Pharmacology For Nurses: Drugs For Disorders and Conditions of The Male Reproductive System

PHARMACOLOGY FOR NURSES
A Pathophysiologic Approach
FIFTH EDITION
Chapter 47
Drugs for Disorders
and Conditions of
the Male
Reproductive
System
Copyright © 2017, 2014, 2011 Pearson Education, Inc. All Rights Reserved
Pituitary and Hypothalamus
Hormones
• Gonadotropin-releasing hormone (GRH)
from hypothalamus
• Follicle-stimulating hormone (FSH)
– Regulates sperm production in men
• Luteinizing hormone (LH)
– Accurately called interstitial cell–stimulating
hormone (ICSH)
– Regulates production of testosterone
Testes
• Secrete testosterone, an androgen
• Primary hormone of male reproductive
system
– Contributes to growth, health maintenance
– Responsible for maturation of male sex organs
– Responsible for secondary sex characteristics of
men
Figure 47.1 Hormonal control of the male reproductive hormones
Androgens
• Include testosterone and related hormones
– Control many aspects of male reproductive
function
– Women have small amounts of androgens
Androgens
• Used to treat hypogonadism in males
– Primary hypogonadism due to testicular failure
– Secondary due to lack of follicle-stimulating
hormone (FSH) or luteinizing hormone (LH)
– Symptoms: sparse hair, increased subcutaneous
fat, small testes
Table 47.2 Androgen Formulations
Table 47.2 Androgen Formulations
Route Drug Advantages Disadvantages
Implantable pellets Testopel: 1–6 pellets are implanted on the Doses last 3–4 months Inflammation or infection may occur around
(subcutaneous) anterior abdominal wall depending on the the insertion site
dose required
Intramuscular (IM) Testosterone cypionate (Depo-Testosterone) Doses last 2–4 wk Serum testosterone levels may vary widely
and testosterone enanthate (Delatestryl) after administration, causing fluctuations in
libido, energy and mood swings; soreness at
the site of injection
testosterone testosterone undecanoate (Aveed) Easy to use May require 3 doses/day; can cause
intranasal nasal side effects such as nasopharyngitis,
epistaxis, and rhinorrhea
Testosterone Striant tablet is applied to the gum area just Produces a continuous May require twice-daily dosing; local irritation
buccal system above the incisor supply of testosterone in the to the buccal mucosa
blood
Transdermal AndroGel, Fortesta, and Testim are applied The drug is absorbed into the Gel can be transferred to another person by
testosterone gel once daily to the upper arms, shoulders, or skin in about 30 minutes and skin-to-skin contact, causing virilization of
abdomen released slowly to the blood; female contacts and fetal harm
causes less skin irritation
than patches
Transdermal Androderm patch is applied daily to the upper Easy to use Rash may occur at the site of patch application
testosterone patch arm, thigh, back, or abdomen, rotating
application sites
Pharmacotherapy with Androgens
• Used to treat hypogonadism, increase
libido, and correct erectile dysfunction
• For treatment of certain cancers
Androgens
• Prototype drug: testosterone
• Mechanism of action: stimulates RNA
synthesis and protein metabolism
• Primary use: for treatment of
hypogonadism in males
Androgens
• Adverse effects: virilization
– Salt and water often retained
 Causes edema, liver damage, acne and skin irritation
Anabolic Steroids
• Testosterone-like compounds
• Frequently abused by athletes, even though
illegal
• Classified as Schedule III drugs
Anabolic Steroids
• Can result in adverse effects with long-term
use
– Increased cholesterol levels, low sperm count,
impotence
– Menstrual irregularities and the appearance of
male characteristics in women
– Aggression, psychological dependence
Table 47.1 Selected Androgens and
Anabolic Steroids
Table 47.1 Route and Adult Dose (max dose where indicated)
Route and Adult Dose
Drug (max dose where indicated) Adverse Effects
fluoxymesterone (Halotestin) PO: 5 mg one to four times/day Acne, gynecomastia, hirsutism
and male sex characteristics
methyltestosterone (Android, Methitest, PO: 10–50 mg/day (in women), sodium and water
Testred) Buccal; 5–25 mg/day retention, hypercholesterolemia
Nandrolone IM; 50–200 mg/wk Anaphylaxis, testicular atrophy

and oligospermia at high doses
oxandrolone (Oxandrin) PO: 2.5–20 mg/day divided bid–qid for 2–4 wk
oxymetholone (Anadrol-50) PO: 1–5 mg/kg/day
testosterone (buccal: Striant); Buccal: 30 mg q12h

