Drugs for Male Reproductive System Nursing Considerations & Management

Notes

Drugs affecting the male reproductive system include androgens (male steroid hormones), anabolic steroids, and drugs that improve penile dysfunction.


Table of Common Drugs and Generic Names

Here is a table of commonly encountered drugs affecting the male reproductive system, their generic names, and brand names:

Classifications Generic Name Brand Name
Androgens danazol Danocrine
fluoxymesterone Androxyl
testosterone Androderm, Depo-testosterone, Striant, Androgel, Fortesta
methyltestosterone Testred, Virilon
Anabolic Steroids oxandrolone Oxandrin
oxymetholone Anadrol-50
Penile Erectile Dysfunction Drugs alprostadil Caverject, Muse
sildenafil Viagra, Revatio
tadalafil Cialis, Adcirca
vardenafil Levitra, Staxyn

Androgens

Description

Androgens are male sex hormones, which include testosterone (produced in the testes) and androgens (produced in the adrenal glands).

Testosterone (Duratest, Testoderm) is the primary natural androgen and is the classic androgen used today. It is used for treatment of certain breast cancers and hypogonadism, a condition where there is undeveloped testis. All testosterones are class III controlled substances.

Therapeutic Action

The desired and beneficial actions of androgens are as follows:

  • Growth and development of male sex organs and the maintenance of secondary male sex characteristics.
  • Increase the retention of nitrogen, sodium, potassium, and phosphorus and decrease the urinary excretion of calcium.
  • Increase protein anabolism and decrease protein catabolism.
  • Increase the production of red blood cells.
Indications

Androgens are indicated for the following medical conditions:

  • Danazol is used for treatment of endometriosis, fibrocystic breast disease, and hereditary angioedema. It does this by inhibiting the hypothalamic-pituitary-adrenal (HPA) and gonadotropin-releasing hormones (GnRH), leading to a drop in follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Pharmacokinetics

Here are the characteristic interactions of androgens and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Buccal Slow 10-12 h
IM Slow 1-3 d
IM cypionate Slow 2-4 wk
IM enanthate Slow 2-4 wk
Dermal Rapid 24 h
T1/2: 10-100 min
Metabolism: liver
Excretion: kidney (urine) and intestines (feces)
Contraindications and Cautions

The following are contraindications and cautions for the use of androgens:

  • Allergy to androgens or other ingredients in the drug. Prevent hypersensitivity reactions.
  • Pregnancy, lactation. Potential adverse effects on the neonate. It is not clear whether androgens enter breast milk.
  • Presence of prostate or breast cancer in men. Aggravated by the testosterone effects of the drug.
  • Liver dysfunction, CV disease. Can be exacerbated by the effects of the hormones.
  • Topical forms of testosterone have a Black Box Warning alerting user to the risk of virilization in children who come in contact with the drug from touching the clothes and skin of the man using the drug.
  • Danazol has Black Box warning regarding the risk of thromboembolic events, fetal abnormalities, hepatitis, and intracranial hypertension.
Adverse Effects

Use of androgens may result to these adverse effects:

  • Androgenic effects: acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decrease in breast size, and testicular atrophy.
  • Antiestrogen effects: flushing, sweating, vaginitis, nervousness, and emotional lability.
  • Common effects: headache (possibly related to fluid and electrolyte changes), dizziness, sleep disorders and fatigue, rash, and altered serum electrolytes.
  • A potentially life-threatening effect that has been documented is hepatocellular cancer.
Interactions

The following are drug-laboratory interactions involved in the use of androgens:

  • Decreased thyroid function
  • Increased creatinine and creatinine clearance (results that are not associated with disease states)
  • These effects can last up to 2 weeks after therapy has been discontinued.
Nursing Considerations

Here are important nursing considerations when administering this drug:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for the mentioned cautions and contraindications (e.g. drug allergy, hepatic dysfunction, CV diseases, breast/prostate cancer in men, etc.) to prevent any untoward complications.
  • Perform a thorough physical assessment (e.g. skin assessment, mental status, abdominal examination, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
  • Arrange for radiographs of the long bones in children to assess for testosterone effects on growth.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Disturbed body image related to androgenic effects
  • Sexual dysfunction related to androgenic effects

