McKenna's Pharmacology for Nursing, 2e

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P A R T 7  Drugs acting on the reproductive system

TEACHING FOR K.S. If the person is taking these drugs to increase body mass following severe weight loss due to trauma, you would teach about the following. Sharing this information with those considering the unprescribed use of the drugs might be helpful. • Androgens or anabolic steroids have properties similar to those of the male sex hormones. Because the formulations have widespread effects, there are often many adverse effects associated with their use. • These drugs are controlled substances because the tendency for people, and athletes in particular, to abuse them can cause serious medical problems. When the drug is used as prescribed, it is safe, but you will need to be monitored. • Some of the following adverse effects may occur: • GI upset, nausea, vomiting: Taking the drug with food usually helps to relieve these effects. • Acne: This is a hormonal effect; washing your face regularly and avoiding oily foods may help. • Increased facial hair, decreased head hair: These are hormonal effects; if they become bothersome, consult with your healthcare provider. • Menstrual irregularities (women): This is a normal effect of the androgens; if you suspect that you might be pregnant, consult with your healthcare provider immediately. • Weight gain, increased muscle development: These are common hormonal effects. • Change in sex drive: This can be distressing and difficult to deal with; consult with your healthcare provider if this is a serious concern. • Report any of the following to your healthcare provider: swelling in fingers or legs; continual erection; uncontrollable sex drive; yellowing skin; fever, chills or rash; chest pain or difficulty breathing; hoarseness, loss of hair or growth of facial hair (women). • Tell any doctor, nurse or other healthcare provider involved in your care that you are taking this drug. • Take this medicine only as directed. In addition schedule regular medical follow-up, including blood tests, to monitor your response to this drug. • Keep this drug and all medications out of the reach of children. Do not give this medication to anyone else or take any similar medication that has not been prescribed for you.

DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION Penile erectile dysfunction is a condition in which the corpus cavernosum does not fill with blood to allow for penile erection. This can result from the ageing process The sale or distribution of anabolic steroids without a prescription is illegal, and this fact further complicates the situation for K.S. Because she is planning to become a healthcare provider, she may be obliged by law to report this information to the authorities. K.S. should research these issues and discuss them further with her clinical instructor and other resource people. CARE GUIDE FOR K.S.: ANDROGENS, ANABOLIC STEROIDS A person receiving an anabolic steroid for a medical condition would have the following care plan: Assessment: History and examination Assess the person’s health history for allergies to any steroids; breast cancer or prostate cancer in men; hepatic dysfunction; coronary artery disease; pregnancy or breastfeeding in women; or concurrent use of insulin or oral anticoagulants. Focus the physical examination on the following: Neurological: orientation, reflexes, affect Skin: colour, lesions, hair CV: pulse, cardiac auscultation, blood pressure, oedema GI: abdominal examination, liver examination Laboratory tests: serum electrolytes, hepatic function tests, long-bone X-ray studies Implementation Administer as prescribed. Monitor liver function before and periodically during therapy. Monitor response and adjust dose as appropriate. Provide support and reassurance to deal with drug therapy. Provide teaching regarding drug name, dosage, adverse effects, precautions, warnings to report and safe administration. Evaluation Evaluate drug effects: maintenance of male sex characteristics, suppression of breastfeeding in women. Monitor for adverse effects: androgenic effects, hypo- oestrogenic effects, hepatic dysfunction, electrolyte imbalance, endocrine changes. Monitor for drug–drug interactions: decreased need for insulin, increased bleeding with oral anticoagulants. Evaluate the effectiveness of the teaching program and comfort and safety measures.

and in vascular and neurological conditions. Two very different types of drugs are approved for the treatment of this condition. These include the prostaglandin alprosta- dil ( Caverject ) and the phosphodiesterase type 5 (PDE5) receptor inhibitors sildenafil ( Viagra , also available as Revatio for the treatment of pulmonary hypertension),