NSG 225_Chapter 57_EDBPH_audio

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Chapter 57:

Chapter 57 Drugs for Male reproductive disorders

Erectile Dysfunction:

Erectile Dysfunction ED – a lso known as impotence A persistent inability to achieve or sustain an erection suitable for satisfactory sexual performance ED commonly associated with chronic illnesses Risk for ED increases with advancing age

Treatment for ED:

Treatment for ED Drugs Oral agents – PDE5 inhibitors Sildenafil, vardenafil, and tadalafil Psychotherapy Surgical implantation of penile prosthesis

Sildenafil (Viagra):

Sildenafil (Viagra) Phosphodiesterase type 5 (PDE5) inhibitor I Only enhances normal erectile response in the presence of stimuli No significant impact on men who do not have ED Not approved for women 2005 approved as Revatio to treat pulmonary arterial hypertension

Sildenafil (Viagra):

Sildenafil (Viagra) Adverse effects Hypotension: *NO organic nitrates *Alpha blockers: cause symptomatic postural hypotension Priapism: an erection lasting for more than 4 hours….. Rare side effects Nonarteritic ischemic optic neuropathy: painless visual loss with optic disc swelling. Sudden hearing loss

Sildenafil (Viagra):

Sildenafil (Viagra) Drug should be used with caution by men with the following conditions: MI, stroke, and life-threatening dysrhythmia within the last 6 months Heart failure Unstable angina Sildenafil should not be used at all by men taking nitroglycerin or any other drug in the nitrate family

Vardenafil (Levitra):

Vardenafil (Levitra) Relaxes arterial and trabecular smooth muscle in the penis Adverse effects Headache and flushing Rhinitis and dyspepsia Can lower blood pressure Can also be associated with vision loss from nonarteritic ischemic optic neuropathy (NAION) Drug interactions Nitrates Could cause life-threatening hypotension Alpha blockers Can cause symptomatic postural hypotension

Tadalafil (Cialis):

Tadalafil (Cialis) PDE5 inhibitor II Relaxes the penile and arterial and trabecular smooth muscle Effects last up to 36 hours (longest of the three PDE5 inhibitors) Adverse effects Can also be associated vision loss from NAION Drug interactions Nitrates

Benign Prostatic Hyperplasia:

Benign Prostatic Hyperplasia BPH is a non-cancerous enlargement of the prostate Caused by excessive growth of epithelial (glandular) cells and smooth muscle cells –

Symptoms of bladder outlet obstruction caused by BPH include: :

Symptoms of bladder outlet obstruction caused by BPH include: Hesitancy Weakness of urinary stream Intermittent urinary stream A feeling of incomplete bladder emptying and need for repeat voiding Bladder ‘irritability,’ as manifested by urinary frequency and urinary urgency 10

Benign Prostatic Hyperplasia:

Benign Prostatic Hyperplasia Treatment modalities Surgery Drug therapy 5-Alpha-reductase inhibitors (mechanical obstruction) Finasteride Dutasteride Alpha1-adrenergic antagonists (dynamic obstruction)

Finasteride (Proscar):

Finasteride (Proscar) 5-α-reductase inhibitors: finasteride (Proscar) and dutasteride (Avodart) Works by inhibiting the enzyme that normally converts testosterone to 5-a-dihydrotestosterone DHT  Block the effects of endogenous androgens Used to treat benign prostatic hypertrophy (BPH)

5-α-reductase inhibitors: Proscar:

5-α- reductase inhibitors: Proscar May also be used for treatment of male-pattern baldness ( propecia ) Adverse effects Loss of libido, loss of erection, ejaculatory dysfunction 13

Special Considerations: finasteride (Proscar) :

Special Considerations : finasteride ( Proscar ) Pregnancy category X teratogenic to pregnancy Pregnant women should not handle crushed or broken finasteride tablets 14

Alpha1-Adrenergic Antagonists:

Alpha 1 -Adrenergic Antagonists Four are approved for treatment of BPD Teraz osin (Hytrin) Doxaz osin (Cardura) Tamsul osin (Flomax) Alfuz osin (Uroxatral) Alpha-blockers relax the smooth muscle tissue in the prostate and the opening to the bladder Impact on blood pressure: HYPOTENSION

Herbal::

Herbal: Saw palmetto “ natural” tx for Benign prostatic hyperplasia Men should see a primary care provider for diagnosis of BPH Well tolerated…. BUT the long-term effectiveness and ability to prevent complications are not currently known

Androgens: ATI book :

Androgens: ATI book Testosterone : responsible for normal development and maintenance of the primary and secondary male sex characteristics Androgen : Any hormone with testosterone-like actions Anabolic steroids initially used in medicine to treat hypogonadism – a condition in which testes produce abnormally low testosterone levels 17

Current uses: :

Current uses: 18 Serving medicinal purposes (treating delayed puberty, impotence and muscle deterioration brought upon by HIV infection) Athletic manipulation and taboo.

Side effcts:

Side effcts Mild – increased sexual drive, acne, increased body hair , aggressive behavior. Prolonged use interferes with ability to naturally produce testosterone testicular atrophy Chronic abuse: hypertension , retention of Na & K, hyperlipidemia, liver damage , erythropoietic effect that it stimulates the production of RBC ( polycthemia vera ) . 19