1. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Chapter 35
Men’s Health Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

2. Copyright © 2014 by Mosby, an imprint 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
Stimulates the production of blood cells
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

3. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Androgens (cont’d)
Several synthetic derivatives of testosterone are available
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

4. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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)
oxandrolone (Oxandrin)
nandrolone (Deca-Durabolin)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

5. 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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

6. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Androgen Inhibitors
5-Alpha-reductase inhibitors
Alpha1-adrenergic blockers
Androgen receptor blockers
Gonadotropin-releasing hormone (Gn-RH) analogs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

7. 5-Alpha-Reductase Inhibitors
Finasteride (Proscar) and dutasteride (Avodart)
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

8. Alpha1-Adrenergic Blockers
Used for symptomatic relief of obstruction caused by BPH
doxazosin (Cardura)
tamsulosin (Flomax)
terazosin (Hytrin)
alfuzosin (Uroxatral)
silodosin (Rapaflo)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

9. Androgen Receptor Blockers
Block the activity of androgen hormones at target tissue (prostate) receptors
flutamide (Eulexin)
nilutamide (Nilandron)
bicalutamide (Casodex)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

10. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Gn-RH Analogs
Used to treat prostate cancer
goserelin (Zoladex)
leuprolide (Lupron)
triptorelin (Trelstar)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

11. Drugs to Treat Erectile Dysfunction
sildenafil (Viagra)
First oral drug for treatment of ED
vardenafil (Levitra)
tadalafil (Cialis)
alprostadil (Caverject)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

12. Classroom Response Question
A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil?
Transdermal nitroglycerin
Hydrochlorothiazide
Potassium
Multivitamin with iron
Correct answer: A
Rationale: Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

13. Men’s Health Drugs: Indications
Primary use: replacement therapy
Other uses vary with the specific drug
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

14. Men’s Health Drugs: Adverse Effects
Androgens cause fluid retention
Anabolic steroids
Peliosis of the liver, other severe hepatic effects
Many other effects
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

15. Classroom Response Question
When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review?
Hemoglobin A1C
Triglycerides
Potassium
Lactate dehydrogenase (LDH)
Correct answer: D
Rationale: Assess the patient for liver disease because formation of blood-filled cavities may occur. This condition, also called peliosis, is associated with long-term therapy and may be life-threatening. Perform liver function studies (e.g., LDH, CPK, and bilirubin levels) as ordered to monitor for the possible adverse effect of abnormal liver function and jaundice.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

16. 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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

17. 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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

18. Herbal Products: Saw Palmetto
Serenoa repens, Sabal serrulata
Used for treatment of BPH and alopecia
Adverse effects
GI upset
Headache
Back pain
Dysuria
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

19. Classroom Response Question
A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse?
Calcium with vitamin D
acetaminophen (Tylenol)
St. John’s wort
ibuprofen (Motrin)
Correct answer: D
Rationale: The nurse should be most concerned about concurrent use of saw palmetto with the NSAID ibuprofen (Motrin) because of the potential for drug interactions.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

20. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Nursing Implications
Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications
Obtain baseline vital signs, weight, height, serum electrolyte levels
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

21. Nursing Implications (cont’d)
Assess renal and liver function
Assess PSA level and perform digital rectal examination (DRE) before beginning any drugs for treatment of prostate disease
Assess current medications for potential interactions
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

22. Nursing Implications (cont’d)
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

23. Nursing Implications (cont’d)
Pregnant women should not touch crushed or broken hormone drugs
Educate patients on proper administration techniques for each drug
Monitor for therapeutic responses
Monitor for adverse effects
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.