CH 35: MEN'S HEALTH DRUGS

7. A 16-year-old male is to receive testosterone cypionate (Depo-Testosterone), 50 mg IM every 2 weeks. The medication is available in 100-mg/mL containers. How many mL will the nurse draw up in the syringe to administer for each dose?

0.5 mL per dose

What should be the daily dose of finasteride for an adult patient who is being treated for androgenetic alopecia? 1. 1 mg by mouth 2. 5 mg by mouth 3. 25 to 100 mg 1 hour before intercourse 4. 50 to 400 mg by intramuscular injection

1. 1 mg by mouth The expected adult daily dose for finasteride is 1 mg by mouth when prescribed for the treatment of androgenetic alopecia. A daily dose of 5 mg is prescribed for patients who are being treated for benign prostatic hyperplasia. This medication is not administered 1 hour before sexual intercourse or by intramuscular injection.

Which medication is an alpha1-adrenergic blocker? 1. Alfuzosin 2. Goserelin 3. Nilutamide 4. Nandrolone

1. Alfuzosin Alfuzosin is an alpha 1-adrenergic blocker. Goserelin is a gonadotropin-hormone-releasing analogue. Nilutamide is an antiandrogen. Nandrolone is an anabolic steroid.

A patient is sterile because of low testosterone levels. Which other complication should the nurse suspect in this patient? 1. Anemia 2. Fatty liver 3. Hyperacidity 4. Hypoglycemia

1. Anemia Testosterone is a hormone that plays an important role in erythropoiesis. It helps in the formation of red blood cells. Reduced levels of testosterone cause reduced production of red blood cells, which in turn causes anemia from reduced hemoglobin. Unlike alcohol consumption, low levels of testosterone do not cause fatty liver. Testosterone does not affect the function of the proton pump in the stomach, and hence, it does not cause hyperacidity. Testosterone does not affect the function of the pancreas. Therefore, it does not cause hypoglycemia.

While reviewing the medical records of a patient, the nurse learns that the patient has taken finasteride in the past. The patient does not have a history of difficulty with urination. What is the probable reason for administering finasteride to this patient? 1. Baldness 2. Infertility 3. Hypertension 4. Benign prostate hyperplasia (BPH)

1. Baldness Finasteride is a 5-alpha reductase inhibitor drug that is also known to stimulate the hair follicles and stimulate hair growth. Thus, it is recommended for treating male-pattern baldness. Sperm production is not affected by finasteride. Thus, finasteride is not recommended for treating infertility in males. Finasteride does not affect blood pressure levels, unlike the alpha blockers used to treat BPH, which can cause hypotension. Because the patient had not reported any difficulty in urination in the past, it is unlikely that the patient ever had BPH.

A patient receiving finasteride has increased hair growth. What is the nurse's priority action? 1. Continue to assess. 2. Hold the medication. 3. Measure testosterone levels. 4. Call the health care provider.

1. Continue to assess. Increased hair growth is a therapeutic effect of this medication. The nurse should continue to assess. It is not necessary to hold the medication or notify the provider. Because it is a therapeutic effect, drug levels do not need to be tested.

A patient has been taking sildenafil for erectile dysfunction. The patient reports episodes of dizziness and fainting spells after using this drug. For which other drug should the nurse assess while taking the drug history of the patient? 1. Nitrates 2. Antibiotics 3. Alpha agonists 4. Anticoagulant

1. Nitrates Dizziness and fainting spells are signs associated with low blood pressure. Sildenafil decreases blood pressure by releasing nitric oxide. Nitrates also decrease the workload of the heart by reducing the blood pressure. Administration of both drugs may cause severe hypotension in the patient. Thus, the nurse should determine whether the patient is taking nitrate drugs. Alpha-agonist drugs will cause hypertension, whereas sildenafil will be helpful in reducing blood pressure in patients taking an alpha agonist. Antibiotic drugs and anticoagulants do not interact with sildenafil. Antibiotics such as erythromycin and clarithromycin increase the concentration of tamsulosin in the blood. Anticoagulants interact with androgens, thereby causing increased or decreased activity of oral anticoagulant drugs.

