McKenna's Pharmacology for Nursing, 2e

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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 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.

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.

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 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. ■ ■ Reconstitute the drug according to the