McKenna's Pharmacology for Nursing, 2e

631

C H A P T E R 4 1 Drugs affecting the male reproductive system

Therapeutic actions and indications Anabolic steroids promote body tissue-building pro- cesses, reverse catabolic or tissue-destroying processes and increase haemoglobin and red blood cell mass. Indic­ ations for particular anabolic steroids vary with the drug (see Table 41.2). They can be used to treat anaemias, certain cancers and angio-oedema, to promote weight gain and tissue repair in debilitated people, and protein anabolism in individuals who are receiving long-term corticosteroid therapy. Anabolic steroids are also known to be used illegally for the enhancement of athletic performance by promot- ing increased muscle mass, increased haematocrit and, theoretically, an increase in strength and endurance. The adverse effects of these drugs can be deadly when they are used in the amounts needed for enhanced athletic performance (see Adverse effects). Pharmacokinetics Like the androgens, the anabolic steroids are well absorbed and widely distributed throughout the body. They are metabolised in the liver and excreted in the urine. Anabolic steroids are contraindicated for use in pregnancy because of adverse effects on the male fetus. It is not known whether anabolic steroids enter breast milk, but because of the potential for adverse effects, another method of feeding the baby should be used if these drugs are needed during breastfeeding. Contraindications and cautions These drugs are contraindicated in the presence of any known allergy to anabolic steroids; during pregnancy and breastfeeding because of potential masculinisation in the neonate ; and in the presence of liver dysfunction because these drugs are metabolised in the liver and are known to cause liver toxicity , coronary disease because of cholesterol-raising effects through effects on the liver or prostate or breast cancer in males. Adverse effects In prepubertal males, adverse effects include virili- sation (e.g. phallic enlargement, hirsutism, increased skin pigmentation). Postpubertal males may experience

■■ Androgens are the male sex hormones that are responsible for the development and maintenance of male sex characteristics and secondary sex characteristics or androgenic effects. ■■ Androgens are used for replacement therapy or to block other hormonal effects. ANABOLIC STEROIDS The anabolic steroids are analogues of testosterone that have been developed to produce the tissue-building effects of testosterone with less androgenic effect. Nan- drolone is an available form for the management of acute and chronic renal failure and associated anaemia. ■ ■ Monitor liver function periodically with long-term therapy, and arrange to discontinue the drug at any sign of hepatic dysfunction. ■ ■ Provide thorough teaching, including measures to avoid adverse effects, warning signs of problems and the need for regular evaluation, including blood tests. Instruct a family member or caregiver in proper preparation and administration techniques as appropriate to enhance knowledge about drug therapy and to promote compliance with the drug regimen. Evaluation ■ ■ Monitor for adverse effects (androgenic effects, cardiac effects, serum electrolyte imbalance, headache, sleep disturbances, rash, hepatocellular carcinoma). plan (person can name drug, dosage, adverse effects to watch for and specific measures to avoid them; family member or caregiver can demonstrate proper technique for preparation and administration of the drug as appropriate). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen. ■ ■ Monitor response to the drug. ■ ■ Evaluate the effectiveness of the teaching KEY POINTS

TABLE 41.2

DRUGS IN FOCUS Anabolic steroids

Drug name

Dosage/route

Usual indications

Nitrates nandrolone (Deca-Decabolin)

25–150 mg/week by deep IM injection

Treatment of acute renal failure, chronic renal insufficiency or associated anaemia, management of inoperative breast cancer, osteoporosis, aplastic anaemia; promotion of catabolism with prolonged corticosteroid use