Sample Answer for NUR-635 Topic 7 DQ 2 Included After Question
Select one of the prompts below to complete this discussion question:
Select a prescription or nonprescription medication and explain the cultural and genetic factors that need to be considered when recommending or prescribing for contraception or hormone replacement. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including interactions with CAM. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.
Hypogonadism affects many men and is known to be one of the main causes of infertility. Explain the pathophysiology of infertility. Discuss testosterone replacement therapy (TRT), including the benefits, risks, contraindications, potential drug interactions, preparations, and dosing. Explain the cultural and genetic factors that need to be considered when recommending or prescribing TRT. Discuss evidence and treatment guidelines to determine appropriate therapeutic options for a patient with infertility. Use evidence-based, peer-reviewed research to support your answer. Include references using APA format.
American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2
A Sample Answer For the Assignment: NUR-635 Topic 7 DQ 2
Title: NUR-635 Topic 7 DQ 2
Medication: Testosterone Replacement Therapy (TRT)
Cultural and Genetic Factors:
When recommending or prescribing Testosterone Replacement Therapy (TRT), healthcare providers should consider cultural and genetic factors that can influence its effectiveness and safety. These factors may include variations in androgen receptor sensitivity, differences in metabolism, and cultural perceptions of masculinity and virility(Hackett, 2017). Genetic variations, such as polymorphisms in the androgen receptor gene, can impact the response to TRT. Additionally, cultural beliefs and expectations around masculinity and sexual health may affect a patient’s willingness to accept TRT as a treatment option.
Mechanism of Action:
TRT involves the administration of exogenous testosterone to replace or supplement the body’s own production. Testosterone acts through the androgen receptor to exert its effects, which include promoting secondary sexual characteristics, increasing muscle mass, and maintaining bone density (Rosenthal, 2022). TRT can be administered through various forms, including gels, injections, patches, and implants, with each method having a different mechanism of release and absorption.
Monitoring, Side Effects, and Drug Interactions:
Regular monitoring of testosterone levels, hematocrit, and lipid profiles is essential to ensure that testosterone levels remain within the therapeutic range and to detect any adverse effects. Common side effects of TRT may include acne, oily skin, increased hematocrit, mood swings, and gynecomastia. More severe side effects may include cardiovascular risks, sleep apnea exacerbation, and worsening of prostate conditions in some cases (Hayes, 2020).
TRT can interact with other medications. For example, TRT may decrease the anticoagulant effect of warfarin, and it can interact with medications like insulin, leading to changes in blood glucose levels. Patients should inform their healthcare provider about all medications and supplements they are taking to minimize potential interactions (Bogehave, 2023).
Contraindications:
TRT is contraindicated in patients with prostate or breast cancer. It is also not recommended for patients with uncontrolled heart failure, severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), or those with elevated hematocrit (Bogehave, 2023).
Preparations and Dosing:
Several TRT formulations are available, including intramuscular injections, transdermal gels, patches, buccal systems, and long-acting injections. The choice of preparation and dosing depends on individual patient characteristics, including preferences, lifestyle, and the specific indications for treatment. The dosing regimen should be tailored to maintain testosterone levels within the therapeutic range.
Evidence and Treatment Guidelines:
Treatment guidelines for TRT are typically based on peer-reviewed research and evidence-based practices. Guidelines, such as those from the Endocrine Society, provide recommendations for the diagnosis and treatment of hypogonadism and infertility in men (PaRK, 2019). They emphasize the importance of a thorough evaluation, including clinical symptoms and laboratory testing, before initiating TRT. The decision to prescribe TRT should be based on the presence of clinical symptoms and consistent laboratory evidence of low testosterone.
References:
Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., & Swerdloff, R. S. (2010).
Barbonetti, A., D’Andrea, S., & Francavilla, S. (2020). Testosterone replacement therapy. Andrology, 8(6), 1551–1566. https://doi.org/10.1111/andr.12774
Testosterone therapy in men with androgen deficiency syndromes: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 95(6), 2536-2559.
Hackett, G., Kirby, M., Edwards, D., Jones, T. H., & Wylie, K. (2017). British Society for Sexual Medicine guidelines on the management of erectile dysfunction in men-2017. The Journal of Sexual Medicine, 14(5), 551-564.
Salonia, A., Rastrelli, G., Hackett, G., Seminara, S. B., Huhtaniemi, I. T., Rey, R. A., … & Tajar, A. (2019). Paediatric and adult-onset hypogonadism: differences in clinical presentation and long-term outcome. European Journal of Endocrinology, 181(6), 585-596.
Bogehave, M., Glintborg, D., Gram, J. B., Bladbjerg, E. M., Andersen, M. S., & Sidelmann, J. J. (2023). Testosterone therapy increases the anticoagulant potential in men with opioid-induced hypogonadism: a randomized, placebo-controlled study. Endocrine connections, 12(4), e220455. https://doi.org/10.1530/EC-22-0455
Park, H. J., Ahn, S. T., & Moon, D. G. (2019). Evolution of Guidelines for Testosterone Replacement Therapy. Journal of clinical medicine, 8(3), 410. https://doi.org/10.3390/jcm8030410
