C H A P T E R 4 1
Drugs affecting the male reproductive system
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serious cardiovascular effects, including death, have
occurred. There is also a possibility of increased varde-
nafil or tadalafil levels and effects if PDE5 inhibitors are
taken with ketoconazole, itraconazole or erythromycin;
monitor the person and reduce dose as needed.
Vardenafil and tadalafil serum levels can increase if
these drugs are combined with indinavir or ritonavir.
If these drugs are being used, limit the dose of the PDE5
inhibitor.
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Penile erectile dysfunction can inhibit erection and
male sexual function.
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Alprostadil, a prostaglandin, can be injected into the
penis to stimulate erection.
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The PDE5 inhibitors are oral agents that act quickly
to promote vascular filling of the corpus cavernosum
and promote penile erection. They differ in duration
and time of onset. They are effective only in the
presence of sexual stimulation.
CHAPTER SUMMARY
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Androgens are male sex hormones—specifically
testosterone or testosterone-like compounds.
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Androgens are responsible for the development
and maintenance of male sex characteristics
and secondary sex characteristics or androgenic
effects.
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Side effects related to androgen use involve excess
of the desired effects, as well as potentially deadly
hepatocellular carcinoma.
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Androgens can be used for replacement therapy or to
block other hormone effects, as is seen with their use
in the treatment of specific breast cancers.
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Anabolic steroids are analogues of testosterone
that have been developed to have more anabolic
or protein-building effects and fewer androgenic
effects.
KEY POINTS
Care considerations for people receiving
drugs to treat penile erectile dysfunction
Assessment: History and examination
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Assess for the following conditions,
which could
be cautions or contraindications to the use of the
drug:
history of allergy to any of the preparations,
penile structural abnormalities, penile implants,
bleeding disorders, active peptic ulcer, coronary
artery disease, hypotension or severe hypertension,
congenital prolonged QT interval or severe hepatic
or renal disorders.
■
■
Assess baseline status before beginning therapy
to
determine any potential adverse effects.
■
■
Assess skin and lesions
to monitor for adverse
reactions to the drug and cardiovascular perfusion.
■
■
Monitor orientation, affect and reflexes
to evaluate
CNS changes that might be related to changes in
blood pressure and blood flow.
■
■
Assess blood pressure, pulse, respiration and
adventitious sounds
to evaluate blood flow and
potential changes in cardiovascular function.
■
■
When using alprostadil, perform a local inspection
of the penis
to assess local reaction to injection
and to monitor for potential infection.
■
■
Evaluate laboratory tests for bleeding time and
liver function
to monitor potential adverse effects
on the liver.
Implementation with rationale
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Assess the cause of dysfunction before beginning
therapy
to ensure appropriate use of these drugs.
■
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Monitor people with vascular disease for any
sign of exacerbation
so that the drug can be
discontinued before severe adverse effects occur.
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Instruct the person in the injection of alprostadil,
storage of the drug, filling of the syringe, sterile
technique, site rotation and proper disposal of
needles
to ensure safe and proper administration
of the drug.
■
■
Monitor people who are taking PDE5 inhibitors
for use of nitrates or alpha-blockers
to avert
potentially serious cardiovascular drug–drug
interactions.
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Provide thorough teaching, including measures
to avoid adverse effects and warning signs
of problems, as well as the need for regular
evaluation,
to enhance knowledge about drug
therapy and to promote compliance with the drug
regimen.
Evaluation
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Monitor response to the drug (improvement in
penile erection).
■
■
Monitor for adverse effects (dizziness, flushing,
local inflammation or infection, fibrosis, diarrhoea,
dyspepsia).
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects
to watch for and specific measures to avoid them;
person can demonstrate proper administration of
injected drug).
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Monitor the effectiveness of comfort measures and
compliance with the regimen.
