Drugs Affecting the Male Reproductive System PDF

Drugs Affecting the Male Reproductive System Prepared by: Yvette M. Batar, RN, MAN, DM Source: Focus on Nursing Pharmacology by Karch (Chapter 41) Learning Objectives Upon completion of this chapter, learners will be able to: 1. Discuss the e...

Drugs Affecting the Male Reproductive System Prepared by: Yvette M. Batar, RN, MAN, DM Source: Focus on Nursing Pharmacology by Karch (Chapter 41) Learning Objectives Upon completion of this chapter, learners will be able to: 1. Discuss the effects of testosterone and androgens on the male body and use this information to explain the therapeutic and adverse effects of these agents when used clinically. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug–drug interactions associated with drugs affecting the male reproductive system. 3. Discuss the use of drugs that affect the male reproductive system across the lifespan. 4. Compare and contrast the prototype drugs testosterone, oxandrolone, and sildenafil with other agents in their class. 5. Outline the nursing considerations, including important teaching points, for patients receiving drugs used to affect the male reproductive system.  DRUGS AFFECTING THE MALE REPRODUCTIVE SYSTEM Drugs affecting the male reproductive system include: o Androgens (male steroid hormones). o Anabolic steroids (synthetic variants of testosterone). o Drugs for penile dysfunction (e.g., erectile dysfunction treatments). Male Hormones (Androgens): o Produced in the testes. o Influence the entire male reproductive system. SITES OF ACTION OF DRUGS AFFECTING THE MALE REPRODUCTIVE SYSTEM  DRUGS AFFECTING THE MALE REPRODUCTIVE SYSTEM ACROSS THE LIFESPAN Children: Adults: o Anabolic steroids or androgens may be o Reinforcement of information regarding anabolic steroids and athletics is necessary. used for replacement therapy and o Women may experience masculinizing effects and may need emotional support. to increase red blood cell production in renal failure. o Men on replacement therapy may need to learn self-injection techniques and explore depot forms or dermal systems. o Close monitoring required due to effects o Periodic liver function tests are important due to potential liver impact. on epiphyseal closure; hand and wrist radiographs needed before treatment o Not indicated for pregnancy or lactation due to risks to fetus or neonate. and every 6 months. Older Adults: o If precocious puberty occurs, the drug o May have complications with androgen therapy due to underlying conditions should be discontinued. like hypertension, heart failure, or coronary artery disease. o Adolescents should be warned about o Benign prostatic hypertrophy may worsen, leading to urinary issues and potential for increased acne and other increased prostate cancer risk. effects. o Older adults with hepatic dysfunction should be carefully monitored; reduced doses may be needed due to hepatotoxicity risks. o Adolescent athletes need education on the risks of anabolic steroid use and lack o If signs of liver failure or hepatitis appear, the drug should be stopped immediately. of evidence for athletic benefits.  ANDROGENS Androgens are male sex hormones. Includes testosterone (produced in the testes) and androgens (produced in the adrenal glands). Testosterone (e.g., Duratest, Testoderm) is the primary natural androgen: Used for replacement therapy in hypogonadism (underdeveloped testes). Also used to treat certain breast cancers. Classified as a class III controlled substance. Other androgens include: Danazol (generic). Fluoxymesterone (Android). Methyltestosterone (Testred). Variety of adverse effects and toxicities associated with the use of drugs that affect the male reproductive system. ANDROGENS  ANDROGENS o Androgens, including testosterone, promote growth and development of male sex organs and maintain secondary male characteristics. Therapeutic Actions & o Increase nitrogen, sodium, potassium, and phosphorus retention while reducing urinary calcium excretion. Indications o Increase protein anabolism (building) and reduce protein catabolism (breakdown).Boost red blood cell production. o Danazol is used for treating endometriosis, fibrocystic breast disease, and hereditary angioedema in women by inhibiting the hypothalamic–pituitary–adrenal axis. o Testosterone is long-acting and available as depot injections, buccal systems, topical gels/sprays, urethral pellets, and dermal patches. Pharmacokinetics o Danazol is available in oral form. o Methyltestosterone and fluoxymesterone are also long-acting and available orally. o Metabolized in the liver, excreted through urine. o Contraindicated with allergy, during pregnancy/lactation, and with prostate or breast cancer in men. Contraindications (C.Is) o Caution in liver dysfunction and cardiovascular disease. & Cautions o Black box warning for topical testosterone: risk of virilization in children from contact with treated areas. o Black box warning for Danazol: risk of thromboembolic events, fetal abnormalities, hepatitis, and intracranial hypertension. o Androgenic effects: acne, edema, hirsutism, deepened voice, oily skin/hair, weight gain, testicular atrophy. o Antiestrogen effects in women: flushing, sweating, vaginitis, emotional lability. o Other effects: headache, dizziness, sleep disorders, rash, and electrolyte changes. Adverse Effects (AEs) o Risk of hepatocellular cancer with long-term use; requires regular liver function tests. o Cardiovascular risks: MI, stroke, DVT, and pulmonary embolism. o FDA warning for testosterone products due to cardiovascular event risks. Drug-Laboratory Test Interferences: Drug-drug Interactions o Can affect thyroid function, creatinine levels, and creatinine clearance. o These effects can last up to 2 weeks after discontinuation.  