Men’s Fertility Drugs – Flashcards

Androgens, also known as the male sex hormones, are produced in the testes, ovaries, and adrenal cortex. Androgens play a part in the growth and management of male sex characteristics, including sexual organs (accessory) and processes and bone and muscle growth. Androgens also control the development and maintenance of cellular metabolism. Testosterone is the primary androgen.

Testosterone is an anabolic steroid that is produced primarily in the testes, although small amounts are produced in the adrenal cortex. Low levels of testosterone in males are associated with low libido, impotence, decreased muscle tone, and testicular atrophy. Since the receptor types that facilitate androgenic (androgen) and anabolic (anabolic steroid) actions for testosterone-like compounds are the same, separating testosterone-like compounds into separate classes is unnecessary; therefore, they will be referred to collectively as androgens.

Testosterone is directly related to the expression of male sex characteristics and plays a key role in health and well-being. Effects of testosterone occur in males through activation of the androgen receptor, either directly by testosterone or by dihydrotestosterone (DHT), the active form of testosterone.

estosterone activates the androgen receptors (NR3A) through the following actions: Testosterone is transported to the cytoplasm of a cell Testosterone binds to the cell's androgen receptors or is reduced to DHT (DHT binds more strongly); reactions are dependent upon specific receptors in the cytoplasm Testosterone moves to the nucleus of the cell and affects the DNA, promoting production of messenger RNA molecules Proteins are created and cellular tissue builds up (anabolism) Secondary characteristics develop: hair growth in the pubic area, face, and body, lowered voice, bigger muscles, baldness, red blood cell formation, bone development

Treatment of conditions related to androgen deficiency Hypogonadism: Testosterone used as replacement therapy Condition where testes produce inadequate amounts of testosterone Most common reason for androgen therapy Puberty is delayed until treatment with long-acting parenteral dose is started Testicular failure: Testosterone used as replacement therapy Treatment improves libido, ejaculation amount and secondary characteristics Treatment does not reverse infertility Delayed puberty Other Uses COPD and AIDs: Testosterone may slow the decline of patients with these muscle wasting diseases

The nurse should be knowledgeable about the pharmacokinetics of testosterone in order to provide safe patient care. Secretion of testosterone happens in both men and women; however, the amount is much greater in men. Only 2% of testosterone is unbound, and it is this portion that is active. This percentage is lower for women due to their higher estrogen levels (estrogen causes increased production of sex hormone-binding globulin or SHBG). Oral administration of testosterone requires higher doses to account for the loss of up to 50% of the drug when it is metabolized by the liver. Oral doses are only available for synthetic androgens because these have a longer half-life. The onset and peak of testosterone IM are currently unknown. The duration is 2-4 weeks. Route: IV Absorption: well Distribution: 2% unbound Elimination half-life: 10-100 min Elimination: urine, bile

Sexual processes Cellular metabolism Bone and muscle growth Development of male secondary sexual characteristics

testes adrenal cortex

testosterone

It is important for the patient to be properly assessed before beginning testosterone replacement therapy. The following information is vital for successful therapy and should be included in the baseline assessment. Ask why androgen therapy is necessary for this patient. Ask what the patient thinks about androgen therapy. Record the patient's weight, BP, liver, and thyroid function. Draw labs, including Hgb, hct, glucose, creatinine, lipids and electrolytes, and blood count. Ask if the patient is on any anticoagulation therapy. Evaluate the patient's affect. Some patients on large doses of testosterone may become more aggressive.

There are several contraindications for testosterone. In particular, older male patients on androgen therapy have an increased risk of benign prostatic hypertrophy and prostate cancer. Contraindications: Nephrosis Hypercalcemia Pituitary insufficiency Benign prostatic hypertrophy Hepatic dysfunction Prostate cancer History of myocardial infarction Cautions: high blood pressure, high cholesterol, heart disease, kidney disease, and seizure disorders.

