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P A R T 7
Drugs acting on the reproductive system
DRUGS FOR TREATING PENILE ERECTILE
DYSFUNCTION
Penile erectile dysfunction
is a condition in which the
corpus cavernosum does not fill with blood to allow for
penile erection. This can result from the ageing process
and in vascular and neurological conditions. Two very
different types of drugs are approved for the treatment of
this condition. These include the prostaglandin alprosta-
dil (
Caverject
) and the phosphodiesterase type 5 (PDE5)
receptor inhibitors sildenafil (
Viagra
, also available as
Revatio
for the treatment of pulmonary hypertension),
The sale or distribution of anabolic steroids without
a prescription is illegal, and this fact further complicates
the situation for K.S. Because she is planning to become a
healthcare provider, she may be obliged by law to report
this information to the authorities. K.S. should research
these issues and discuss them further with her clinical
instructor and other resource people.
CARE GUIDE FOR K.S.: ANDROGENS, ANABOLIC
STEROIDS
A person receiving an anabolic steroid for a medical
condition would have the following care plan:
Assessment: History and examination
Assess the person’s health history for allergies to any
steroids; breast cancer or prostate cancer in men; hepatic
dysfunction; coronary artery disease; pregnancy or
breastfeeding in women; or concurrent use of insulin or
oral anticoagulants.
Focus the physical examination on the following:
Neurological: orientation, reflexes, affect
Skin: colour, lesions, hair
CV: pulse, cardiac auscultation, blood pressure, oedema
GI: abdominal examination, liver examination
Laboratory tests: serum electrolytes, hepatic function tests,
long-bone X-ray studies
Implementation
Administer as prescribed.
Monitor liver function before and periodically during
therapy.
Monitor response and adjust dose as appropriate.
Provide support and reassurance to deal with drug therapy.
Provide teaching regarding drug name, dosage, adverse
effects, precautions, warnings to report and safe
administration.
Evaluation
Evaluate drug effects: maintenance of male sex
characteristics, suppression of breastfeeding in women.
Monitor for adverse effects: androgenic effects, hypo-
oestrogenic effects, hepatic dysfunction, electrolyte
imbalance, endocrine changes.
Monitor for drug–drug interactions: decreased need for
insulin, increased bleeding with oral anticoagulants.
Evaluate the effectiveness of the teaching program and
comfort and safety measures.
TEACHING FOR K.S.
If the person is taking these drugs to increase body mass
following severe weight loss due to trauma, you would
teach about the following. Sharing this information with
those considering the unprescribed use of the drugs might
be helpful.
• Androgens or anabolic steroids have properties similar
to those of the male sex hormones. Because the
formulations have widespread effects, there are often
many adverse effects associated with their use.
• These drugs are controlled substances because the
tendency for people, and athletes in particular, to abuse
them can cause serious medical problems. When the
drug is used as prescribed, it is safe, but you will need to
be monitored.
• Some of the following adverse effects may occur:
•
GI upset, nausea, vomiting:
Taking the drug with food
usually helps to relieve these effects.
•
Acne:
This is a hormonal effect; washing your face
regularly and avoiding oily foods may help.
•
Increased facial hair, decreased head hair:
These are
hormonal effects; if they become bothersome, consult
with your healthcare provider.
•
Menstrual irregularities (women):
This is a normal effect
of the androgens; if you suspect that you might be
pregnant, consult with your healthcare provider
immediately.
•
Weight gain, increased muscle development:
These are
common hormonal effects.
•
Change in sex drive:
This can be distressing and difficult
to deal with; consult with your healthcare provider if this
is a serious concern.
• Report any of the following to your healthcare
provider: swelling in fingers or legs; continual erection;
uncontrollable sex drive; yellowing skin; fever, chills or
rash; chest pain or difficulty breathing; hoarseness, loss
of hair or growth of facial hair (women).
• Tell any doctor, nurse or other healthcare provider
involved in your care that you are taking this drug.
• Take this medicine only as directed. In addition schedule
regular medical follow-up, including blood tests, to
monitor your response to this drug.
• Keep this drug and all medications out of the reach of
children. Do not give this medication to anyone else or
take any similar medication that has not been prescribed
for you.
