NURS 1141 - Gonadal Hormones

What does testosterone develop?

Develop male sex organs; voice; hair distribution; male body form

What do androgens produce?

Produce masculinizing effects

Nursing Implications for Gonadal Hormones

• Self-examination

• Prior illnesses

• Medication

• Does the patient smoke?

• Physical examination

• Obtain baseline data

Patient Education

• Discuss expectations of therapy

• Explain risks of continuing to smoke

• Seek cooperation with medication adherence

• Enlist patient’s aid with maintaining written record of signs and symptoms appropriate to condition

• Use baseline assessment to track response to drug therapy

What is the action of Androgens?

Dominant male sex hormone

What is the use of Androgens?

Treat hypogonadism, eunuchism, androgen deficiency, and palliation of breast cancer in postmenopausal women with certain types of cancer (suppress cancer cells)

Common adverse effect of Androgens

Gastric irritation

Serious adverse effects of Androgens

Electrolyte imbalance

Serious adverse effects of Androgens

Edema

Serious adverse effects of Androgens

Hypercalcemia

Serious adverse effects of Androgens

Masculinization

Serious adverse effects of Androgens

Hepatotoxicity

Females Nursing Implications - Assessment

• Age of menarche

• Usual pattern and characteristic of menses

• Number of pregnancies, live births, miscarriages, or abortions

• Vaginal discharges, infections, genital lesions, or warts.

• Contraceptive methods used

• History of multiple sexual partners

• Is breast self-examination performed regularly?

• History and frequency of Papanicolaou (Pap) smears

• Reproductive problems

• History of STIs

• If a prescription for oral contraceptive therapy is being requested, ask about any indication of hypertension, heart or liver disease, thromboembolic disorders, smoking history, or cancer of the reproductive organs.

Males Nursing Implications - Assessment

• Pattern of urination.

• Presence of a urethral discharge or genital or perianal lesions. Is there any swelling of the penis?

• Is there pain in the lower back, perineum, or pelvis?

• History of prostatitis, benign prostatic hyperplasia, or prostatic cancer

• Is testicular self-examination performed regularly?

• History of STIs

• History of multiple sexual partners

• History of arthralgia, fever, chills, malaise, pharyngitis, or oral lesions

• History of prior illnesses

• History of erectile dysfunction and description of pattern of altered erectile functioning

• Has the individual had prostate surgery? If so, was the onset of the erectile dysfunction before or after the surgery?

• Refrain from using irritating substances such as deodorants, scented toilet paper, and perfumed soaps or sprays.

• Warm sitz baths may help relieve vaginal or perineal irritation.

• Douching should be avoided unless specifically prescribed by the healthcare provider. Douching alters the pH of the vagina and may encourage the growth of opportunistic organisms.

• Personal hygiene should include wiping from front to back after voiding and defecation, voiding before and after intercourse, cleansing genitals thoroughly before and after intercourse, and changing menstrual tampons or pads frequently. Avoid wearing underwear made of synthetic materials; cotton materials help prevent moisture accumulation.

• Contraceptive methods (e.g., oral and other hormonal contraceptives, intrauterine devices) or surgical procedures such as hysterectomy do not provide any protection against HIV or other STIs. It is necessary to use physical and chemical barriers (e.g., condoms, foam spermicides).

• Stress the need for an annual Pap smear to detect cervical cancer that originates from cervical intraepithelial neoplasia.

Females Patient Education Continued

• Refrain from using irritating substances such as deodorants, scented toilet paper, and perfumed soaps or sprays.

• Warm sitz baths may help relieve vaginal or perineal irritation.

• Douching should be avoided unless specifically prescribed by the healthcare provider. Douching alters the pH of the vagina and may encourage the growth of opportunistic organisms.

• Personal hygiene should include wiping from front to back after voiding and defecation, voiding before and after intercourse, cleansing genitals thoroughly before and after intercourse, and changing menstrual tampons or pads frequently. Avoid wearing underwear made of synthetic materials; cotton materials help prevent moisture accumulation.

• Contraceptive methods (e.g., oral and other hormonal contraceptives, intrauterine devices) or surgical procedures such as hysterectomy do not provide any protection against HIV or other STIs. It is necessary to use physical and chemical barriers (e.g., condoms, foam spermicides).

• Stress the need for an annual Pap smear to detect cervical cancer that originates from cervical intraepithelial neoplasia.

Males Patient Education Continued

• Practice good personal hygiene. Keep the penis, scrotum, and perianal area thoroughly cleansed. Wash areas before and after intercourse. Urinate after intercourse.

• Prostatitis is treated with antibiotics, antiinflammatory agents, and stool softeners. The local application of heat with a sitz bath, drinking plenty of fluids, and adequate rest are also usually used for relief of the symptoms of prostatitis.

• Men need annual physical examinations after age 40.

• Discuss appropriate interventions for men with altered sexual function that may be treated with medications such as phosphodiesterase inhibitors (e.g., Viagra, Cialis) or surgical intervention.

• Latex condoms can be effective in reducing sexual transmission of HIV and some other STIs (e.g., gonorrhea, trichomonas, chlamydia), but condoms are not as effective against STIs transmitted by skin-to-skin contact, such as herpes simplex virus, HPV, and syphilis.

• Men having homosexual relationships and people who inject drugs should be vaccinated for hepatitis A virus. The frequent use of nonoxynol-9 spermicide during anal intercourse irritates the epithelial lining of the rectum, providing a portal of entry for HIV and other STIs.

What are Bisphosphonates for?

