men’s health drugs
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Mens Health Drugs
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Androgens
Produced by the testes, ovaries, and
adrenal cortex
Group of male sex hormones Major endogenous androgen is
testosterone
Primary clinical application is
management of androgen deficiency in
males
Principal adverse effects are virilization
and hepatotoxicity 2
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Androgens
Testosterone
Responsible for normal development and
maintenance of primary and secondarymale sex characteristics
Development of bone and muscle tissue
Inhibition of protein catabolism (metabolic
breakdown)
Retention of various electrolytes
Erythropoietic effect
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Androgens & other Drugs
Several synthetic derivatives of
testosterone
Oral forms have a high first-pass effect Transdermal forms available
Patches and gel
Injectible: testosterone cypionate [Depo-testosterone]
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Testosterone
Biosynthesis and secretion Males: testosterone
Females: preandrogens Effects on sex characteristics in males
Pubertal transformation
Spermatogenesis
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Testosterone
Effects on sex characteristics in females Clitoral growth
Anabolic effects Skeletal muscle
Erythropoietic effects Synthesis of erythropoietin
Men have greater hematocrit than women
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Androgens
Anabolic steroids
Synthetic derivatives of testosterone
Anabolic activity: synthesis of tissue andincreasing tissue formation
Schedule III, great potential for misuse by
athletes
Abuse by athletes: growing problem Dosage up to 30 therapeutic dose
Serious and some irreversible side effects
Use banned by all major athletic associations7
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Androgen [Anabolic Steroid]
Abuse by Athletes Many athletes use to enhance athletic performance
Significant risks
Hypertension, suppression of release of LH and
FSH, testicular shrinkage, sterility, gynecomastia,acne, reduction in HDL and increase in LDL
Hepatotoxicity with 17-alpha-alkylated compounds
Renal damage
Psychologic effects Mentally healthy: minimal impact
Psychologically unbalanced: could intensify
aggression
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Anabolic Steroids: End -lone
oxymetholone (Anadrol-50)
oxandrolone (Oxandrin)
nandrolone (Deca-Durabolin)
stanozolol (Winstrol)
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Indications
Approved
Anemia
Hereditary
angioedema Metastatic breast
cancer
Male hypogonadism
Replacementtherapy
Delayed puberty
Replacement
therapy in
menopausal women
Unlabeled [non-FDA
approved]
HIV-associated
wasting syndrome
[oxandrolone]
Alcoholic hepatitis
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Androgens:
Mechanism of Action Effects are similar to the bodys
endogenous androgens
Stimulation of normal growth anddevelopment of the male sex organs
Development and maintenance of malesecondary sex characteristics
Stimulate increased synthesis of bodyproteins, aiding in the formation ofmuscular and skeletal proteins
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Drugs for Treatment of BPH-
Androgen Inhibitors 5-alpha reductase inhibitors: end -
ride
Finasteride (Proscar)-Prototype Dutasteride (Avodart, Duagen)
Alpha-adrenergic blocking agents:
end losin/zosin Tamsulosin (Flomax)
Doxazosin (Cardura)
Terazosin (Hytrin)
Alfuzosin (Uroxatrel)
Silodosin [Rapaflo] 13
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5-Alpha-Reductase Inhibitors
Finasteride and dutasteride Block the effects of endogenous androgens
Inhibits enzyme 5-alpha reductase which
converts testosterone to 5-alphadihydrotestosterone
Used to treat benign prostatic hyperplasia(BPH)
Lowers prostatic DHT concentrations:Reduce size of prostate and results inalleviation of symptoms of BPH
Easierpassage of urine 14
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5-Alpha-Reductase Inhibitors:
Finasteride [Proscar]Prevents thinning of hair-Increased hair
growth noted [treat male-pattern baldness
as Propecia]-Male onlyWomen: teratogenic [pregnancy] & not
recommended for any age
Women must wear gloves when handling
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Drug Therapy
Antiandrogen agents (5-alpha-
reductase inhibitors (5-ARI) : finasteride
(Proscar), dutaseride (Avodart) Lower level of dihydrotesterone (DHT)
Take for 6 months before improvement
noted S/E: ED, decreased libido, gynecomastia,
flushing
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Alpha1-Adrenergic Blockers
Used for symptomatic relief of
obstruction caused by BPH
doxazosin (Cardura)
tamsulosin (Flomax)
terazosin (Hytrin)
alfuzosin (Uroxatral)
Silodosin [Rapaflo]- Preg. B
Clinical effects of prostate shrinkage
immediately
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Drug Therapy
Alpha-adrenergic blockers Relax smooth muscle of bladder neck
sphincter/prostate
tamulosin (Flomax), alfuzosin (Uroxatral): Constricts prostate gland: reduces uretheal
pressure & improves urine flow
terazosin (Hytrin), doxazosin (Cardura):
used for pt w/BPH & HTN ALPHA BLOCKERS: **MUST MONITOR BP
(INPATIENT SETTING)
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Androgen Receptor Blockers
Block the activity of androgen hormones
at target tissue (prostate) receptors
Use: prostate Ca
Agents: endmide/tamide
