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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Drugs Affecting the Male Reproductive System Chapter 41

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Page 1: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drugs Affecting the Male Reproductive System

Drugs Affecting the Male Reproductive System

Chapter 41

Page 2: Ppt 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

Page 3: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sites of Action for Drugs Affecting the Male Reproductive System

Sites of Action for Drugs Affecting the Male Reproductive System

Page 4: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 5: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 6: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 7: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 8: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 9: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 10: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alternative Therapies Used to Enhance Athletic Performance

Alternative Therapies Used to Enhance Athletic Performance

Page 11: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.

Page 12: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

False

Rationale: Androgens are male sex hormones and include testosterone produced in the testes, and the androgens

produced in the adrenal glands.

Page 13: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 14: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 15: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 16: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 17: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anabolic Steroids (cont.)Anabolic Steroids (cont.)

• Drug-to-Drug Interactions

– Oral anticoagulants

– Antidiabetic medications

Page 18: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 19: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 20: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 21: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 22: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 23: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.

Page 24: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Use of Drugs Affecting the Male Reproductive System Across the Lifespan

Use of Drugs Affecting the Male Reproductive System Across the Lifespan

Page 25: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype AndrogenPrototype Androgen

Page 26: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype Androgen (Continued)Prototype Androgen (Continued)

Page 27: Ppt chapter 41

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Prototype Anabolic Steroids Prototype Anabolic Steroids

Page 28: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype Drugs for Treatment of Erectile Dysfunction

Prototype Drugs for Treatment of Erectile Dysfunction

Page 29: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Considerations for AndrogensNursing Considerations for Androgens

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation

Page 30: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Considerations for Anabolic Steroids

Nursing Considerations for Anabolic Steroids

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation

Page 31: Ppt chapter 41

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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