Bisphosphonates (alendronate, risedronate, and zoledronic acid) inhibit bone resorption by actions on osteoclasts. Decreasing the rate of bone resorption leads to an indirect increase in BMD.

What is Alendronate used in?

Alendronate is used in the treatment and prevention of osteoporosis in postmenopausal women, the treatment of osteoporosis in men, and the treatment of glucocorticoid-induced osteoporosis in men and women with low BMD who are receiving a daily dosage of 7.5 mg or more of prednisone.

What is Risedronate used in?

Risedronate is used in the treatment and prevention of osteoporosis in postmenopausal women, the treatment of osteoporosis in men, and the treatment and prevention of glucocorticoid-induced osteoporosis.

What is Zoledronic used in?

Zoledronic acid is used in the treatment and prevention of osteoporosis in postmenopausal women, the treatment of osteoporosis in men, and the treatment and prevention of glucocorticoid-induced osteoporosis in men and women who are initiating or continuing systemic glucocorticoids in a daily dosage equivalent to 7.5 mg or more of prednisone and who are expected to remain on glucocorticoids for at least 12 months.

What is the action of Alpha-1 Adrenergic Blocking Agents?

Alpha-1 adrenergic blocking agents have selectivity for the alpha-1A receptor subtype found on the prostate gland. Approximately 70% of the alpha-1 receptors in the human prostate are of the alpha-1A subtype. Alfuzosin, silodosin, and tamsulosin are alpha-1A–specific adrenergic blocking agents, whereas doxazosin and terazosin are nonspecific alpha-1 blocking agents. These agents block alpha-1 receptors on the prostate gland and certain areas of the bladder neck, causing muscle relaxation and allowing greater urinary outflow in men with an enlarged prostate gland. Alpha-1 blocking agents do not reduce prostate size or inhibit testosterone synthesis as do the 5-alpha reductase inhibitors, nor do they affect PSA levels.

What is the use of Alpha-1 Adrenergic Blocking Agents?

Alpha-1 blocking agents are used to reduce mild to moderate urinary obstruction manifestations (e.g., hesitancy, terminal urine dribbling, interrupted stream, impaired size and force of stream, sensation of incomplete bladder emptying) in men with BPH. They produce a 20% to 30% increase in urine flow rate in up to 50% of men with urinary symptoms. Symptoms show improvement after 1 week of therapy, but 2 to 3 months of continued therapy are required to assess full effect. Alpha-1A–specific drugs (i.e., alfuzosin, tamsulosin, silodosin) are not used to treat hypertension.

What is action of Antiandrogen Agent - finasteride?

Finasteride is an androgen hormone inhibitor that acts by inhibiting the enzyme 5-alpha reductase. The conversion of testosterone to DHT is catalyzed by 5-alpha reductase. Reduction in DHT levels reduces the hyperplastic cell growth associated with prostatic hyperplasia. Elevated DHT levels also induce androgenetic alopecia, more commonly known as male pattern baldness (vertex and anterior midscalp).

What is use of Antiandrogen Agent - finasteride?

Finasteride inhibits 5-alpha reductase type 2. Proscar is used to treat the symptoms associated with BPH, reduce the risks associated with urinary retention, and minimize the need for surgery associated with BPH. More than 6 to 12 months of treatment may be necessary to assess whether a therapeutic response has been achieved. Patients who respond to therapy have fewer symptoms associated with partial obstruction, improved urinary flow rates, and a smaller prostate gland.

What is Propecia used to treat?

Propecia is used to treat androgenetic alopecia. After at least 3 months of daily use, finasteride maintains hair count and stimulates new hair growth in those who respond. Continued use is necessary to sustain the results. With discontinuation of treatment, the effects are reversed within 1 year. Finasteride does not appear to affect nonscalp body hair.

What is the action Phosphodiesterase Inhibitors?

Phosphodiesterase inhibitors are selective inhibitors of the phosphodiesterase 5 (PDE5) enzyme. Research indicates that nitric oxide, a naturally occurring neurotransmitter found in nerve endings and endothelial cells, activates the enzyme guanylate cyclase, which converts guanosine triphosphate to cyclic guanosine monophosphate (cGMP) in smooth muscle cells. The increase in cGMP causes smooth muscle relaxation. In the corpus cavernosum of the penis, smooth muscle relaxation allows blood inflow to fill the many small sinusoidal spaces, resulting in an erection. In the corpus cavernosum, the enzyme PDE5 inactivates cGMP. The phosphodiesterase inhibitors enhance the relaxant effect of nitric oxide released in response to sexual stimulation by increasing cGMP concentration in the corpus cavernosum, resulting in smooth muscle relaxation and greater blood flow into the corpus cavernosum, which produces an erection.

What is the use of Phosphodiesterase Inhibitors?

Sildenafil was approved in 1998 as the first oral therapy to treat male ED. Three other products, vardenafil, tadalafil, and avanafil, have since been approved. Sexual stimulation is required for an erection because the phosphodiesterase inhibitors do not have a direct relaxant effect on the smooth muscle of the corpus cavernosum. In the absence of sexual stimulation, these agents have no pharmacologic effect. They are not an aphrodisiac; they do not increase sexual desire or sexual stimulation or affect the frequency of sexual intercourse. Sildenafil and vardenafil are taken at any point from 30 minutes to 4 hours before sexual activity. Avanafil is approved to be taken 15 minutes before sexual activity. Tadalafil also starts to work within 30 minutes, but may last for up to 36 hours. Tadalafil has also been approved as a once-daily dose that, when taken daily, may significantly reduce the onset of action, allowing more spontaneity in sexual relations. Tadalafil is also approved for the treatment of BPH.