flutamide [Eulexin, Apo-flutaminde]-Preg D
nilutamide [Nilandron]
Bicalutamide [Casodex]
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Gn-RH Analogs
Gonadotropin-releasing hormone
analogs
Action: inhibits secretion of primary
gonadotropin which leads to decreasein testosterone production
Used to treat prostate cancer
Agents
Goserelin [Zoladex]
Leuprolide [Lupron]
Triptorelin [Trelstar] 20
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Drugs Used to Treat Erectile
Dysfunction [ED]
Pharmacologic agents for sexual
dysfunction
Phosphodiesterase inhibitors: endnafil/fil
Sildenafil citrate (Viagra)-prototype
Vardenafil (Levitra)
Tadalafil (Cialis) Others used:
Apomorphine (Uprima)
Phentolamine (Vasomax)
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Mechanism of Action
Inhibiting the action of the enzyme
phosphodiesterase
Cialis & Levitra have similar action &longer duration of action
Tadalafil [Cialis]- The Weekender
Do not eat fatty foods
No Etoh in excess
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Pharmacologic Therapy
Sildenafil (Viagra) PO Take 1 hour before sex & no more than once
Vardenafil (Levitra) PO Take 1 hour before intercourse
Peak action: 30 to 120 minutes
Recommended frequency: 10 mg in 24 hrs
Tadalafil(Cialis) The WeekenderPO Take before sexual activity
Effect peaks at 30 min to 6 hours
May last 36 hrs.23
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Recommended Administration
Sexual stimulation is required for an
erection to occur.
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Other Pharmacologic Measures
Injecting vasoactive agents
directly into penis: alprostadil
(Caverject), papaverine,phentolamine (Vasomax)
Complications:
Priapism
Fibrotic plaques at injection sites
Alprostadil suppository
Gel pellet inserted into urethra to
create an erection 25
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Other Options
intraurethral inserts:Tablets (Muse)
self-injection of theerectile tissues with amedication thatimproves penile bloodflow, such as
Pros tagland in E-1:alprostadil (Caverjector Edex).
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Contraindication [HH]
Do not take if you are taking nitrate
medications such as nitroglycerine (eg,
Nitrobid) or isosorbide mononitrate (eg,
Imdur).Do not take if you have high uncontrolled
blood pressure, coronary artery disease, or
have had a heart attack within the past 6
months.
Do not take if you have been diagnosed
with a cardiac dysrhythmia or kidney or
liver dysfunction. 27
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Adverse Effects
Drugs for erectile dysfunction
Headache, flushing, dyspepsia, chest pain
hypotension Priapism
Unexplained visual loss
In men with preexisting cardiovasculardisease, especially those taking nitrates
Lower BP substantially
May cause serious adverse effects
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Interactions
Androgens: oral anticoagulants, oral
hypoglycemics [enhance effect]
ED: severe hypotension [nitrate use]
Alpha-blockers: additive effect
hypotension with other BP lowering
drugs
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Herbal Products:
Saw Palmetto
Serenoa repens, sabal serrulata
Used for treatment of BPH and alopecia
Must check with HCP before taking
Can interfere with prescription medications
Cannot use w i th medicat ions conta in ing estrogen
(saw palmetto)
Adverse effects
GI upset
Headache
Back pain
Dysuria 30
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Nursing Implications
Assessment should include complete
history, including medication history,
urinary elimination problems, potentialcontraindications
Obtain baseline vital signs, weight,
height, serum electrolyte levels
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Nursing Implications
Assess renal and liver function
Assess PSA level and perform digital
rectal exam (DRE) before beginning anydrugs for treatment of prostate disease
Assess current medications for potential
interactions
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Nursing Implications
IM testosterone should be givendeeplychoose landmarks carefully
Follow exact instructions for SL, buccal,
and PO forms Transdermal Testoderm patches are
applied to the scrotal skin
Transdermal Androderm patches areapplied to the skin on the body, neverto
scrotal skin
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Nursing Implications
Pregnant women should not handle
crushed or broken finasteride tablets
Establish baseline LFTs w/finasteride Educate patients on proper
administration techniques for each drug
Monitor for therapeutic responses
Monitor for adverse effects
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Patient Teaching
Finesteride-Protect from light or heat
Instruct about potential side effects if on
an ED drug: dizziness, heartburn &
hypotension esp. on a nitrate
Instruct with ED drugs that they are not
effective if no sexual stimulation occurs
Reinforce f/u appt. if on testosterone
Instruct to seek immediate attention if
w/a prolonged erection >4 hours 35
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Patient Teaching
Instruct that testosterone should not be
abruptly stopped-must be weaned over
several weeks
Testoderm patch: place on clean, dry
scrotal skin that has been shaved;
replace every 22-24 hours as ordered
Androderm patch: place on clean, dry
skin on back, abd, upper arms or thighs.
AVOID scrotal or bony areas. Change
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