Pharm, part 43: Reproductive Medications - Testosterone, BPH and Erectile Dysfunction

September 21, 2021 Updated: January 17, 2022 7 min read

This article continues our coverage of reproductive system medications, specifically, androgens, BPH medications, and medications for erectile dysfunction.

The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

Androgens: testosterone

Testosterone is an androgen, a sex hormone that brings on puberty.

It is used in the treatment of delayed puberty in boys, as well as hypogonadism, a failure of the gonads to produce sufficient sex hormones, limiting proper function (affecting the testes in men and the ovaries in women).

Testosterone could also be used for postmenopausal breast cancer. And it is used for people undergoing gender transition.

Mode of action of testosterone

Testosterone promotes the development of male sex organs and maintenance of male secondary sex characteristics.

It occurs in small amounts in women, and, in conjunction with estrogen, helps the growth, maintenance, and repair of a woman’s reproductive tissues, as well as bone mass.

Side effects of testosterone

Testosterone has many side effects, including edema (swelling), acne, liver dysfunction, polycythemia (when the body produces too many red blood cells), and premature epiphyseal closure (when the bones stop growing).

In women, testosterone's side effects can cause deepening of the voice, baldness, and unusual hair growth, also known as hirsutism, where a female may experience male-patterned hair growth, such as hair growth on the face, chest, or back.

finasteride (Propecia, Proscar)

Cool Chicken Finasteride: Think of checking out a guy in his sports car - “Yeah, he has a fine ride, but he is bald with BPH too.”

Androgen inhibitors are medications used to treat benign prostatic hyperplasia or BPH.

A patient with BPH has an enlarged prostate, which puts pressure on the urethra, which runs through the prostate. This causes urinary symptoms.

One class of medication to treat BPH is the androgen inhibitor finasteride, which may be used to treat baldness as well.

Mode of action of finasteride

The mode of action of this medication is to inhibit 5-alpha-reductase, an enzyme that prevents conversion of testosterone. This in turn reduces the size of the prostate while increasing hair growth.

Side effects of finasteride

The side effects of finasteride can include erectile dysfunction, as well as gynecomastia (the development of breast tissue in men).

Note: Pregnant women should not handle this medication. Finasteride can be absorbed through the skin and may cause birth defects in a male baby.

tamsulosin (Flomax), doxazosin (Cardura)

Cool Chicken Tamsulosin will help you lose urine. Most end in -osin.

Another medication class used in the treatment of BPH are peripherally acting antiadrenergics.

Medications that fall within this class include tamsulosin and doxazosin. In addition to treating BPH and baldness, doxazosin is used in the treatment of hypertension.

Mode of action of tamsulosin, doxazosin

The mode of action of this medication class is to antagonize alpha 1 receptors, which relaxes the smooth muscles of the prostate, which helps to improve urine flow. It also causes vasodilation (a widening of the blood vessels).

Side effects of tamsulosin, doxazosin

A key side effect with this medication class is hypotension (low blood pressure, due to vasodilation). Other side effects include dizziness, headache, and issues with ejaculation.

Monitor the patient's blood pressure during therapy. It is also important to take this medication at the same time every day.

sildenafil (Viagra), tadalafil (Cialis)

Cool Chicken Sildenafil will help you “fill” out down there.

Another class of medication is phosphodiesterase type 5 inhibitors. Medications that fall within this class include sildenafil and tadalafil. These medications are used for erectile dysfunction.

Mode of action of sildenafil, tadalafil

Phosphodiesterase type 5 inhibitors like sildenafil and tadalafil work by enhancing the effect of nitric oxide that is released during sexual stimulation. This, in turn, increases blood flow to the corpus cavernosum in the penis, as well as vasodilation of the pulmonary vasculature.

Side effects of sildenafil, tadalafil

Side effects include priapism (prolonged erection) and an increased risk for myocardial infarctions (MI, or heart attack).

Patients should not take this medication with any other nitrates, e.g., nitroglycerin, as this can increase their risk for having an MI.

Also, use this medication cautiously in men with cardiovascular disease.


Full Transcript

Hi, I am Cathy, with Level Up RN. In this video, I'm going to continue my coverage of reproductive system medications. Specifically, I'll be covering androgens, BPH medications, and medications for erectile dysfunction. If you have our pharmacology second edition flashcards, be sure to pull those out so you can follow along with me. At the end of the video, I'm going to provide you guys a little quiz, a little knowledge check to test your understanding of some of the key points I'll be covering in this video. So definitely stay tuned for that.

