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M6 13-005

Exam 8: Reproductive System; Drugs that Effect Men's Health

Androgens Group of male sex hormones (primarily testosterone) that medicate the normal development and maintenance of male characteristics through androgenic activity.
Androgens: Actions Responsible for the normal growth and development of male sex organs.
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
Androgens: Category; Androgens (Hormones) testosterone cypionate (Depo-Testosterone) testosterone enanthate (Delatestryl) testosterone transdermal Testoderm Androderm AndroGel
Androgens: Indications Hypogonadism in androgen-deficient men Delayed puberty in men Inoperable breast cancer Androgen-responsive breast cancer in post-menopausal women (palliative)
Androgens: Contraindications Hypersensitivity. Pregnancy and lactation. Male patients with breast or prostate cancer. Severe liver, renal, or cardiac disease.
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).
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
Androgens: Interactions May ↑action of warfarin, oral hypoglycemic agents, and insulin. Concurrent use with corticosteroids may ↑risk of edema formation.
Androgens: Nursing Assessment Monitor intake and output ratios, weigh patient twice weekly, and assess patient for edema. Report significant changes indicative of fluid retention.
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.
Androgens: nursing Assessment (Women) Assess for virilism (deepening of voice, unusual hair growth or loss, clitoral enlargement, acne, menstrual irregularity)
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.
Androgens: Implementation (IM) testosterone cypionate (Depo-Testosterone) Administer IM deep into gluteal muscle every 2-4 weeks
Androgens: Implementation (SQ) pellets are to be implanted subcutaneously by a health care professional
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
Androgens: Implementation (Transdermal); Testoderm Applied only to clean, dry, hairless scrotal skin
Androgens: Implementation (Transdermal); Androgel Applied to shoulder, arms, or abdominal skin
Androgens: Implementation (Transdermal); Buccal apply to gum region twice daily (about 12 hr apart), rotating sides with each dose
Androgens: Evaluation Resolution of the signs of androgen deficiency without side effects.
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.
Phosphodiesterase Type-5 Inhibitors (Action) Inhibits the enzyme phosphodiesterase type 5 (PDE5), PDE5 inactivates cGMP. Enhances effects of nitric oxide released during sexual stimulation.
Phosphodiesterase Type-5 Inhibitors (Use) Erectile dysfunction sildenafil (Revatio): pulmonary hypertension
Phosphodiesterase Type-5 Inhibitors (Category) Erectile Dysfunction Agents sildenafil (Revatio, Viagra) tadalafil (Cialis) vardenafil (Levitra)
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
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
Phosphodiesterase Type-5 Inhibitors (Adverse Effects) CNS: headache EENT: abnormal vision CV: chest pain, hypotension or HTN, MI GI: dyspepsia Derm: flushing
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
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
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
Phosphodiesterase Type-5 Inhibitors (Implementation); Reatio Dose for pulmonary hypertension is administered 3 times daily without regard to food
Phosphodiesterase Type-5 Inhibitors (Evaluation) Male erection sufficient to allow intercourse Revatio: increased exercise tolerance
Created by: jtzuetrong