Which medication treats erectile dysfunction? 1. Sildenafil 2. Minoxidil 3. Finasteride 4. Testosterone

1. Sildenafil Sildenafil treats erectile dysfunction. Minoxidil treats female and male androgenetic alopecia. Finasteride treats benign prostatic hyperplasia. Testosterone treats primary or secondary hypogonadism.

A patient who has been taking sildenafil has developed angina. The health care provider has prescribed isosorbide mononitrate. What is the nurse's primary intervention? 1. Take the patient's blood pressure. 2. Advise the patient not to take the sildenafil. 3. Instruct the patient to take the medications on opposite days. 4. Tell the patient to take the isosorbide mononitrate before the sildenafil.

2. Advise the patient not to take the sildenafil. When taken in conjunction with nitrates, sildenafil can cause severe hypotension that is unresponsive to treatment. The patient should never take these medications together. The remaining responses are not the priority intervention.

Which is an off-label use of oxandrolone? 1. Anemia 2. Alcoholic hepatitis 3. Hereditary angioedema 4. Metastatic breast cancer

2. Alcoholic hepatitis An off-label use of oxandrolone is for the treatment of alcoholic hepatitis. The approved clinical uses of anabolic steroids, such as oxandrolone, are anemia, hereditary angioedema, and metastatic breast cancer.

Which drug will be prescribed for a patient who presents with erectile dysfunction? 1. Finasteride 2. Alprostadil 3. Testosterone 4. Fluoxymesterone

2. Alprostadil Alprostadil is used in the treatment of erectile dysfunction. The intracavernous injection is also used as a single injection in the diagnosis of erectile dysfunction. Finasteride is used to treat benign prostatic hyperplasia. Fluoxymesterone and testosterone are used to treat male hypogonadism.

The nurse will administer testosterone to a patient. Which route will provide the best absorption? 1. Oral 2. Buccal 3. Injection 4. Transdermal

2. Buccal Testosterone tablets, which are administered in the buccal cavity, can be easily dissolved and absorbed by the liver. Compared to the buccal process, oral administration has a very poor rate of absorption; the dose is metabolized and destroyed. Injections are another preferable way to administer the hormone, second to buccal application as an ideal option. The transdermal route, or skin patches, is useful when it comes to administration of the hormone, but they are not as useful as buccal administration.

The nurse is caring for a patient receiving androgen therapy. For which conditions is androgen therapy indicated? Select all that apply. 1. Priapism 2. Endometriosis 3. Prostate cancer 4. Hypergonadism 5. Refractory anemias

2. Endometriosis 5. Refractory anemias Androgen therapy is indicated for the treatment of endometriosis, refractory anemias, advanced breast cancer in women, hypogonadism, angioneurotic edema, and tissue wasting associated with severe or chronic illness. It is not indicated for priapism, prostate cancer, or hypergonadism. In fact, hypergonadism and prostate cancer may be worsened with androgen administration.

Which condition is an indication for a primary health care provider to prescribe danazol for a female patient? 1. Facial hair 2. Endometriosis 3. High testosterone levels 4. Cardiovascular disorder

2. Endometriosis Danazol is a synthetic androgen. It is prescribed to women for the treatment of endometriosis, because it causes atrophy of the endometrium and therefore helps alleviate its symptoms. Danazol increases the testosterone levels and may cause growth of facial hair. Therefore, it is not given for the treatment of facial hair. Women treated with the drug may develop infertility from the medication, because it also increases the production of testosterone. Danazol causes cardiovascular disorders. Therefore, danazol should not be prescribed if the patient has facial hair, high testosterone levels, or cardiovascular disorders.

