McKenna's Pharmacology for Nursing, 2e

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

■ ■ Monitor endocrine function, hepatic function and serum electrolytes before and periodically during therapy so that dose can be adjusted appropriately and severe adverse effects can be avoided. ■ ■ Arrange for radiography of the long bones of children every 3 to 6 months so that the drug can be discontinued if bone growth reaches the norm for the child’s age. ■ ■ Provide thorough teaching, including measures to avoid adverse effects and warning signs of problems, as well as the need for regular evaluation, including blood tests, to enhance knowledge about drug therapy and to promote compliance with the drug regimen. Evaluation

■ ■ Monitor for adverse effects (androgenic effects, serum electrolyte disturbances, epiphyseal closure, hepatic dysfunction, personality changes, cardiac effects). ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug, dosage, adverse effects to watch for and specific measures to avoid them). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen.

KEY POINTS

■■ Anabolic steroids are testosterone analogues with more anabolic or protein-building effects than androgenic effects. ■■ Deadly effects may result from the abuse of anabolic steroids by athletes trying to build muscle mass and improve performance.

■ ■ Monitor response to the drug (increase in haematocrit, protein anabolism).

CRITICAL THINKING SCENARIO Adverse effects of anabolic steroids

THE SITUATION Senior nursing student K.S. recently became engaged. Her fiancé is a university senior who is training as a javelin thrower in hopes of competing in the Olympics. K.S. noticed that her fiancé had been suffering from GI upset for the last 3 weeks and more recently had developed tremors and muscle cramps. K.S. first suspected that he was suffering from a viral infection, but when the symptoms did not resolve, she became concerned. K.S. tried to get her fiancé to see a doctor, but he refused. Eventually, he admitted that he had begun using anabolic steroids to develop his muscles and improve his athletic prowess. He said that the friend who gave him the drugs told him that stomach upset was normal. He refuses to see a doctor because he knows that the use of these drugs is illegal. He believes that using the anabolic steroids for a while will put him closer to his goal. K.S. accepts his explanation but is upset about the use of anabolic steroids. She consults with her clinical instructor about the effects of these drugs. CRITICAL THINKING What does K.S. need to know? Think about the systemic effects of anabolic steroids and the possible long-term effects from their abuse. What implications do these effects have for the athlete? Consider the concern that K.S. must be experiencing. Suggest ways for K.S. to share the information about the actual effects of anabolic steroids with her fiancé and still cope with her own feelings and concerns.

What are the ethical and legal issues involved when a heathcare provider knows about illegal drug use and abuse? Outline a plan for helping K.S. and her fiancé cope with this issue and its implications for their futures. DISCUSSION Use of anabolic steroids is illegal in almost all organised athletic contests. Random drug testing is done to rule out use of these and other drugs. Not surprisingly, K.S. feels insecure about her fiancé’s decision. She needs to know that her discussion will be confidential and that she will receive support for her concerns and her fears. K.S. needs to review the effects of anabolic steroids. Although they do promote muscle development, there has never been any evidence that they actually improve athletic performance. The potential adverse effects of these drugs can be deadly, especially if K.S.’s fiancé is receiving the drugs from a friend and has no medical evaluation or dosage guidance to reduce the risk. Personality changes, cardiomyopathy, liver cancer and impotence are just a few of the possible adverse effects. K.S. is in a precarious position. She does not want to interfere with her fiancé’s dreams or cause problems in their relationship. She should be encouraged to explain the adverse effects of the drugs to her fiancé, pointing out that he is already experiencing some of them. Adverse effects associated with the drugs can ultimately interfere with, not enhance, his athletic performance. She might be encouraged to practise what she will tell her fiancé and to seek other support as needed.