Drugs for Disorders and Conditions of the Male Reproductive System

Hypothalamus and Pituitary Regulation of Male Reproductive System Gonadotropin releasing hormone (GRH) Pituitary: Follicle stimulating hormone (FSH) Luteinizing hormone (LH)

Anabolic Steriods Testosterone-like compounds Frequently abused by athletes, even though illegal Schedule III drugs Can result in serious adverse effects with long-term use Increased cholesterol levels, low sperm count, impotence, liver damage Menstrual irregularities and the appearance of male characteristics in women Aggression, psychological dependence

Male Infertility Rule out psychologic etiology Goal of pharmacology is to increase sperm production IM injections to increase testosterone secretion and spermatogenesis.

Erectile Dysfunction Etiology: Vascular diseases Certain medications Thiazide diuretics, beta blockers, selective serotonin reuptake inhibitors (SSRI)s, antidepressants Psychogenic causes Depression, fatigue, guilt, fear of failure *GOAL –patient and partner achieve satisfactory sexual relationship Sildenafil (Viagra): does not cause erection; enhances it Vardenafil (Levitra): faster onset, slightly longer duration than Viagra Tadalafil (Cialis): acts within 30 minutes and lasts 24–36 hours

Benign Prostatic Hyperplasia (BPH) Enlargement of prostate Not precursor to cancer Symptoms: Increased urinary frequency, urgency Post void leakage, nocturia, decreased force of urine stream Incomplete emptying of bladder

Finasteride (Proscar) Prototype Drugs Testosterone Sildenafil (Viagra) Finasteride (Proscar)

Testosterone Primary therapeutic use is for treatment of delayed puberty and hypogonadism in males. Adverse Effects: masculinity (high concern when being used by women), salt and water retention, edema, acne and skin irritation. Extreme doses in men (anabolic steroid abuse) may cause feminization rather then masculinity because excess testosterone is metabolized to estrogen.

Sildenafil (Viagra) Relaxing smooth muscles in corpora cavernosa, allowing increased blood flow. Onset of action <1 hour, lasting for up to 4 hours. Adverse Effects: HA, dizziness, flushing, rash, nasal congestion Most serious: hypotension in patients concurrently taking nitrates for angina and can result in MI and sudden cardiac death. Priapism –erection lasting longer than 6 hours.

Finasteride (Proscar) Inhibits enzyme responsible for converting testosterone to metabolite, causing growth of prostate cells and promotes enlargement of the gland. Adverse Effects: causes various types of sexual dysfunction including impotence, impaired fertility, diminished libido, and ejaculatory dysfunction.

Monitor client’s condition Provide client education Role of Nurse Monitor client’s condition Provide client education Obtain medical, surgical, drug history Assess lifestyle and dietary habits Obtain description of symptomology and current therapies

Androgen Therapy for Hypogonadism Assess impaired sexual functioning and diminished libido Note physical signs of decreased hormone production Decreased or absent body hair, small testes, delayed signs of puberty Monitor emotional status Monitor lab results, especially liver enzymes Monitor serum cholesterol, especially with history of MI or angina Drug can increase this lab value

Pharmacotherapy in Erectile Dysfunction Therapy Obtain physical exam and history Impaired sexual function Cardiovascular disease Presence of emotional disturbances

Pharmacotherapy in Erectile Dysfunction Therapy Obtain testosterone, prolactin, thyroxin levels Nocturnal penile tumescence and rigidity (NPTR) test may be ordered A blood-flow test used to determine if sufficient blood flow to penis Sildenafil, vardenafil, and tadalafil contraindicated with use of organic nitrates and alpha-adrenergic blockers

Drug Therapy with Antiprostatic Agents for BPH Assess for changes in urinary elimination Urine retention, nocturia, dribbling Difficulty starting urinary stream, frequency, urgency Monitor for hypotension (first-dose phenomenon) and throughout treatment Alpha-blockers should be used cautiously in clients with asthma or heart failure Cause bradycardia and bronchoconstriction

Drug Therapy with Antiprostatic Agents for BPH Monitor emotional status of clients taking alpha-blockers Depression common side effect May take 6–12 months of treatment before maximum benefit achieved Monitor for impotence, decreased volume of ejaculate, or decreased libido