The nurse is providing care for a patient receiving androgen therapy for weight gain. Which adverse effect of the medication can be mistaken as weight gain? 1. Hirsutism 2. Fluid retention 3. Roundness of face 4. Peliosis of the liver

2. Fluid retention Fluid retention is an adverse effect of androgen therapy that may be mistaken for weight gain in a patient. Hirsutism refers to excessive amounts of hair growth on the body. Roundness of the face is seen in patients taking corticosteroids. Peliosis of the liver refers to the formation of blood-filled cavities.

A patient has been diagnosed with benign prostatic hyperplasia (BPH). Why will the primary health care provider prescribe finasteride? 1. It helps relax urine retention. 2. It helps stop a growing prostate. 3. It helps treat erectile dysfunction. 4. It helps increase penile blood flow.

2. It helps stop a growing prostate. Finasteride focuses on the degeneration of the prostate epithelial tissue, which further helps reduce mechanical obstruction in the urethra. Finasteride inhibits 5-alpha reductase, responsible for converting testosterone to 5-dihydrotestosterone. Finasteride has no effect on urine retention. Sildenafil helps treat erectile dysfunction and increases penile blood flow.

Which medication is used to treat baldness in both men and women? 1. Sildenafil 2. Minoxidil 3. Finasteride 4. Methyltestosterone

2. Minoxidil Minoxidil treats baldness in both men and women. Sildenafil treats erectile dysfunction in men. Finasteride treats baldness in men. Methyltestosterone treats postpubertal cryptorchidism.

The nurse should inform a male patient about which potential type of cancer associated with testosterone therapy? 1. Kidney cancer 2. Prostate cancer 3. Bladder cancer 4. Intestine cancer

2. Prostate cancer Testosterone plays a role in the development of prostate cancer, but the extent to which supplemental testosterone therapy increases cancer risk is unclear. Testosterone does not affect the kidneys, bladder, or intestines in a direct way.

Which location should be used for placing a transdermal patch of testosterone on a patient for the treatment of primary hypogonadism? 1. Thighs 2. Scrotum 3. Abdomen 4. Upper arms

2. Scrotum A transdermal patch is applied on the scrotum to treat primary hypogonadism. A testosterone transdermal patch is not applied on the thighs, abdomen, or upper arms.

Which group of college students does the nurse need to include in a teaching session on the risks of androgen abuse? 1. Students who are often tardy 2. Students who are on athletic teams 3. Students who do not socialize well in school 4. Students who perform extraordinarily in class

2. Students who are on athletic teams Androgens are potent anabolic agents that stimulate the formation and maintenance of muscular and skeletal proteins. Athletes use androgens to increase weight, musculature, and muscle strength. Many major sporting events disqualify athletes who have documented use of such products. Tardy students need to be evaluated for developmental delays. Psychotherapy is used to help children socialize well. Students who perform extraordinarily need not take any therapy.

Which drug requires wearing gloves during administration? 1. Minoxidil 2. Stanozolol 3. Dutasteride 4. Tamsulosin

3. Dutasteride Dutasteride is a teratogenic medication that requires specific handling precautions. Stanozolol is an androgen that does not necessitate any kind of precautionary measures. Tamsulosin is an alpha1-adrenergic blocker and is safe for handling. Minoxidil is a peripheral vasodilator and does not need this kind of precaution.

The nurse is assessing a patient who is taking fluoxymesterone to treat reduced testosterone levels. The patient has gained weight 1 week after beginning the medication. What is the likely cause for weight gain in the patient? 1. Impaired liver function 2. Impaired thyroid activity 3. Increased fluid retention 4. Impaired lipid metabolism

3. Increased fluid retention Fluoxymesterone is an androgenic drug that may cause fluid retention in some patients. Thus, in this patient, fluid retention would have been the most probable cause of weight gain. Impaired liver function is a complication associated with anabolic steroids and not fluoxymesterone. Impaired thyroid activity may cause weight gain; however, androgenic drugs do not affect the thyroid activity. Impaired lipid metabolism is also a complication associated with androgens that causes elevated cholesterol levels. However, weight gain from high cholesterol levels takes place over a long period of time.

