Men's Reproductive Disorders and Antivirals for Hepatitis

Men's Reproductive Disorders

Antivirals for Hepatitis

Contraindications

  • Pregnancy: Especially notable for ribavirin, which is highly teratogenic.

  • Severe renal impairment: Dose adjustments necessary.

  • Decompensated liver disease: Varies depending on treatment regimen.

Labs to Monitor

  • Renal function: Measured via creatinine and Blood Urea Nitrogen (BUN).

  • Hepatic function: Assessed through AST (Aspartate Aminotransferase), ALT (Alanine Aminotransferase), and bilirubin levels.

  • Viral load: Monitored via HBV DNA or HCV RNA tests.

  • Complete Blood Count (CBC): Keep an eye out for conditions such as pancytopenia and anemia.

  • Thyroid function: Required monitoring, specifically when using peginterferon.

Patient Teaching

  • Administration Guidelines:
      - Sofosbuvir/velpatasvir: Can be taken without regard to food.
      - Ribavirin: Must be taken with food.
      - Pellet formulations: Swallowed whole without chewing; can take with water or soft food.

  • Critical Safety Points:
      - Do NOT stop suddenly: This can lead to a transient exacerbation of hepatitis.
      - Ribavirin and pregnancy: Absolutely contraindicated; requires use of two forms of contraception.
      - Immediate reporting required for:
        - Vision changes
        - Severe fatigue
        - Unusual bleeding/bruising
        - Mood changes (including depression).
      - Alcohol: Should be avoided as it accelerates disease progression in chronic HBV/HCV.

  • Follow-up Care:
      - Regular monitoring for at least 1 year after diagnosis.
      - Watch for relapse symptoms.
      - Blood Donation: Individuals with HBsAg+ or HCV antibody+ cannot donate blood.
      - Report Symptoms:
        - Bloody/tarry stools
        - Vomiting blood
        - Sudden weight gain
        - Increased abdominal girth (ascites).

  • Drug Resistance:
      - Both HBV and HCV can develop resistance.
      - Importance of adherence to maintenance treatment for success.

Lactulose

Side Effects

  • Common side effects include flatulence, diarrhea, abdominal cramps, nausea, and vomiting.

  • Diabetes Mellitus: Should avoid lactulose due to glucose and fructose content.

Use

  • Indicated for cirrhosis to decrease ammonia levels, acts as a saline laxative.

Drugs Related to Male Reproductive Disorders

Androgens

  • Testosterone: Essential for the control of development and maintenance of sexual processes, accessory sexual organs, metabolism of cells, and growth of bones/muscles.

Action

  • Utilized for androgen deficiency and hypogonadism, serves as replacement therapy and assists in delayed puberty.

Indications

  • Administration routes include buccal, nasal, transdermal, and parenteral methods.

Side Effects and Adverse Reactions

  • Potential side effects include:
      - Priapism
      - Gynecomastia
      - Urinary urgency
      - Polyuria
      - Cessation of spermatogenesis
      - Oligospermia
      - Virilization
      - Gastrointestinal distress
      - Increased salivation
      - Mouth soreness
      - Insomnia
      - Injection site reactions
      - Impaired bone growth
      - Variability in sexual desire (increase or decrease)
      - Lethargy
      - Hypercalcemia
      - Decreased muscle tone
      - Edema
      - Muscle cramps
      - Elevated cholesterol
      - Menstrual irregularities in women
      - Clitoral hypertrophy
      - Hair thinning or hirsutism
      - Vocal changes
      - Depression
      - Weakness
      - Confusion
      - Dizziness
      - Paresthesia
      - Skin discoloration
      - Headaches

Drug Interactions

  • Risk assumptions include additives with:
      - Oral anticoagulants
      - Calcitonin
      - Parathyroid hormones
      - Antidiabetic agents
      - Corticosteroids
      - Barbiturates
      - Phenytoin
      - Phenylbutazone

  • Can result in changes to hemoglobin (Hgb), hematocrit (Hct), and cholesterol levels.

  • May elevate serum alkaline phosphatase, bilirubin, calcium, potassium, sodium, AST levels, and decrease HDL.

  • Can decrease serum glucose, requiring insulin adjustments.

Cautions

  • Conditions predisposing to caution include:
      - Hypertension
      - Coronary artery disease
      - Seizures
      - Hypercholesterolemia
      - Renal disease
      - Considerations for infants, prepubertal children, and older men.

Contraindications

  • Contraindications for androgen therapy include:
      - Pregnancy
      - Nephrosis or nephrotic phase of nephritis
      - Hypercalcemia
      - Pituitary insufficiency
      - Hepatic dysfunction
      - Benign Prostatic Hyperplasia (BPH)
      - Prostate cancer
      - History of myocardial infarction
      - Men with breast cancer.

Anabolic Steroids

Overview

  • Anabolic steroids are a class of steroid hormones related to testosterone.

  • Action: They increase protein synthesis in cells, resulting in anabolism, particularly in muscle tissue.

  • Also play a role in developing and maintaining masculine characteristics.

Testosterone Precursors

  • Often available as nutritional supplements.

