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P A R T 7
Drugs acting on the reproductive system
Contraindications and cautions
These drugs are contraindicated with any known allergy
to the drug or ingredients in the drug; during pregnancy
and breastfeeding
because of potential adverse effects on
the male neonate
(another method of feeding the baby
should be used if these drugs are needed during breast-
feeding)
;
and in the presence of prostate or breast cancer
in men,
which could be aggravated by the testosterone
effects of the drugs
. They should be used cautiously in
the presence of any liver dysfunction or cardiovascular
disease
because these disorders could be exacerbated by
the effects of the hormones.
Adverse effects
Androgenic effects
include acne, oedema,
hirsutism
(increased hair distribution), deepening of the voice,
oily skin and hair, weight gain, decrease in breast
size and testicular atrophy. Anti-oestrogen effects—
flushing, sweating, vaginitis, nervousness and emotional
lability—can be anticipated when these drugs are used
with women. Other common effects include headache
(possibly related to fluid and electrolyte changes), dizzi-
ness, sleep disorders and fatigue, rash and altered serum
electrolytes. A potentially life-threatening effect that
has been documented is hepatocellular cancer. This may
occur because of the effect of testosterone on hepatic
cells. People on long-term therapy should have hepatic
function tests monitored regularly—before beginning
therapy and every 6 months during therapy.
Clinically significant drug–laboratory test
interferences
While a person is taking androgens, there may be
decreased thyroid function, as well as increased cre-
atinine clearance, results that are not associated with
disease states. These effects can last up to 2 weeks after
the discontinuation of therapy.
Prototype summary: Testosterone
Indications:
Replacement therapy in hypogonadism,
inoperable breast cancer.
Actions:
Primary natural androgen, responsible
for growth and development of male sex organs
and maintenance of secondary sex characteristics;
increases the retention of nitrogen, sodium,
potassium and phosphorus; decreases urinary
excretion of calcium; increases protein anabolism;
stimulates red blood cell production.
Pharmacokinetics:
Route
Onset
Peak
IM
Slow
1–3 days
IM cypionate
Slow
2–4 weeks
IM enanthate
Slow
2–4 weeks
Dermal
Rapid
24 hours
T
1/2
:
10 to 100 minutes, with hepatic metabolism
and excretion in the urine and faeces.
Adverse effects:
Dizziness, headache, sleep disorders,
fatigue, rash, androgenic effects (acne, deepening
voice, oily skin), hypo-oestrogenic effects (flushing,
sweating, vaginitis), polycythaemia, nausea,
hepatocellular carcinoma.
Care considerations for
people receiving androgens
Assessment: History and examination
■
■
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 breastfeeding
to avoid
potential adverse effects on the male fetus or
baby
; hepatic dysfunction
to avoid the risk of
hepatocellular disorders
; and cardiovascular
disease and breast or prostate cancer in men,
which
could be aggravated by the drug
.
■
■
Perform a physical assessment
to determine
baseline status before beginning therapy and for
any potential adverse effects
.
■
■
Assess skin colour, lesions, texture and hair
distribution
to monitor for drug effects on the
body and potential adverse effects.
■
■
Monitor affect, orientation and peripheral
sensation
to assess central nervous system (CNS)
effects related to drug use.
■
■
Perform abdominal examination and serum
electrolytes, serum cholesterol and liver function
tests
to monitor for potential effects on liver
function.
■
■
Arrange for radiography of the long bones in
children
to assess for testosterone effects on
growth.
Implementation with rationale
■
■
Reconstitute the drug according to the
manufacturer’s directions
to ensure proper
reconstitution and to administer as prescribed.
■
■
Remove any old dermal system before applying
a new system to clean, dry, intact skin
to ensure
accurate administration and decrease risk of toxic
levels.
■
■
Monitor response carefully when beginning therapy
so that the dose can be adjusted accordingly.