Implementation with Rationale

These are vital nursing interventions done in patients who are taking androgens:

  • Monitor responses carefully when beginning therapy so that the dose can be adjusted accordingly.
  • Remove an old dermal system before applying a new system to clean, dry, and intact skin to ensure accurate administration and decrease risk of toxicity.
  • Monitor liver function periodically with long-term therapy and arrange to discontinue the drug at any sign of hepatic dysfunction.
  • Provide thorough patient teaching (e.g. measures to avoid adverse effects, warning signs, need for regular evaluation, especially blood pressure, etc.) to enhance patient knowledge about drug therapy and to promote compliance with the drug regimen.
  • Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (e.g. onset of puberty, maintenance of male sexual characteristics, palliation of breast cancer, etc.).
  • Monitor for adverse effects (e.g. androgenic effects, hypoestrogen effects, serum electrolyte imbalance, headache, etc).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Anabolic Steroids

Description

Anabolic steroids are testosterone analogues that have been developed to produce the tissue-building effects of testosterone with less androgenic effect.

Therapeutic Action

The desired and beneficial actions of anabolic steroids are as follows:

  • Promote body tissue-building processes.
  • Reverse catabolic or tissue-destroying processes
  • Increase hemoglobin and red blood cell mass.
Indications

Anabolic steroids are indicated for the following medical conditions:

  • Anemias, certain cancers, and angioedema
  • Promote weight gain and tissue repair in debilitated patients and protein anabolism in patients who are receiving long-term corticosteroid therapy.
  • Also known to be used illegally for the enhancement of athletic performance by promoting increased muscle mass, hematocrit, strength, and endurance.
Pharmacokinetics

Here are the characteristic interactions of anabolic steroids and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
PO Slow
T1/2: 9 h
Metabolism: liver
Excretion: kidney (urine)
Contraindications and Cautions

The following are contraindications and cautions for the use of anabolic steroids:

  • Allergy to androgens or other ingredients in the drug. Prevent hypersensitivity reactions.
  • Pregnancy, lactation. Potential masculinization in neonates.
  • Liver dysfunction. Drug is metabolized in the liver and are known to cause hepatic toxicity.
  • Coronary disease. Potentional increase in cholesterol level through the effect of the drug on the liver.
  • Prostate/breast cancer in males. Exacerbated by the effects of these drugs.
Adverse Effects

Use of anabolic steroids may result to these adverse effects:

  • In prepubertal males: virilization (e.g. phallic enlargement, hirsutism, increased skin pigmentation).
  • In postpubertal males: inhibition of testicular function, gynecomastia, testicular atrophy, priapism (painful and continual erection of the penis), baldness, and change in libido.
  • In women: hirsutism, hoarseness, deepening of the voice, clitoral enlargement, baldness, menstrual irregularitie.
Interactions

The following are drug-drug interactions involved in the use of anabolic steroids:

  • Potential interaction with oral anticoagulants
  • Potentially decreased need for antidiabetic agents
  • Altered lipid metabolism and lack of effectiveness for lipid-lowering agents
Nursing Considerations

Here are important nursing considerations when administering this drug:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for the mentioned cautions and contraindications (e.g. drug allergy, pregnancy and lactation, CV diseases, etc.) to prevent any untoward complications.
  • Perform a thorough physical assessment (e.g. skin assessment, mental status, abdominal examination, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
  • Arrange for radiographs of the long bones in children to assess for testosterone effects on growth.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Disturbed body image related to systemic effects
  • Acute pain related to GI or CNS effects

Implementation with Rationale

These are vital nursing interventions done in patients who are taking androgens:

