CHAPTER 35
Men’s Health Drugs
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
2
Androgens (cont’d)




Several synthetic derivatives of testosterone
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
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
3
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)
 stanozolol (Winstrol)
 oxandrolone (Oxandrin)
 nandrolone (Deca-Durabolin)
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
4
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
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
5
Androgen Inhibitors




5-Alpha-reductase inhibitors
Alpha1-adrenergic blockers
Androgen receptor blockers
Gonadotropin-releasing hormone (Gn-RH)
analogs
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
6
5-Alpha-Reductase Inhibitors




Finasteride and dutasteride
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)
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
7
Alpha1-Adrenergic Blockers





Used for symptomatic relief of obstruction
caused by BPH
doxazosin (Cardura)
tamsulosin (Flomax)
terazosin (Hytrin)
alfuzosin (Uroxatral)
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
8
Androgen Receptor Blockers




Block the activity of androgen hormones at
target tissue (prostate) receptors
flutamide
nilutamide
bicalutamide
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
9
Gn-RH Analogs





Gonadotropin-releasing hormone analogs
Used to treat prostate cancer
Goserelin
Leuprolide
Triptorelin
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
10
Drugs to Treat Erectile
Dysfunction

sildenafil (Viagra)



First oral drug for treatment of ED
vardenafil (Levitra)
tadalafil (Cialis)
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
11
Men’s Health Drugs: Indications


Primary use: replacement therapy
Other uses vary with the specific drug
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
12
Men’s Health Drugs:
Adverse Effects


Androgens cause fluid retention
Anabolic steroids


Peliosis of the liver, other severe hepatic effects
Many other effects
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
13
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
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
14
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
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
15
Herbal Products:
Saw Palmetto



Serenoa repens, sabal serrulata
Used for treatment of BPH and alopecia
Adverse effects




GI upset
Headache
Back pain
Dysuria
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
16
Nursing Implications


Assessment should include complete history,
including medication history, urinary
elimination problems, potential
contraindications
Obtain baseline vital signs, weight, height,
serum electrolyte levels
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
17
Nursing Implications (cont’d)



Assess renal and liver function
Assess PSA level and perform digital rectal
exam (DRE) before beginning any drugs for
treatment of prostate disease
Assess current medications for potential
interactions
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
18
Nursing Implications (cont’d)




IM testosterone should be given deeply—
choose landmarks carefully
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
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
19
Nursing Implications (cont’d)




Pregnant women should not handle crushed or
broken finasteride tablets
Educate patients on proper administration
techniques for each drug
Monitor for therapeutic responses
Monitor for adverse effects
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
20