Adverse Effects

  • Side effects can include:
      - Weight gain and increased body size
      - Acne
      - Mood swings and behavioral changes including increased aggression
      - Elevation of low-density lipoprotein cholesterol (LDL)
      - Reduction of high-density lipoprotein cholesterol (HDL)
      - Hypertension
      - Potential for liver damage
      - Structural changes in cardiac tissues.

Clinical Judgment: Androgens

Conceptual Points

  • Hormonal Regulation: Recognizing cues and monitoring relevant health indicators includes:
      - Patient's weight
      - Blood pressure
      - Liver and thyroid function
      - Blood lab results.

  • Constant assessment of a patient’s expressive affect and adjustment of treatment accordingly.

Implementation Strategies

  • Advise patients on the importance of monitoring their endocrine status through intermittent therapy.

  • Encourage monitoring of muscle strength as part of regular assessments.

  • Prompt patients to report any instances of priapism immediately.

  • Instruct patients to be vigilant about any changes in urinary stream and record weights multiple times weekly for effective tracking.

  • Evaluate outcomes consistently to ascertain the efficacy of treatment.

Antiandrogens

Overview

  • Action: Antiandrogens block the synthesis and actions of androgens.

  • Uses include treatment for:
      - Benign prostatic hypertrophy
      - Advanced prostatic cancer
      - Endometriosis
      - Male pattern baldness
      - Acne
      - Hirsutism
      - Precocious puberty in boys
      - Virilization syndrome in women.

Adverse Effects

  • Patients should avoid combining antiandrogens with black cohosh, chasteberry, or DHEA due to potential adverse reactions, including:
      - Impotence
      - Decreased libido
      - Decreased ejaculate.

  • Important caution regarding females of childbearing age regarding handling finasteride, particularly crushed or broken tablets due to potential risks for male fetuses.

Sexual Dysfunction

Erectile Dysfunction (ED)

  • Treatment options include phosphodiesterase-5 inhibitors such as:
      - Vardenafil
      - Tadalafil
      - Sildenafil

  • Contraindications: Use with nitrates is dangerous.

  • Notable drug-to-drug interactions, particularly with grapefruit products.

Side Effects

  • Common side effects:
      - Abdominal symptoms like diarrhea, heartburn, and stomach upset
      - Abnormal vision disturbances:
        - Blurring
        - Light sensitivity
        - Blue-green color tint
      - Dizziness
      - Flushing
      - Headaches
      - Nasal congestion
      - Potential for hearing loss or tinnitus.

Benign Prostatic Hyperplasia (BPH)

Overview

  • BPH is characterized by hyperplasia of glandular units in the prostate gland with aging.

Symptoms

  • Common symptoms include:
      - Sensation of bladder fullness
      - Increased frequency of urination
      - Nocturia
      - Hesitation in urination
      - Dribbling
      - Erectile dysfunction.

Treatment Options

  • Treatment modalities include:
      - Alpha-adrenergic antagonists
      - 5-Alpha-reductase inhibitors
      - Anticholinergics
      - Phosphodiesterase-5 inhibitors.

5-Alpha-Reductase Inhibitors (Finasteride)

Use

  • Indicated for BPH, specifically with moderate to severe symptoms and larger prostates.

Mechanism

  • Blocks the conversion of testosterone to Dihydrotestosterone (DHT), leading to prostate shrinkage.

Side Effects

  • Common side effects may include:
      - Decreased libido
      - Erectile dysfunction
      - Orthostatic hypotension
      - Gynecomastia.

Labs

  • Prostate-Specific Antigen (PSA) levels may appear 50% lower; practitioners must double the PSA value after 6+ months of treatment for accurate comparisons.

Patient Teaching

  • Effectiveness takes approximately 6 months; must be taken regularly to maintain its effect.

Alpha-adrenergic Blockers (Tamsulosin, Alfuzosin)

Use

  • Primarily for relief of BPH symptoms.

Mechanism

  • These agents relax smooth muscle in the prostate but do not reduce prostate size.

Side Effects

  • Common adverse effects:
      - Retrograde ejaculation
      - Dizziness
      - Headache
      - Orthostatic hypotension
      - Decreased libido
      - Symptoms of upper respiratory infection
      - Possibility of priapism.

Patient Teaching

  • Improvement in symptoms may be noticed within days to weeks; changes in ejaculation are to be expected.

  • Can be used in conjunction with 5α-reductase inhibitors.

Practice Questions

Question 1

  • Nurse's Teachings: Sildenafil is contraindicated for patients taking which medications?
      - A) Sulfonylureas
      - B) Beta blockers
      - C) Nitrates
      - D) Proton pump inhibitors

Question 2

  • Patient on Androgen Therapy: Common side effects include which of the following?
      - A) Abdominal pain and hives at injection site
      - B) Dry mouth and hyperhidrosis
      - C) Weight gain and blurred vision
      - D) Generalized rash

Question 3

  • Female Patient on Androgens: Common potential symptom development includes?
      - A) Impaired bone growth
      - B) Gynecomastia
      - C) Vocal changes
      - D) Priapism

Question 4

  • Contraindications of Androgen Therapy: Must be known prior to therapy initiation?
      - A) Chronic obstructive pulmonary disease
      - B) Diabetes mellitus
      - C) Pregnancy
      - D) Serum calcium of 8.0