  • Administer with food if GI effects are severe to relieve GI distress.
  • Monitor endocrine and hepatic functions, serum electrolytes before and periodically during therapy so that dose can be adjusted appropriately and severe adverse effects can be avoided.
  • Provide thorough patient teaching (e.g. measures to avoid adverse effects, warning signs, need for regular evaluation, especially blood pressure, etc.) to enhance patient knowledge about drug therapy and to promote compliance with the drug regimen.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (e.g. increase in haematocrit, protein anabolism, etc.).
  • Monitor for adverse effects (e.g. androgenic effects, serum electrolyte disturbances, epiphyseal closure, hepatic dysfunction, etc).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Drugs For Treating Penile Erectile Dysfunction

Description

Penile erectile dysfunction is a condition in which the corpus cavernosum does not fill with blood to allow for penile erection.

Approved drugs for treatment of penile erectile dysfunction include prostaglandinalprostadil and phosphodiesterase type 5 (PDE5) receptor inhibitor sildenafil.

Therapeutic Action

The desired and beneficial actions of drugs for treatment of penile erectile dysfunction are as follows:

  • Alprostadil acts locally to relax the vascular smooth muscle and allow filling of the corpus cavernosum, causing penile erection.
  • PDE5 receptor inhibitors act to increase nitrous oxide levels in the corpus cavernosum. Nitrous oxide activates the enzyme cyclic guanosine monophosphate (cGMP) to cause smooth muscle relaxation and increased flow of blood.
Indications

Prostaglandin and PDE5 receptor inhibitors are indicated for the following medical conditions:

  • Treatment of penile erectile dysfunction.
Pharmacokinetics

Here are the characteristic interactions of drugs affecting the male reproductive system and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Buccal 15-30 min 30-120 min 4 h
T1/2: 4 h
Metabolism: liver
Excretion: kidney (urine) and intestines (feces)
Contraindications and Cautions

The following are contraindications and cautions for the use of these drugs:

  • Presence of any anatomical obstruction or condition that might predispose to priapism. The risk could be exacerbated by these drugs.
  • Penile implants.
  • Bleeding disorders, CV diseases, optic neuropathy, severe hepatic and renal disorders. 
Adverse Effects

Use of these drugs may result to these adverse effects:

  • Local effects associated with alprostadil: pain at injection site, infection, priapism, fibrosis, rash.
  • Effects associated with PDE5 inhibitors: headache, flushing, dyspepsia, urinary tract infection, diarrhea, dizziness, possible eight cranial nerve toxicity and loss of hearing.
  • A potentially life-threatening effect that has been documented is hepatocellular cancer.
Interactions

The following are drug-drug interactions involved in the use of these drugs:

  • Organic nitrates, alpha-adrenergic blockers. Serious CV effects, including death, have occurred.
  • Ketoconazole, itraconazole, erythromycin. Increased sildenafil levels.
Nursing Considerations

Here are important nursing considerations when administering this drug:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for the mentioned cautions and contraindications (e.g. drug allergy, penile implants, bleeding disorders, etc.) to prevent any untoward complications.
  • Perform a thorough physical assessment (e.g. skin assessment, mental status, vital signs, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
  • Evaluate laboratory tests for bleeding time and liver function to monitor potential adverse effects on the liver.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Disturbed body image related to drug effects
  • Sexual dysfunction related to drug effects

Implementation with Rationale

These are vital nursing interventions done in patients who are taking these drugs:

  • Assess the cause of dysfunction before beginning therapy to ensure appropriate use of these drugs.
  • Monitor patients with vascular disease for any sign of exacerbation so that the drug can be discontinued before severe adverse effects occur.
  • Monitor responses carefully when beginning therapy so that the dose can be adjusted accordingly.
  • Provide thorough patient teaching (e.g. measures to avoid adverse effects, warning signs, need for regular evaluation, especially blood pressure, etc.) to enhance patient knowledge about drug therapy and to promote compliance with the drug regimen.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (improvement of penile erection).
  • Monitor for adverse effects (e.g. dizziness, flushing, local inflammation or infection, fibrosis, diarrhea, etc.).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Practice Exam

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