ANDROGENS Nursing Considerations Nursing Diagnosis Planning o Assess for contraindications or cautions to the use of the drug, including history of allergy to any testosterone or androgen to avoid hypersensitivity reactions, pregnancy or lactation to avoid o The patient will receive potential adverse effects on the fetus or baby, hepatic dysfunction to avoid the risk of hepatocellular disorders, and the best therapeutic effect cardiovascular disease and breast or prostate cancer in men, o Disturbed body image related to from the drug therapy. which could be aggravated by the drug. androgenic effects o The patient will have o Perform a physical assessment to determine baseline status o Acute pain related to need for limited adverse effects to before beginning therapy and for any potential adverse effects. injections the drug therapy. o Assess skin color, lesions, texture, and hair distribution to monitor for drug effects on the body and potential adverse o Sexual dysfunction related to o The patient will have an effects. androgenic effects understanding of the drug o Monitor affect, orientation, & peripheral sensation to assess CNS o Deficient knowledge regarding therapy, adverse effects to effects related to drug use. drug therapy anticipate, and measures o Perform abdominal examination and serum electrolytes, serum to relieve discomfort and cholesterol, and liver function tests to monitor for potential effects on liver function. improve safety. o Arrange for radiographs of the long bones in children to assess for testosterone effects on growth.  ANDROGENS Implementation with Rationale Evaluation o Reconstitute the drug according to the manufacturer’s directions to ensure proper o Monitor patient response to the drug reconstitution and to administer as prescribed. (onset of puberty, maintenance of male o Remove an old dermal system before applying a new system to clean, dry, intact skin sexual characteristics, palliation of breast cancer, blockage of ovulation, prevention to ensure accurate administration and decrease risk of toxic levels. of postpartum breast engorgement, relief o When using any of the topical testosterones or nasal testosterone, follow the of angioedema). manufacturer’s guidelines regarding placement, frequency, and protection of the area o Monitor for adverse effects (androgenic effects, hypoestrogenic effects, serum being used for application to ensure therapeutic effectiveness and decrease the electrolyte imbalance, headache, sleep incidence of adverse effects. disturbances, rash, hepatocellular o Monitor response carefully when beginning therapy so that the dose can be adjusted carcinoma). accordingly. o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, o Monitor liver function periodically with long-term therapy and arrange to discontinue adverse effects to watch for, and specific the drug at any sign of hepatic dysfunction. measures to avoid them; family member o Provide thorough patient teaching including measures to avoid adverse effects, or caregiver can demonstrate proper technique for preparation and warning signs of problems, and the need for regular evaluation including blood tests. administration of the drug as appropriate). Instruct a family member or caregiver in proper preparation and administration o Monitor the effectiveness of comfort techniques as appropriate to enhance patient knowledge about drug therapy and to measures and compliance with the promote compliance with the drug regimen. regimen. ANDROGENS  ANABOLIC STEROIDS Anabolic steroids are analogues of testosterone. o Designed to promote tissue-building effects with reduced androgenic effects. Examples of anabolic steroids include: o Oxandrolone (Oxandrin). o Oxymetholone (Anadrol-50).  