Drugs Affecting Male Repro: Androgens, ED Meds, Anabolics

Drugs Affecting the Male
Reproductive System
Chapter 41
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drugs Used to Affect the Male
Reproductive System
• Male Steroid Hormones or Androgens
– Act like testosterone
– Development of male sexual characteristics
• Male Sex Hormone or Anabolic Steroids
– Synthetic testosterone preparations that have more
anabolic effects than androgenic effects
– Tissue building
• Drugs to Improve Penile Dysfunction

Sites of Action for Drugs Affecting the
Male Reproductive System

Signs and Symptoms of Adverse Effects of
Androgens/Anabolic Steroids
• Swelling in fingers or legs
• Continual erection
• Uncontrollable sex drive
• Yellowing skin
• Fever, chills, or rash
• Chest pain or difficulty breathing
• Hoarseness
• Loss of hair or growth of facial hair in women

Androgens and Their Indications
• Testosterone (Duratest, Testoderm, others)
– Hypogonadism; breast cancer
• Danazol (Danocrine)
– Block the release of FSH and LH in women
• Fluoxymesterone (Halotestin)
– Hypogonadism; breast cancer
• Testolactone (Teslac)
– Breast cancers

Androgens
• Actions
– Increase the retention of nitrogen, sodium,
potassium
– Decrease the urinary excretion of calcium
– Increase protein anabolism
– Decrease protein catabolism
– Increase the production of red blood cells

Androgens (cont.)
• Pharmacokinetics
– Well absorbed and widely distributed throughout the
body
– Metabolized in the liver and excreted in the urine
• Contraindications
– Allergy
– Pregnancy and lactation
– Prostate or breast cancer in men

Androgens (cont.)
• Caution
– Liver dysfunction or cardiovascular disease
• Indications
– Replacement therapy in hypogonadism and delayed
puberty in males
– Inoperable breast cancer
– Prevention of ovulation to treat endometriosis
• Adverse Effects
– Acne, edema, hirsutism
– Deepening of the voice, oily skin and hair, weight gain,
decreased breast size, testicular atrophy

Androgens (cont.)
• Adverse Effects (cont.)
– Flushing sweating, vaginitis, nervousness, and
emotional labiality
– Headache, dizziness, sleep disorders, and altered
electrolytes
• Drug Laboratory Test
– Thyroid function
– Creatinine

Alternative Therapies Used to Enhance
Athletic Performance

Question
Please answer the following statement as true or false.
Androgens are male sex hormones and include
testosterone produced in the testes, and the androgens
which are produced in the posterior pituitary gland.

Answer
False
Rationale: Androgens are male sex hormones and include
testosterone produced in the testes, and the androgens
produced in the adrenal glands.

Anabolic Steroids and Their Indications
• Oxandrolone (Oxandrin)
– Promote weight gain in debilitated patients
– Increase protein anabolism
– Treat certain cancers
• Oxymetholone (Anadrol-50)
– Treat various anemias

Anabolic Steroids
• Actions
– Promote body tissue-building processes
– Reverse catabolic or tissue-destroying processes
– Increase hemoglobin and red blood cell mass
• Indications
– Indications vary with each drug
– Treatment of anemias, certain cancers, and
angioedema
– Promote weight gain and tissue repair
– Protein anabolism

Anabolic Steroids (cont.)
– Well absorbed and widely distributed throughout the
body
– Metabolized in the liver and excreted in the urine
– Allergy and liver dysfunction
– Pregnancy and lactation
– Coronary disease
– Prostate or breast cancer in males

• Adverse Effects
– Cardiomyopathy
– Hepatic carcinoma
– Personality changes
– Sexual dysfunction
– Virilization
– Inhibition or testicular function, gynecomastia,
testicular atrophy, priapism, baldness, and change in
libido

• Drug-to-Drug Interactions
– Oral anticoagulants
– Antidiabetic medications

Drugs Approved for the Treatment of
Penile Erectile Dysfunction
• Alprostadil (Caverject, MUSE)
– Prostaglandin that relaxes vascular smooth muscle
and allows filling of the corpus cavernosum when it is
injected directly into the cavernosum
• Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil
(Levitra)
– Selectively inhibits phosphodiesterase type 5
receptors (PDE5) and increases nitrous oxide levels,
allowing blood to flow into the corpus cavernosum

Drugs for Treatment of Penile Erectile
Dysfunction
• Actions
– Alprostadil: Injected and acts locally to relax vascular
smooth muscle and promote blood flow into the corpus
cavernosum causing penile erection.
– Inhibits PDE5 receptors, leading to a release of nitrous
oxide, which activates cGMP to cause a prolonged
smooth muscle relaxation, allowing the flow of blood
into the corpus cavernosum and facilitating erection.
• Indications
– Treatment of erectile dysfunction in the presence of
sexual stimulation

Dysfunction (cont.)
– Well absorbed, metabolized in the liver and excreted in the
urine
– Condition that might predispose to priapism
– Penile implants
– Use in women
• Caution
– Bleeding disorders, coronary artery disease, active peptic
ulcer, retinitis pigmentosa, hypotension or severe
hypertension, congenital prolonged Q T interval, or severe
hepatic or renal disorders

Dysfunction (cont.)
• Adverse Effects
– Edema, headache, dizziness, syncope, angina,
dyspnea
• Drug-to-Drug Interactions
– PDE5 inhibitors combined with organic nitrates or
alpha blockers
• Can cause dangerous cardiovascular effects,
including death
• Careful patient teaching is essential

Question
After six months of use what is the mean dose of
Caverject?
A. 2.5 mcg
B. 10.3 mcg
C. 15.9 mcg
D. 20.7 mcg

Answer
D. 20.7 mcg
Rationale: Alprostadil (Caverject, MUSE): 2.5 mcg injected
intracavernously, titrate the dose to one that will allow a
satisfactory erection that is maintained no longer than 1
hr; mean dose after 6 mo is reported to be 20.7 mcg.

Use of Drugs Affecting the Male
Reproductive System Across the Lifespan

Prototype Androgen

Prototype Androgen (Continued)

Prototype Anabolic Steroids

Prototype Drugs for Treatment of Erectile
Dysfunction

Nursing Considerations for Androgens
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Anabolic
Steroids
• Implementation
• Evaluation

Nursing Considerations for Drugs Used in
the Treatment of Erectile Dysfunction
• Implementation
• Evaluation

Drugs Affecting Male Repro: Androgens, ED Meds, Anabolics

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