First up, we have testosterone, which is an androgen.

It is used in the treatment of delayed puberty in boys, as well as hypogonadism. It could also be used for postmenopausal breast cancer.

Testosterone is contraindicated in a patient with prostate cancer. And we also need to keep in mind that this medication has a high abuse potential as well.

In terms of side effects, testosterone has a lot of side effects with use. So this includes edema, acne, liver dysfunction, polycythemia, which is where your body produces too many red blood cells, premature epiphyseal closure. In women, it can cause deepening of the voice, baldness, and unusual hair growth, which is something hirsutism. So with hirsutism, the female may have hair growth on the face, or chest, or back.

Next, let's talk about some medications that are used for benign prosthetic hyperplasia or BPH.

If you recall, BPH is where we have an enlarged prostate, which puts pressure on the urethra which runs through the prostate, so it causes urinary symptoms. So there are two different classes of medications I'm going to cover that are used to treat BPH.

One is an androgen inhibitor, which is finasteride.

So finasteride is used to treat not only BPH, but baldness as well.

The mode of action of this medication is that it inhibits five alpha reductase, which is an enzyme, and this prevents conversion of testosterone. And then this in turn reduces the size of the prostate and also increases hair growth.

So side effects of finasteride can include erectile dysfunction as well as gynecomastia, which is the development of breast tissue in men.

So our little cool chicken hint here for remembering this medication is finasteride, think of checking out a guy in a sports car. So you're checking out his fine ride and you're thinking to yourself, "Yeah, he has a fine ride, but he is also bald with BPH." So got away those things. Again, this hint is just to help you remember the name of this medication and what it's for. I totally don't have a thing against guys with baldness or BPH for that matter. I'm just looking for anything to help you guys remember all of these medications. So hopefully that was helpful.

Another medication class used in the treatment of BPH are peripherally acting antiadrenergics, and medications that fall within this class include tamsulosin and doxazosin, and they're both in that osin.

We would use these medications to treat BPH as well as baldness, and doxazosin is also used in the treatment of hypertension.

The mode of action of this medication class is that it antagonizes alpha one receptors, which results in relaxation of the smooth muscles in the prostate, which helps to improve urine flow. It also causes vasodilation.

So a key side effect with this medication class is hypotension. So we're definitely going to want to monitor our patients blood pressure during therapy. Other side effects include dizziness, headache, and issues with ejaculation.

The last medication class that I'm going to cover in this video are phosphodiesterase type five inhibitors, and medications that fall within this class include sildenafil and tadalafil. So these both end in fil.

We would use these medications for erectile dysfunction, and they work by enhancing the effect of nitric oxide that is released during sexual stimulation. And this, in turn, increases blood flow to the corpus cavernosum in the penis.

Side effects include priapism, which is a prolonged erection. In addition, this medication can cause an increased risk for myocardial infarctions.

So a key teaching you need to provide your patient is that they should not take this medication with any other nitrates, including nitroglycerin, as this can increase their risk for having an MI. Also, we want to use this medication cautiously in men with cardiovascular disease.

So our cool chicken hint for remembering these medications is that sildenafil will help you fill out down there. So I probably should have warned you that this was a PG-13 hint ahead of time, but it's out there now, and I hope it was helpful.

All right, time for quiz. I have three questions for you. First question, finasteride is used to treat what disorder? If you said BPH, you're correct. It's also used to treat baldness, but primarily BPH. Second question, what erectile dysfunction medication causes an increased risk for an MI? Answer, sildenafil or tadalafil. So any of the phosphodiesterase type five inhibitors. Question number three, what key teaching do you need to provide a patient who is taking sildenafil? The answer is you need to advise your patient to not take any other nitrates at the same time. So this includes nitroglycerin as this could increase their risk for having an MI.

Okay. I hope this video has been helpful, and I hope you like these quiz questions. If this has helped you, definitely leave me a comment. I love to hear from students and nurses who watch my videos. Also, if you have another little trick or mnemonic for remembering some of these drugs, definitely share those in the comments as well so everyone can benefit from your ideas. Thank you so much for watching.


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