Which pharmacologic class is used to describe testosterone drugs? 1. Schedule I 2. Schedule II 3. Schedule III 4. Schedule IV

3. Schedule III Testosterone, a naturally occurring androgenic hormone produced primarily by the testes, regulates male sexual development. Most androgens are classified as Schedule III drugs in the United States. They have less abuse potential than Schedule II drugs and a moderate dependence liability. Schedule I and II drugs have a high potential for abuse. Schedule IV drugs have less abuse potential than Schedule III drugs.

A patient with hypogonadism gives a return demonstration of application of a testosterone dermal patch. Which patient action when applying the patch indicates the need for additional teaching? 1. The patient applies the patch on the scrotum. 2. The patient applies the patch on shaved skin. 3. The patient replaces the patch every other day. 4. The patient applies the patch on clean, dry skin.

3. The patient replaces the patch every other day. The testosterone patch is usually prescribed to treat hypogonadism. The patch shows its maximum effect when it is used as prescribed. The patch is replaced every day, rather than on alternate days, for maximum benefit. Therefore, the nurse should instruct the patient to replace the patch every day. The patch is applied only on the scrotal skin for optimal action. The patch should be applied on shaved scrotal skin to facilitate maximum skin contact. The scrotal skin should be clean and dry for easy application.

Why does the United States Drug Enforcement Administration classify anabolic steroids as Schedule III medications? 1. They cause endometriosis. 2. They cause erectile dysfunction. 3. They cause physical dependence. 4. They cause sedation and hypnosis.

3. They cause physical dependence. Anabolic steroids increase muscle growth; because of this, they are often abused and may cause physical and psychological dependence in the patient. Therefore, anabolic steroids are classified as Schedule III medications by the United States Drug Enforcement Administration. Steroids enhance testosterone levels and therefore they do not cause endometriosis or erectile dysfunction. Anabolic steroids do not have central nervous system depressant effects. Hence, they do not cause sedation and hypnosis.

Which condition is an indication of saw palmetto use? 1. Dysuria 2. Back pain 3. Gastrointestinal upset 4. Benign prostatic hyperplasia

4. Benign prostatic hyperplasia Saw palmetto is an herbal supplement used to treat benign prostatic hyperplasia and alopecia. Dysuria, back pain, and gastrointestinal upset are the adverse effects associated with the use of saw palmetto.

The nurse notes that a patient is prescribed dutasteride. Which condition should the nurse suspect in the patient? 1. Impotence 2. Hypogonadism 3. Testicular cancer 4. Benign prostatic hyperplasia (BPH)

4. Benign prostatic hyperplasia (BPH) Dutasteride is an alternative for finasteride, indicated for the treatment of benign prostatic hyperplasia (BPH). The medicine is available in 0.5 mg capsules. Dutasteride has no effect on impotence or testicular cancer. Testosterone is used for the treatment of hypogonadism.

The nurse encounters a male patient who is taking finasteride. Which condition should the nurse suspect in the patient? 1. Priapism 2. Bladder cancer 3. Testicular cancer 4. Benign prostatic hyperplasia (BPH)

4. Benign prostatic hyperplasia (BPH) Finasteride is specifically administered for the treatment of BPH, which leads to enlargement of the prostate. Finasteride is also administered for the treatment of hair loss, occurring in men between the ages of 30 and 80. Finasteride helps lower the dihydrotestosterone (DHT) level. The medication is not directly related to priapism, bladder cancer, or testicular cancer.

