Pharm T4 (Mens Health & Nutritional Supplements)

Provision of food or nutrients through the GI tract either by eating or through a feeding tube in patients who are unable to eat.

What is enteral nutrition?

Oral consumption (Enteral)

What is the most common and least invasive route of nutritional support?

Designed to meet the basic macro & micro nutrient requirements for individuals who are unable to meet their nutritional needs orally.

Indication for enteral nutrition

GI intolerance, Manifesting as diarrhea.

Most common adverse effect of nutritional supplements?

-Elemental

-Polymeric

-Modular

-Altered amino acids.

4 most commonly used enteral formulations?

Enteral Supplements that contain dipeptides, tripeptides, or crystalline amino acids. Minimal digestion is required with elemental formulations (available without prescription)

Elemental Formulations:

Enteral Supplements that contain complex nutrients derived from proteins, carbs, and fat. The commonly used enteral nutritional polymeric form is Ensure.

Polymeric Formulations:

Contains Carbohydrate, Fat, and Protein

Modular Formulations:

-Contains varying amounts of specific amino acids, metabolic altered diseases.

-Used commonly in Pt’s who have metabolic disorders such as phenylketonuria, homocystinuria, or maple syrup urine disease. Also used to supply nutritional support to Pts with illnesses: kidney impairment, eclampsia… etc

Altered amino acids formulations:

-IV administration. whole GI is bypassed eliminating the need for absorption metabolism and excretion peripheral or central.

-Preferred method in patients who are unable to tolerate and maintain adequate enteral or oral intake.

Whats Total Parenteral Nutrition (TPN)?

IV directly into the circulatory, large central subclavian vein, and internal jugular.

How can TPN be administered?

Phlebitis- Inflammation of the vein can cause loss of limb and fluid overload.

Long-Term use of peripherally delivered TPN lead to?

anorexia, GI illness, post-op pt’s, mild deficits, or those who are restricted from oral intake.

Who could benefit from peripherally delivered TPN?

Short- term, less than 2 weeks.

How long can peripheral TPN be delivered?

Because it is Limited to solutions with lower dextrose concentration less than 10%, to avoid sclerosis in the vein.

Why are patients at risk for fluid overload with peripheral TPN?

Patients who require nutritional supplements for prolonged periods: long-term use (7-10 days). Delivered through a large central vein, subclavian, internal jugular.

Who is central TPN indicated for?

Risks associated with the central line insertion, use, and maintenance. Higher risk for infection, catheter induced trauma, and metabolic alterations.

What are disadvantages of Central TPN?

absorption of the drug is reduced, recommended to stop 2 hr before and after administration of the drug.

What happens when a patient is on tube feeding and taking phenytoin?

Diarrhea, SOB, and rashes.

Most common adverse effect of nutritional supplements?

-Dextrose: so no hypoglycemia occur.

-Peripheral: 5-10% DEXTROSE

-Central: 35-50% DEXTROSE

What may occur if TPN finishes and there is no other TPN on hand? What should the nurse hang?

Androgens

Male sex hormones- responsible the development & maintenance of male sex characteristics

Testosterone

Most IMPORTANT ANDROGEN

Exogenous Testosterone

Testosterone deficiency is treated with…

Responsible for normal development and maintenance of primary & secondary male sex characteristics

-development of bone and muscle tissue

What does testosterone do?

Poor absorption due to the dose being metabolized and destroyed by the liver before it can reach the circulation.

What is the disadvantage to oral testosterone

Anabolic steroids

Synthetic drugs that closely resembles the natural hormone but possess high anobolic activity

Health Canada Special Access Programme, health care providers can request meds that are not available in Canada

Access to anabolic steroids:

Corticosteroids & Anabolic Steroids

What are the two steroids called?

-psychological/physical dependence

-liver problems

-kidney failure

-heart attack

Adverse effects of using anabolic steroids

Block effects of naturally occurring androgens.

-benign prostatic hyperplasia (BPH) tx.

What do 5-a reductase (androgens) inhibitors treat?

Obstructed urinary outflow; digital rectal examination is recommended (men over 50 y/o)

What’s the most trouble symptom of BPH?

Finasteride & Dutasteride

What are the two 5-a reductase inhibitors called?

-works by inhibiting this enzyme, normally converts testosterone to 5α-dihydrotestosterone.

-can lower prostatic DHT concentrations, helps to reduce the size of the prostate to ease the passage of urine

Important to note about finasteride?

Need to be mindful about wearing gloves because of it gets absorbed through the skin it can cause birth defects.

When handling finasteride, what do women need to be mindful of?

Increase hair growth

What else may happen to a male patient taking Finasteride?

Block the activity of androgen hormones at target tissue (prostate) receptors. Used to treat prostate cancer

What are androgen receptor blockers used to treat?

Prostate cancer.

-goserelin (Zoladex ®)

-leuprolide (Lupron ®)

-triptorelin (Trelstar ®)

What is gonadotropin-releasing hormone analogues used to treat?

a1-androgen blockers

Used for symptomatic relief of obstruction caused by benign prostatic hyperplasia.

Relaxation of the smooth muscle in the erectile tubes of the penis and permits the inflow of blood. First drug approved for tx of erectile dysfunction

Sildenafil is used for…

Similar to sildenafil (viagra) but has a longer duration of action.

Vardenafil (levitra) & tadalafil (cialis) are..

Also used to treat pulmonary hypertension

Sildenafil and Tadalafil are..

contraindicated for men with major cardiovascular disorders, especially if they use nitrate medications such as nitroglycerin.

What is contraindicated in a patient taking an erectile dysfunction drug? Why?

the most devastating effects of androgenic steroids occur in the liver (peliosis of the liver).

What organ are anabolic steroids most detrimental to?

Fluid retention is another undesirable effect of androgens and may account for some of the weight gain seen with their use.

Why does fluid retention occur with androgens? How would we know if fluid retention was occurring?

Patients should be informed that prolonged erections (i.e., longer than 4 hours) must be reported immediately to a health care provider and are considered a medical emergency.

What should a patient do if their erection lasts more than 4 hours?

-Transdermal Testoderm® patches are applied to the scrotal skin. Apply the patch to clean, dry scrotal skin that has been shaved for optimal skin contact.

-Transdermal Androderm® patches are applied to the skin on the body, never to scrotal skin.

What instructions should be given to the patient for application of testosterone Testoderm transdermal patch?