Drugs Affecting the Reproductive System

Chapter 22: Drugs Affecting the Reproductive System •Know the pharmacodynamics, pharmacotherapeutics, clinical use, drug interactions, and ADRs for: Erectile dysfunction (ED) drugs, Estrogens and Progesterone, and Antiandrogen drugs •Androgen drugs oTestosterone is the primary male androgen oResponsible for: ▪Growth, maturation, and maintenance of male sex organs and secondary sexual characteristics ▪Skeletal growth spurt in adolescence and termination of linear growth by fusion of the epiphyseal growth plate ▪Activation of sebaceous glands (acne during puberty) ▪Enhances production of erythropoietic stimulating factor, increased RBCs production ▪Libido oAndrogen Drugs: testosterone propionate (in oil, DepoTesterone), testosterone enanthate (in oil, Delatestryl), testosterone cypionate (in oil, Depo-Testosterone), methyltestosterone (Android, Methitest, Testred, Virilon), testosterone gel (AndroGel 1%, AndroGel 1.62%, Axiron, Testium), fluoxymesterone, TD testosterone (Testoderm, Androderm), and buccal testosterone (Striant) ▪Used to treat Indicated for the symptomatic Tx of •1) deficiency states in males associated with hypogonadism and •2) in both sexes for d/os such as CA and HIB, Tx libido, endometriosis, and postmenopausal symptoms in women, have been used illicitly to enhance athletic performance and increase muscle mass oContraindicated: male breast CA, prostate CA, and Pregnancy (Category X), and lactation •Antiandrogens: several different categories oAndrogen hormone inhibitors (5-alpha-reductase inhibitors) ▪Drugs: Finasteride (Propecia, Proscar) and dutasteride (Avodart) ▪MOA: Block conversation of testosterone to dihydrotesterone ▪Used to Tx BPH ▪PSA levels and digital prostate examination are required monitoring for men on these agents ▪Finasteride (Propecia, Proscar): •Extensive hepatic metabolism •BPH: 5mg/day, 6 to 12 months of therapy until therapeutic response oRegression of prostate size increased urinary flow, and improve BPH symptoms •Approved for Male pattern baldness: 1 mg/day, three months until results •Stopping the drugs reverses the effect within 12 months •ADRs: decreased libido, impotence (can occur at both doses) ▪Dutasteride (Avodart) •Inhibits both type 1 and 2 (5-alpha-reductase) •Peak clinical effect 6 to 12 months of therapy •Extensively metabolized in the liver (CYP3A4 and CYP3A5)