McKenna's Pharmacology for Nursing, 2e

637

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

serious cardiovascular effects, including death, have occurred. There is also a possibility of increased varde- nafil or tadalafil levels and effects if PDE5 inhibitors are taken with ketoconazole, itraconazole or erythromycin; monitor the person and reduce dose as needed. Vardenafil and tadalafil serum levels can increase if these drugs are combined with indinavir or ritonavir. If these drugs are being used, limit the dose of the PDE5 inhibitor.

■■ Penile erectile dysfunction can inhibit erection and male sexual function. ■■ Alprostadil, a prostaglandin, can be injected into the penis to stimulate erection. ■■ The PDE5 inhibitors are oral agents that act quickly to promote vascular filling of the corpus cavernosum and promote penile erection. They differ in duration and time of onset. They are effective only in the presence of sexual stimulation. CHAPTER SUMMARY ■■ Androgens are male sex hormones—specifically testosterone or testosterone-like compounds. ■■ Androgens are responsible for the development and maintenance of male sex characteristics and secondary sex characteristics or androgenic effects. ■■ Side effects related to androgen use involve excess of the desired effects, as well as potentially deadly hepatocellular carcinoma. ■■ Androgens can be used for replacement therapy or to block other hormone effects, as is seen with their use in the treatment of specific breast cancers. ■■ Anabolic steroids are analogues of testosterone that have been developed to have more anabolic or protein-building effects and fewer androgenic effects. potentially serious cardiovascular drug–drug interactions. ■ ■ Provide thorough teaching, including measures to avoid adverse effects and warning signs of problems, as well as the need for regular evaluation, to enhance knowledge about drug therapy and to promote compliance with the drug regimen. Evaluation ■ ■ Monitor response to the drug (improvement in penile erection). ■ ■ Monitor for adverse effects (dizziness, flushing, local inflammation or infection, fibrosis, diarrhoea, dyspepsia). ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug, dosage, adverse effects to watch for and specific measures to avoid them; person can demonstrate proper administration of injected drug). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen. KEY POINTS

Care considerations for people receiving drugs to treat penile erectile dysfunction

Assessment: History and examination

■ ■ Assess for the following conditions, which could be cautions or contraindications to the use of the drug: history of allergy to any of the preparations, penile structural abnormalities, penile implants, bleeding disorders, active peptic ulcer, coronary artery disease, hypotension or severe hypertension, congenital prolonged QT interval or severe hepatic or renal disorders. ■ ■ Assess baseline status before beginning therapy to determine any potential adverse effects. ■ ■ Assess skin and lesions to monitor for adverse reactions to the drug and cardiovascular perfusion. ■ ■ Monitor orientation, affect and reflexes to evaluate CNS changes that might be related to changes in blood pressure and blood flow. ■ ■ Assess blood pressure, pulse, respiration and adventitious sounds to evaluate blood flow and potential changes in cardiovascular function. ■ ■ When using alprostadil, perform a local inspection of the penis to assess local reaction to injection and to monitor for potential infection. ■ ■ Evaluate laboratory tests for bleeding time and liver function to monitor potential adverse effects on the liver. Implementation with rationale ■ ■ Assess the cause of dysfunction before beginning therapy to ensure appropriate use of these drugs. ■ ■ Monitor people with vascular disease for any sign of exacerbation so that the drug can be discontinued before severe adverse effects occur. ■ ■ Instruct the person in the injection of alprostadil, storage of the drug, filling of the syringe, sterile technique, site rotation and proper disposal of needles to ensure safe and proper administration of the drug. ■ ■ Monitor people who are taking PDE5 inhibitors for use of nitrates or alpha-blockers to avert