ANABOLIC STEROIDS o Promote body tissue-building processes. Reverse catabolic (tissue-destroying) processes. o Increase hemoglobin and red blood cell mass. o Indications: Treat anemias, certain cancers, and angioedema. Promote weight gain and tissue repair in debilitated patients. Therapeutic Actions & Support protein anabolism in patients on long-term corticosteroids. Indications o Illegal Use: Used illegally to enhance athletic performance. Promotes increased muscle mass, hematocrit, and theoretically boosts strength and endurance. o Controlled Substance: Classified as class III controlled substances. o Oxandrolone and oxymetholone are available orally. Well absorbed, widely distributed, metabolized in the liver, and excreted Pharmacokinetics in urine. Contraindicated during pregnancy due to adverse effects on the fetus. Unknown if they pass into breast milk, so alternative feeding methods should be used during lactation. o Allergy to anabolic steroids. Pregnancy/lactation (risk of masculinization in the neonate). Contraindications (C.Is) o Liver dysfunction (due to liver toxicity). Coronary disease (raises cholesterol and affects the vascular system). & Cautions o Prostate or breast cancer in males. o Prepubertal males: Virilization (phallic enlargement, hirsutism, skin pigmentation). o Postpubertal males: Inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, and libido changes. o Women: Hirsutism, deepened voice, clitoral enlargement, baldness, and menstrual irregularities. o Common side effects: Electrolyte changes, liver dysfunction, insomnia, and weight gain. Adverse Effects (AEs) o Black box warnings: Risk of liver tumors, hepatitis, and blood lipid level changes (coronary artery disease risk). Excessive use linked to: Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction. Increased risk of prostate problems, especially in elderly patients. o Can be deadly when used in excessive amounts for athletic performance enhancement. o May interact with oral anticoagulants (e.g., warfarin) and antidiabetic agents. o May increase sensitivity to anticoagulants and delay metabolism of antidiabetic drugs. Drug-drug Interactions o Can affect lipid metabolism, reducing effectiveness of lipid-lowering agents. o Class III controlled substances: Monitored by the Drug Enforcement Agency. o Herbal alternatives are marketed as "safe" options for improving athletic performance.  ANABOLIC STEROIDS Nursing Considerations Nursing Diagnosis Planning o Assess for the following conditions, which could be cautions or contraindications to use of the drug: History of allergy to any androgens or anabolic steroids, pregnancy or lactation o The patient will receive because of masculinization of the neonate, prostrate or o Disturbed body image the best therapeutic effect breast cancer, coronary disease, and hepatic dysfunction. o Perform a physical assessment to determine baseline status related to systemic effects from the drug therapy. before beginning therapy and for any potential adverse o Acute pain related to GI or o The patient will have effects. CNS effects limited adverse effects to o Assess skin color, lesions, texture, and hair distribution to the drug therapy. monitor for drug effects on the body and potential adverse o Risk for impaired liver o The patient will have an effects. function related to liver understanding of the drug o Monitor affect, orientation, and peripheral sensation to toxic effects therapy, adverse effects to assess CNS effects related to drug use. o Deficient knowledge anticipate, and measures o Perform abdominal examination and serum electrolytes, to relieve discomfort and serum cholesterol, and liver function tests to monitor for regarding drug therapy potential effects on liver function. improve safety. o Arrange for radiographs of the long bones in children to assess for testosterone effects on growth.  ANABOLIC STEROIDS Implementation with Rationale Evaluation o Monitor patient response to the o Administer with food if GI effects are severe to relieve GI distress. drug (increase in hematocrit, protein anabolism). o Monitor endocrine function, hepatic function, and serum electrolytes o Monitor for adverse effects before and periodically during therapy so that dose can be adjusted (androgenic effects, serum appropriately and severe adverse effects can be avoided. electrolyte disturbances, o Arrange for radiographs of the long bones of children every 3 to 6 epiphyseal closure, hepatic months so that the drug can be discontinued if bone growth reaches dysfunction, personality o changes, cardiac effects). the norm for the child’s age. o Evaluate the effectiveness of the o Provide thorough patient teaching, including measures to avoid teaching plan (patient can name adverse effects and warning signs of problems, as well as the need for drug, dosage, adverse effects to regular evaluation, including blood tests, to enhance patient watch for, and specific measures to avoid them). knowledge about drug therapy and to promote compliance with the Monitor the effectiveness of drug regimen. comfort measures and compliance with the regimen.  DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION Penile Erectile Dysfunction (ED): o A condition where the corpus cavernosum does not fill with blood, preventing an erection. Causes of ED: Can result from aging, vascular, or neurological conditions. Treatment Drugs: 1. Prostaglandin (Alprostadil): Available as Caverject or Muse. 2.Phosphodiesterase Type 5 (PDE5) Inhibitors: ✓ Avanafil (Stendra) ✓ Sildenafil (Viagra, Revatio): Also used to treat pulmonary hypertension. ✓ Tadalafil (Cialis, Adcirca) ✓ Vardenafil DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION  DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION Therapeutic Actions: o Alprostadil: Injected into the corpus cavernosum; relaxes vascular smooth muscle, allowing blood flow for an erection. o PDE5 inhibitors (avanafil, sildenafil, tadalafil, vardenafil): Oral drugs; increase nitrous oxide and cGMP levels to relax smooth muscle Therapeutic Actions & and promote blood flow into the corpus cavernosum. Indications Indications: o Both alprostadil and PDE5 inhibitors are used to treat erectile dysfunction (ED). o Sildenafil and tadalafil are also used to treat pulmonary arterial hypertension in men and women by relaxing smooth muscle in the pulmonary artery. o lprostadil: Metabolized in the lungs, excreted in urine. o PDE5 inhibitors: Absorbed via the GI tract, metabolized in the liver, and excreted in feces. Differences in onset and duration of action: ✓ Sildenafil: Onset 27 minutes, duration 4 hours. Pharmacokinetics ✓ Vardenafil: Onset 26 minutes, duration 4 hours. ✓ Tadalafil: Onset 45 minutes, duration 36 hours. ✓ Avanafil: Onset 30–40 minutes, duration 2–3 hours. o Contraindicated in anatomical obstructions, penile implants, priapism risk, and caution with bleeding disorders or cardiovascular Contraindications (C.Is) diseases. & Cautions o Caution for interactions with food and certain medications, especially nitrates, alpha-adrenergic blockers, and drugs like ketoconazole, itraconazole, and ritonavir. o Alprostadil: Pain, infection, priapism, fibrosis, and rash at the injection site. Adverse Effects (AEs) o PDE5 inhibitors: Systemic effects like headache, flushing, UTI, diarrhea, dizziness, optic neuropathy, hearing loss, and increased melanoma risk. o PDE5 inhibitors cannot be taken with organic nitrates or alpha-adrenergic blockers due to risk of serious cardiovascular effects, Drug-drug Interactions including death. o Dose adjustments may be needed when combined with ketoconazole, itraconazole, indinavir, or ritonavir.  DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION Nursing Considerations Nursing Diagnosis Planning o Assess for the following conditions, which could be cautions or contraindications to the use of the drug: History of allergy to any of the preparations, penile structural abnormalities, penile implants, bleeding disorders, active peptic ulcer, coronary artery disease, hypotension or severe o The patient will receive hypertension, congenital prolonged QT interval, or severe the best therapeutic effect hepatic or renal disorders. o Disturbed body image related from the drug therapy. o Assess baseline status before beginning therapy to determine any potential adverse effects. to drug effects and indication o The patient will have o Assess skin & lesions to monitor for adverse reactions to the o Acute pain related to injection limited adverse effects to the drug therapy. drug & cardiovascular perfusion. of alprostadil o The patient will have an o Monitor orientation, affect, and reflexes to evaluate CNS o Sexual dysfunction changes that might be related to changes in blood pressure understanding of the drug and blood flow. o Deficient knowledge therapy, adverse effects to o Assess BP, PR, RR, & adventitious sounds to evaluate blood regarding drug therapy anticipate, and measures flow & potential changes in cardiovascular function. When to relieve discomfort and using alprostadil, perform a local inspection of the penis to improve safety. assess local reaction to injection & to monitor for potential infection. o Evaluate laboratory tests for bleeding time & liver function to monitor potential adverse effects on the liver.  DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION Implementation with Rationale Evaluation o Monitor patient response to the o Assess the cause of dysfunction before beginning therapy to ensure drug (improvement in penile appropriate use of these drugs. erection). o Monitor patients with vascular disease for any sign of exacerbation so that Monitor for adverse effects the drug can be discontinued before severe adverse effects occur. Instruct (dizziness, flushing, local the patient in the injection of alprostadil, storage of the drug, filling of the inflammation or infection, fibrosis, syringe, sterile technique, site rotation, and proper disposal of needles to diarrhea, dyspepsia). o Evaluate the effectiveness of the ensure safe and proper administration of the drug. teaching plan (patient can name o Monitor patients who are taking PDE5 inhibitors for use of nitrates or drug, dosage, adverse effects to alpha-blockers to avert potentially serious cardiovascular drug–drug watch for, and specific measures to interactions. avoid them; patient can o Provide thorough patient teaching, including measures to avoid adverse demonstrate proper administration effects and warning signs of problems as well as the need for regular of injected drug). evaluation to enhance patient knowledge about drug therapy and to o Monitor the effectiveness of promote compliance with the drug regimen. comfort measures and compliance with the regimen.