(transdermal patch: Androderm); (topical Transdermal: apply 1–2, 2.5 mg patches daily (max: 5 mg/day)
gels: Androgel, Fortesta, Testim, Vogelxo); Gel: apply 5–50 g daily
(implantable pellets: Testopel); (nasal spray: Pellets: 150–450 mg every 6 months (each pellet is 75 mg)
Natesto) Nasal spray: 1 spray in each nostril tid (total daily dose: 33 mg)
testosterone cypionate (Depo-Testosterone) IM: 50–400 mg every 2–4 wk
testosterone enanthate (Delatestryl) IM: 50–400 mg every 2–4 wk
testosterone undecanoate (Aveed) IM: 750 mg initially, followed by the same dose at 4 weeks and
every 10 weeks thereafter
Note: Italics indicate common adverse effects; underlining indicates serious adverse effects.
Role of the Nurse: Androgen
Therapy for Hypogonadism
• Assess impaired sexual functioning and
diminished libido
• Note physical signs of decreased hormone
production
– Decreased or absent body hair, small testes,
delayed signs of puberty
• Monitor emotional status
• Monitor lab results, especially liver enzymes
• Monitor serum cholesterol, especially with
history of MI or angina
– Drug can increase this lab value
• Contraindications
– Prostatic or male breast cancer, renal disease
– Benign prostatic hyperplasia (BPH),
hypertension
• Use cautiously in prepubertal men, older
adults
• Adverse reactions found to occur in women
– Deepening of voice, facial hair growth, enlarged
clitoris, irregular menses
Male Infertility
• 30% to 40% of infertility problems caused
by problems with male's reproductive
system
• Difficult to treat pharmacologically
– Only 5% caused by endocrine problems
– Treatment expensive; requires many injections
Male Infertility
• Other means of conception explored
– In vitro fertilization
– Intrauterine insemination
Medications for Male Infertility
• For hypogonadism
– Human chorionic gonadotropin (HCG) increases
testosterone and sperm production
– Menotropin (Menopur, Repronex) mixture of FSH
and LH
– Testosterone therapy
• Antiestrogens (tamoxifen, clomiphene) to
block negative feedback of estrogen
Erectile Dysfunction
• Common disorder associated with
– Physical conditions (atherosclerosis, diabetes,
kidney disease, stroke, hypertension, tobacco
use)
– Psychogenic causes
 Depression, fatigue, guilt, fear of failure
– Certain medications
 Thiazide diuretics, beta blockers, selective serotonin
reuptake inhibitors (SSRIs), antidepressants
Pharmacotherapy for Erectile
Dysfunction
• May be successfully treated with
phosphodiesterase-5 inhibitors
• Sildenafil (Viagra): Does not cause erection;
enhances it
• Vardenafil (Levitra): faster onset, slightly
longer duration than Viagra
• Tadalafil (Cialis): Acts within 30 minutes
and lasts 24–36 hours
Table 47.3 Drugs for Erectile
Dysfunction
Table 47.3 Drugs for Erectile Dysfunction

avanafil (Stendra) PO: 100 mg approximately 30 min before intercourse Nasal congestion, headache, facial
(max: 200 mg once/day) flushing, dizziness, vision
abnormalities, myalgia
sildenafil (Viagra) PO: 50 mg approximately 30–60 min before
intercourse (max: 100 mg once/day) Hypotension when taken with
nitrates, priapism, hearing loss,
tadalafil (Cialis) PO: 10 mg approximately 30 min before intercourse nonarteritic anterior ischemic optic
(max: 20 mg once/day) neuropathy (blindness)
Once-daily dosing: 2.5–5 mg
vardenafil (Levitra, Staxyn) PO: 10 mg approximately 1 h before intercourse (max:

20 mg once/day)
Agents for Erectile Dysfunction—
Phosphodiesterase-5 Inhibitor
• Prototype drug: sildenafil (Viagra)
• Mechanism of action: relaxes smooth
muscle in corpus cavernosum
– Blocks enzyme phosphodiesterase-5
– Allows increased blood flow into penis
• Primary use: to treat erectile dysfunction
Agents for Erectile Dysfunction—
Phosphodiesterase-5 Inhibitor
• Adverse effects: most serious is
hypotension
– Headache, dizziness, flushing, rash
– Nasal congestion, diarrhea, dyspepsia
– UTI, chest pain, indigestion
– Blurred vision, changes in color perception,
priapism
Role of the Nurse: Pharmacotherapy
for Erectile Dysfunction
• Obtain physical exam and history