A patient has been administered finasteride, a drug specifically prescribed for treatment of an enlarged prostate gland. For which side effects should the nurse monitor the patient? Select all that apply. 1. Impotence 2. Bradycardia 3. Libido enhancement 4. Increase of hair growth 5. Reduction of prostate size

4. Increase of hair growth 5. Reduction of prostate size Finasteride causes excessive hair growth because of prostatic dihydrotestosterone (DHT) concentrations in the patient's body. It mainly helps to reduce the size of the prostate. Finasteride does not cause impotence or bradycardia in adult males; however, it might decrease the libido, rather than increase it.

Minoxidil is prescribed to a patient to treat hair loss. Which nursing intervention will help curtail the adverse effects of the therapy? 1. Drink excess water. 2. Rest to eliminate headaches. 3. Stop eating sodium-rich foods. 4. Report any occurrence of erythema.

4. Report any occurrence of erythema. Minoxidil is considered a potential peripheral vasodilator, but it causes extreme dermatologic reactions like erythema, dermatitis, eczema, and pruritus. Drinking excess water is the best option for patients suffering from hypotension. Rest will not help cure the headaches; they are caused by the anabolic steroids. Avoiding sodium-rich food is a remedial option for patients suffering from hypertension.

A patient who is taking terazosin for benign prostatic hyperplasia (BPH) reports symptoms of hypotension. Which drug should the nurse expect to be prescribed to the patient as an alternative to terazosin? 1. Sildenafil 2. Doxazosin 3. Finasteride 4. Tamsulosin

4. Tamsulosin Tamsulosin has a higher specificity to alpha1-receptors and is thus known to have fewer hypotensive effects in comparison to terazosin. Thus, the patient should ideally be prescribed this drug in place of terazosin. Sildenafil is a drug prescribed for erectile dysfunction; it is not used to treat the symptoms associated with BPH. Doxazosin is another alpha1-receptor antagonist drug, but it may cause hypotensive effects. Finasteride takes a longer time to treat BPH when compared with terazosin and falls within a different category of medications for BPH, so it should not be used as an alternative to terazosin.

A male patient is diagnosed with mild prostate enlargement. What should the nurse expect to administer to control the enlargement? 1. Minoxidil 2. Stanozolol 3. Finasteride 4. Tamsulosin

4. Tamsulosin Tamsulosin is an alpha1-adrenergic blocker, which helps reduce prostate enlargement. Minoxidil is a peripheral vasodilator, used to treat topical baldness. Stanozolol is an androgen. Finasteride is used primarily for benign prostatic hypertrophy (BPH) and generally takes longer to take effect.

The nurse is asked to administer medications to several patients. Which patient is prescribed a proper dose, indication, and route of administration of the medication? 1. Sildenafil, 50 mg injected into the penile shaft 2. Finasteride, 5 mg/day by mouth, for baldness 3. Transdermal testosterone, 4 mg/day applied to the back 4. Testosterone cypionate, 300 mg intramuscularly each month

4. Testosterone cypionate, 300 mg intramuscularly each month The dosage range for testosterone cypionate is an intramuscular injection of 50 to 400 mg every second or fourth week. Sildenafil is taken as a dose of 25 to 100 mg by mouth, 1 hour before intercourse; finasteride is administered in a dos of 1 mg/day for male pattern baldness and 5 mg/day for benign prostatic hyperplasia; and transdermal testosterone is administered as 4 to 6 mg/day; it must be applied to the scrotum.

The nurse is caring for a patient who has prostate cancer who has been prescribed finasteride. After continuing the medication for a few months, the patient's prostate-specific antigen (PSA) value is less than 2.5 ng/mL. What should the nurse infer from this? 1. The patient is nonadherent to the medication. 2. The patient may have hypersensitivity reaction. 3. The patient may have increased risk of liver failure. 4. The patient is responding effectively to the treatment.

