Exam 8: Reproductive System; Drugs that Effect Men's Health
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| Androgens | Group of male sex hormones (primarily testosterone) that medicate the normal development and maintenance of male characteristics through androgenic activity.
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| Androgens: Actions | Responsible for the normal growth and development of male sex organs.
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| Androgens: Secondary Sex Characteristics | Growth and maturation of the prostate, seminal vesicles, penis and scrotum.
Development of male hair distribution
Laryngeal enlargement and thickening of the vocal cords
Alterations in body musculature and fat distribution
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| Androgens: Category; Androgens (Hormones) | testosterone cypionate (Depo-Testosterone)
testosterone enanthate (Delatestryl)
testosterone transdermal
Testoderm
Androderm
AndroGel
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| Androgens: Indications | Hypogonadism in androgen-deficient men
Delayed puberty in men
Inoperable breast cancer
Androgen-responsive breast cancer in post-menopausal women (palliative)
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| Androgens: Contraindications |
Hypersensitivity.
Pregnancy and lactation.
Male patients with breast or prostate cancer.
Severe liver, renal, or cardiac disease.
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| Androgens: Precautions | Diabetes mellitus.
Coronary artery disease (enanthate).
Benign prostatic hyperplasia (cypionate, pellets).
Hypercalcemia (cypionate, enanthate, pellets).
Sleep apnea (buccal).
Obesity (buccal).
Chronic lung disease (buccal).
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| Androgens: Adverse Effects | CNS: anxiety, confusion, depression, fatigue, headache, vertigo
EENT: deepening of voice
CV: Fluid retention, edema
GI
Peliosis of the liver (blood filled cavities)
Abdominal cramps, changes in appetite, drug-induced hepatitis, nausea, vomiting
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| Androgens: Interactions | May ↑action of warfarin, oral hypoglycemic agents, and insulin.
Concurrent use with corticosteroids may ↑risk of edema formation.
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| Androgens: Nursing Assessment | Monitor intake and output ratios, weigh patient twice weekly, and assess patient for edema. Report significant changes indicative of fluid retention.
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| Androgens: Nursing Assessment (Men) | Bone age determinations should be measured every 6 months to determine rate of bone maturation and effects on epiphyseal closure.
Monitor for difficulty urinating in elderly men, because prostate enlargement may occur.
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| Androgens: nursing Assessment (Women) | Assess for virilism (deepening of voice, unusual hair growth or loss, clitoral enlargement, acne, menstrual irregularity)
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| Androgens: Lab Tests | Monitor hemoglobin and hematocrit periodically during therapy; may cause polycythemia.
Monitor hepatic function tests, prostate specific antigen and serum cholesterol levels periodically during therapy.
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| Androgens: Implementation (IM) | testosterone cypionate (Depo-Testosterone)
Administer IM deep into gluteal muscle every 2-4 weeks
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| Androgens: Implementation (SQ) | pellets are to be implanted subcutaneously by a health care professional
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| Androgens: Implementation (Transdermal); Androderm | Apply patch to clean, dry, hairless skin on the back, abdomen, upper arms, or thighs.
Do not apply to the scrotum
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| Androgens: Implementation (Transdermal); Testoderm | Applied only to clean, dry, hairless scrotal skin
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| Androgens: Implementation (Transdermal); Androgel | Applied to shoulder, arms, or abdominal skin
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| Androgens: Implementation (Transdermal); Buccal | apply to gum region twice daily (about 12 hr apart), rotating sides with each dose
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| Androgens: Evaluation | Resolution of the signs of androgen deficiency without side effects.
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| Androgens: Evaluation (Women) | Decrease in the size and spread of breast malignancy in postmenopausal women. In antineoplastic therapy, response may require 3 months of therapy; if signs of disease progression appear, therapy should be discontinued.
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| Phosphodiesterase Type-5 Inhibitors (Action) | Inhibits the enzyme phosphodiesterase type 5 (PDE5), PDE5 inactivates cGMP.
Enhances effects of nitric oxide released during sexual stimulation.
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| Phosphodiesterase Type-5 Inhibitors (Use) | Erectile dysfunction
sildenafil (Revatio): pulmonary hypertension
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| Phosphodiesterase Type-5 Inhibitors (Category) | Erectile Dysfunction Agents
sildenafil (Revatio, Viagra)
tadalafil (Cialis)
vardenafil (Levitra)
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| Phosphodiesterase Type-5 Inhibitors (Contraindication) | Hypersensitivity
Concurrent organic nitrate therapy (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate), ritonavir, ketoconazole and itraconazole
Pulmonary veno-occlusive disease
Newborns, women, children
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| Phosphodiesterase Type-5 Inhibitors (precautions) | Serious underlying cardiovascular disease
History of CHF
Coronary artery disease
Uncontrolled hypertension (BP >170/110 mmHg) or hypotension (BP <90/50 mmHg)
Dehydration
May ↑risk of bleeding with warfarin
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| Phosphodiesterase Type-5 Inhibitors (Adverse Effects) | CNS: headache
EENT: abnormal vision
CV: chest pain, hypotension or HTN, MI
GI: dyspepsia
Derm: flushing
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| Phosphodiesterase Type-5 Inhibitors (INteractions) | ↑risk of severe hypotension with nitrates such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate
Increased risk of hypotension with antihypertensives (especially alpha-blockers) or substantial alcohol
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| Phosphodiesterase Type-5 Inhibitors (Assessment) | Conduct medication reconciliation of all prescription and over the counter medication
Revatio: monitor hemodynamic parameters and exercise tolerance prior to and periodically during therapy
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| Phosphodiesterase Type-5 Inhibitors (Implementation) | sildenafil (Viagra) / vardenafil (Levitra): administered 1 hr before sexual activity, no more than once a day
tadalafil (Cialis): administer at least 30 min prior to sexual activity, effectiveness may continue for 36 hours
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| Phosphodiesterase Type-5 Inhibitors (Implementation); Reatio | Dose for pulmonary hypertension is administered 3 times daily without regard to food
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| Phosphodiesterase Type-5 Inhibitors (Evaluation) | Male erection sufficient to allow intercourse
Revatio: increased exercise tolerance
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