Labs for patients receiving androgen therapy may show elevated serum cholesterol, bun, and creatinine levels, elevated hematocrit, elevated liver function, or elevated urine 17-ketosteroids (by-product of the breakdown of androgens). Look at chart

Administration: Administer deep into the gluteal muscle Shake or warm the vial to break up any crystals that have formed in long-acting solutions Dosage: Testosterone cypionate or enanthate (used for prolonged therapy) = 40-500 mg every 2-4 weeks

apply to gums and hold until administration adheres; adhesion can take up to 30 seconds Remove old administration before a new one is applied Caution patient not to chew or swallow buccal administrations Dosage: Striant = 30 mg every 12 hours

Apply to back, abdomen, upper arms, or thighs (avoid bony prominences and scrotum) Change site every 7 days Inform patient that hypogonadism returns within 24 hours of removing the patch Dosage: Androderm and Testoderm TTS Patch = 4 mg/day (adjust dose based on testosterone levels)

Apply to both axillary (under arm) areas around the same time each morning Avoid getting the site wet or washing within the first two hours after application Wait until completely dry, as medication can be transferred to other persons via skin or clothing contact Do not apply to genitals Dosage: Axiron = 60 mg once a day

The nurse should be aware of the adverse effects associated with testosterone therapy. Adverse effects include: Hypercalcemia; drug therapy should be discontinued if patient shows signs of hypercalcemia Infrequent effects, such as polycythemia, lower extremity edema, dizziness, headaches, skin rash, depression, bleeding, chills, and muscle cramps Hepatic carcinoma (seen with select long-term therapy androgens) Elevated serum cholesterol, hematocrit, and thyroid levels Rare complications, such as hepatic peliosis (blood-filled cysts), necrosis, tumors, leucopenia Altered mood, aggressiveness

The nurse should monitor the following in the patient taking replacement testosterone: daily weights, I;O, changes in BP and lab values, protein intake and calories, sleep patterns, and signs of injection site infection or allergic reaction. The following interventions may be needed based on evaluation of the patient: Report weight gain of more than 5 lbs in a week and check for edema. Adjust dosage to keep testosterone levels within the normal range. Discontinue treatment if the patient shows signs of hypercalcemia. Make changes to the plan of care when necessary.

Medication should be taken just as prescribed; patient compliance is essential for successful treatment. Expected side effects and those that would require the patient to be seen by a medical professional should be explained to the patient. Patient monitoring at a health care facility is necessary throughout the course of treatment. Attention should be paid to changes in muscle strength. Assessment of the area of the gums where buccal administrations have been placed is necessary.

A diet that includes essential nutrients is important for patients taking testosterone therapy. Weekly body weights should be obtained and the patient should be monitored for edema; if edema occurs then sodium intake should be decreased. Increased fluid intake can help prevent kidney stones in patients with high calcium levels.

Oral forms of testosterone should be taken with food.

Side effects of testosterone include: Priapism: frequent erections (seen in patients with hypogonadism) Reduced dose may be required Gynecomastia: enlarged mammary glands Low urine output Patient should be assessed for prostatic hypertrophy Other side effects: GI disturbances, insomnia, low libido, acne Side effects of prolonged use include: Stopped spermatogenesis (formation of spermatozoa) Oligospermia: low sperm count Asthenospermia: low sperm motility

Not all people have the same beliefs about sexuality and the expression of it. Be considerate of the different cultural views related to the use of fertility treatment drugs. Consider the following: How does the patient feel about sexual expression? What does the patient think about different types of relationships? Does the patient's culture prevent him from talking about sexual subjects or showing any body parts?

the dose of warfarin will be decreased

Let the solution completely dry before coming into close contact with someone.

Older male patients are at an increased risk for prostate cancer.

aggression

edema may occur weekly body weights will be obtained monitoring is necessary throughout treatment

bucally transdermally

secondary exposure to testosterone

urinary problems priapism respiratory distress

impotence decreased libido decreased muscle tone

hypogonadism adult testicular failure delayed puberty in adolescents

2-4 wks

developing male sex organs

oral testosterone is metabolized quickly

anticoagulants

blood glucose

cholesterol thyroid liver function hematocrit

apply to the gums remove the old patch before applying the new one

drink adequate fluids take with food do not chew tablet

prostatic hypertrophy

decrease in medication dose