4. The patient is responding effectively to the treatment. Patients with prostate cancer have high levels of PSA. To determine the effectiveness of the treatment, the nurse should monitor the PSA levels of the patient. Values less than 2.5 to 3 ng/mL are considered to be normal and indicate that the patient is effectively responding to the medication. If the patient was not taking the medication as prescribed, the PSA value would be higher than 3 ng/mL. In addition, the patient would have difficulty in urination because of worsening of symptoms. PSA levels do not indicate that the patient has hypersensitivity. The presence of a localized infection or allergy indicates that the patient is hypersensitive to the medication. Alteration in the levels of the liver enzymes and bile is indicative of liver failure. Therefore, the PSA values do not help the nurse to infer that the patient has an increased risk of liver failure.

The nurse is assessing an elderly patient who has angina pectoris who has been prescribed nitroglycerin. After reviewing the patient's medical history, the nurse advises the patient to avoid vardenafil. What is the reason for giving this advice to the patient? 1. Vardenafil reduces the efficacy of nitroglycerin. 2. Vardenafil may cause erectile dysfunction in patients. 3. Vardenafil is contraindicated for use in elderly patients. 4. Vardenafil causes hypotension if taken with nitroglycerin.

4. Vardenafil causes hypotension if taken with nitroglycerin. Vardenafil is a phosphodiesterase inhibitor. It is contraindicated in patients with cardiovascular disorders. This medication will be discontinued when nitrates such as nitroglycerin are prescribed for the patient, because it causes hypotension. This effect is the result of synergistic action of the medications, which results in excessive vasodilation. Vardenafil does not reduce the efficacy of nitroglycerine, because it does not interact with the drug. Vardenafil is prescribed for the treatment of erectile dysfunction. Therefore, it does not cause erectile dysfunction. Vardenafil is not contraindicated in elderly patients. It can be prescribed for them unless they have cardiovascular disorders.

3. During a counseling session for a group of teenage athletes, the use of androgenic steroids is discussed. The nurse will explain that which problem is a rare but devastating effect of androgenic steroid use? a. Peliosis of the liver b. Bradycardia c. Kidney failure d. Tachydysrhythmias

a. Peliosis of the liver

1. A patient has been taking finasteride (Proscar) for almost 1 year. The nurse knows that which is most important to evaluate at this time? a. Complete blood count b. PSA levels c. Blood pressure d. Fluid retention

b. PSA levels

6. When the Testoderm form of testosterone is ordered to treat hypogonadism in a teenage boy, which instructions by the nurse are correct? (Select all that apply.) a. Place the patch on clean, dry skin on the back, upper arms, abdomen, or thighs. b. Place the patch on clean, dry scrotal skin that has been shaved. c. Place the patch on clean, dry scrotal skin, but do not shave the skin first. d. Place the patch on any clean, dry, nonhairy area of the body. e. Remove the old patch before applying a new patch.

b. Place the patch on clean, dry scrotal skin that has been shaved. e. Remove the old patch before applying a new patch.

8. The nurse is reviewing the medication list for a patient and notes that finasteride (Propecia) 1 mg daily is on the list. This drug is for which of these problems? a. Benign prostatic hypertrophy (BPH) b. Erectile dysfunction c. Alopecia in male patients d. Alopecia in male and female patients.

c. Alopecia in male patients

2. The nurse is performing an assessment of a patient who is asking for a prescription for sildenafil (Viagra). Which finding would be a contraindication to its use? a. 65 years of age b. History of thyroid disease c. Medication list that includes nitrates d. Medication list that includes saw palmetto

c. Medication list that includes nitrates

5. A patient is asking about the use of saw palmetto for prostate health. The nurse tells him that drugs that interact with saw palmetto include: a. acetaminophen (Tylenol). b. nitrates. c. nonsteroidal antiinflammatory drugs. d. antihypertensive drugs.

c. nonsteroidal antiinflammatory drugs.

4. The nurse is teaching a patient about the possible adverse effect of priapism, which may occur when taking erectile dysfunction drugs. The nurse emphasizes that, if this occurs, the most important action is to a. stay in bed until the erection ceases. b. apply an ice pack for 30 minutes. c. turn toward his left side and rest. d. seek medical attention immediately.

d. seek medical attention immediately.