– Impaired sexual function
– Cardiovascular disease
– Presence of emotional disturbances
– Monitor results of lab tests related to liver
function
Role of the Nurse: Pharmacotherapy
for Erectile Dysfunction
• Obtain testosterone, prolactin, thyroxin

levels
• Nocturnal penile tumescence and rigidity
(NPTR) test may be ordered
• A blood-flow test is used to determine if
sufficient blood flow to penis
• Sildenafil, vardenafil, and tadalafil
contraindicated with use of organic nitrates
and alpha-adrenergic blockers
Benign Prostatic Hyperplasia (BPH)
• Enlargement of prostate
• Obstructs urethra and decreases flow
• Not precursor to cancer
• Symptoms
– Increased urinary frequency, urgency
– Leakage, nocturia, decreased force
– Incomplete emptying of bladder
Figure 47.2a Benign prostatic hyperplasia: normal prostate with penis
Source: Rice, Jane, Medical Terminology with Human Anatomy, 5th ed.,© 2005, p. 538.
Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ.
Figure 47.2b Benign prostatic hyperplasia: prostate constricting urethra
Source: Rice, Jane, Medical Terminology with Human Anatomy, 5th ed.,© 2005, p. 538.
Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ.
• Aggravating factors
– Alpha-adrenergic agonists, anticholinergics,
testosterone and other anabolic steroids
– Caffeine, alcohol, fluids at bedtime
Pharmacotherapy of Static and
Dynamic Components
• Static
– Relates to anatomical enlargement
• Dynamic
– Relates to excessive numbers of alpha-
adrenergic receptors compressing urethra
• Severe disease requires surgery
Pharmacotherapy of Static and
Dynamic Components
• Drug options
• Alpha1-adrenergic blockers
– Doxazosin (Cardura), terazosin (Hytrin),
tamsulosin (Flomax)
• 5-alpha-reductase inhibitors
– Finasteride (Proscar)
Table 47.4 Drugs for Benign Prostatic
Hyperplasia
Table 47.4 Drugs for Benign Prostatic Hyperplasia
ALPHA1-ADRENERGIC BLOCKERS
alfuzosin (Uroxatral) PO: 10 mg/day (max: 10 mg/day) Orthostatic hypotension, headache, Dizziness
doxazosin (Cardura) (see page PO: 1–8 mg/day (max: 8 mg/day) First-dose phenomenon (severe hypotension and
387 for the Prototype Drug box) syncope), tachycardia
doxazosin XL (Cardura XL) PO (Extended-release): 4–8 mg/day (max: 8 mg/day)
silodosin (Rapaflo) PO: 8 mg once daily with a meal
tamsulosin (Flomax) PO: 0.4 mg 30 min after a meal (max: 0.8 mg/day)
terazosin (Hytrin) PO: 1–5 mg/day (max: 20 mg/day)
5-ALPHA-REDUCTASE INHIBITORS
dutasteride (Avodart) PO: 0.5 mg once daily Erectile dysfunction, decreased libido, decreased ejaculate
volume, gynecomastia
finasteride (Proscar) PO: 5 mg once daily
Hypersensitivity, increased risk of high grade prostate
cancer
Agents for Benign Prostatic Hyperplasia—
5-alpha-reductase Inhibitor
• Prototype drug: finasteride (Proscar)

• Mechanism of action: inhibits 5-alpha-
reductase
• Primary use: promotes shrinkage of
enlarged prostate
– Also prescribed to promote hair regrowth
Agents for Benign Prostatic Hyperplasia—
5-alpha-reductase Inhibitor
• Adverse effects: sexual dysfunction

– Impotence, diminished libido, ejaculatory
dysfunction
Role of the Nurse: Drug Therapy
with Antiprostatic Agents for BPH
• Assess for changes in urinary elimination
– Urine retention, nocturia, dribbling
– Difficulty starting urinary stream, frequency,
urgency
• Monitor for hypotension (first-dose
phenomenon and throughout treatment)
• Alpha blockers should be used cautiously in
patients with asthma or heart failure
– Cause bradycardia and bronchoconstriction
• Monitor emotional status of patients taking
alpha-blockers
– Depression common side effect
• May take 6–12 months of treatment before
maximum benefit achieved
• Monitor for impotence, decreased volume of
ejaculate, or decreased libido

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PHARMACOLOGY FOR NURSES

Nandrolone IM; 50–200 mg/wk Anaphylaxis, testicular atrophy

oxymetholone (Anadrol-50) PO: 1–5 mg/kg/day

testosterone (buccal: Striant); Buccal: 30 mg q12h

testosterone cypionate (Depo-Testosterone) IM: 50–400 mg every 2–4 wk

testosterone enanthate (Delatestryl) IM: 50–400 mg every 2–4 wk

Table 47.3 Drugs for Erectile Dysfunction

Once-daily dosing: 2.5–5 mg

vardenafil (Levitra, Staxyn) PO: 10 mg approximately 1 h before intercourse (max:

• Obtain physical exam and history

• Obtain testosterone, prolactin, thyroxin

doxazosin XL (Cardura XL) PO (Extended-release): 4–8 mg/day (max: 8 mg/day)

silodosin (Rapaflo) PO: 8 mg once daily with a meal

terazosin (Hytrin) PO: 1–5 mg/day (max: 20 mg/day)

• Prototype drug: finasteride (Proscar)

• Adverse effects: sexual dysfunction

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