 35 Men’s Health Drugs

Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Androgens

 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 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Androgens (cont’d)

 Several synthetic derivatives of testosterone  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 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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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)  stanozolol (Winstrol)  oxandrolone (Oxandrin)  nandrolone (Deca-Durabolin) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Androgens: Mechanism of Action

 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 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Androgen Inhibitors

 5-Alpha-reductase inhibitors   Alpha 1 -adrenergic blockers Androgen receptor blockers  Gonadotropin-releasing hormone (Gn-RH) analogs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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5-Alpha-Reductase Inhibitors

     Finasteride and dutasteride 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) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Alpha

1

-Adrenergic Blockers

 Used for symptomatic relief of obstruction caused by BPH  doxazosin (Cardura)  tamsulosin (Flomax)  terazosin (Hytrin)  alfuzosin (Uroxatral) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Androgen Receptor Blockers

 Block the activity of androgen hormones at target tissue (prostate) receptors  flutamide  nilutamide  bicalutamide Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Gn-RH Analogs

 Gonadotropin-releasing hormone analogs  Used to treat prostate cancer  Goserelin  Leuprolide  Triptorelin Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Drugs to Treat Erectile Dysfunction

 sildenafil (Viagra)  First oral drug for treatment of ED  vardenafil (Levitra)  tadalafil (Cialis) Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Men’s Health Drugs: Indications

 Primary use: replacement therapy  Other uses vary with the specific drug Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Men’s Health Drugs: Adverse Effects

 Androgens cause fluid retention  Anabolic steroids  Peliosis of the liver, other severe hepatic effects  Many other effects Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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

 5-alpha-reductase inhibitors  Loss of libido, loss of erection, ejaculatory dysfunction, other effects  May cause PSA concentrations to decrease Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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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 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Herbal Products: Saw Palmetto



Serenoa repens, sabal serrulata

 Used for treatment of BPH and alopecia  Adverse effects  GI upset  Headache  Back pain  Dysuria Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Nursing Implications

 Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications  Obtain baseline vital signs, weight, height, serum electrolyte levels Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Nursing Implications (cont’d)

 Assess renal and liver function  Assess PSA level and perform digital rectal exam (DRE) before beginning any drugs for treatment of prostate disease  Assess current medications for potential interactions Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Nursing Implications (cont’d)

 IM testosterone should be given deeply — choose landmarks carefully  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 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Nursing Implications (cont’d)

 Pregnant women should not handle crushed or broken finasteride tablets  Educate patients on proper administration techniques for each drug  Monitor for therapeutic responses  Monitor for adverse effects Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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