NUR 221- Men's Health

follicle-stimulating hormone (FSH)

initiates spermatogenesis

Luteinizing hormone (LH)

stimulates testosterone production

Testosterone

maturation of sperm, sex characteristics, protein metabolism, muscle development

major endogenous androgen

major endogenous androgen: Testosterone

Androgens most noted for their ability to promote…

expression of male sex characteristics

primary clinical application of androgens

management of androgen deficiency in males

principal adverse effects of androgens

virilization and hepatotoxicity

virilization

overproduction of androgens

• development of male sex characteristics

anabolic effect of testosterone

skeletal muscle

erythropoietic effects of testosterone

• synthesis of erythropoietin

• men have higher hematocrit than women

clinical pharmacology of androgens (testosterone)

delayed puberty

• patient takes until initial signs of puberty begin

  • enlargement of testes is first sign of puberty

Adverse effects of androgens (testosterone)

• virilization in women, girls and boys

• premature epiphyseal closure (hinders growth)

• prostate cancer

• abuse potential (athletic performance)

androgens preparations for males

• IM T esters

• transdermal T patches

• transdermal T gels

• transdermal T under arms

Androgen/Testosterone (Anabolic Steroid) abuse by athlete significant risks

• hypertension, suppression of release of LH and FSH, testicular shrinkage, sterility, gynecomastia, acne, reduced HDL, increase in LDL

• renal damage

• intensified aggression

Amendment to the Controlled Substances Act

schedule III drugs are defined as those with a low to moderate potential for dependence

Benign Prostatic Hypertrophy (BPH)

• prostate becomes huge and obstructs urination

• hyperplasia of prostatic tissue

• compression of urethra and urinary obstruction

• related to estrogen-testosterone imbalance

  • DOES NOT PREDISPOSE PROSTATIC CARCINOMA (cancer)

Continuation of Benign Prostatic Hypertrophy (BPH)

• leads to frequent infections

• continued obstruction causes distended bladder, dilated ureters, hydronephrosis, and renal failure if untreated

S&S of BPH

• hesitancy to start flow

• dribbling

• decreased flow strength

• increased frequency and urgency

• nocturia

BPH treatment

• Dutasteride (Avodart)- slows enlargement

• Tamsulosin (Flomax)- smooth muscle relaxer

• Combo of Finasteride (Proscar) and Doxazosin (Cardura)- reduces progression of hypertrophy

• Surgery

Tamsulosin (Flomax)

may cause sudden drop in BP

Acute bacterial prostatitis

gland is tender + swollen, urine and secretions contain bacteria

Nonbacterial prostatitis

urine and secretions contain large numbers of leukocytes

Chronic bacterial prostatitis

gland only slightly enlargement, dysuria, frequency and urgency

Erectile Dysfunction

• sign of physical or psychological condition

• can be secondary to other conditions

• can be caused by medications

• relationship strain

• poor self-esteem

Drugs that cause ED

• HTN meds (beta blockers, thiazide and loop diuretics)

• Antidepressants

• Anti-hyperlipidemics

Main drugs to treat ED

• Phosphodiesterase (PDE) inhibitors

• Sildenafil (Viagra)

Other drugs to treat ED

• Vardenafil (Levitra)

• Tadalafil (Cialis)

  • similar to viagra but longer duration of action

  • Sildenafil and Tadalafil also used to treat pulmonary hypertension

MAIN

Phosphodiesterase (PDE) inhibits adverse effects

Priapism

• erection lasts > 4 hours

  • may cause ischemia

• seek medical attention

• aspiration

OTHER

Phosphodiesterase (PDE) inhibits adverse effects

Nitrates (nitroglycerine)

• nitrates are contraindicated in patients taking PDE inhibitors

  • may be given in emergency situations if at least 24-48 hours after last dose of PDE inhibitor medications

Alprostadil (caverject)

administered by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra