Libido drugs affecting

Upon examination, a 68-year-old married man was found to have a greatly enlarged prostate. Which one of the following drugs is most likely to suppress prostatic growth without affecting libido ... 

Anabolic steroids, antidepressants and drugs of abuse affect libido, potency, and ejaculatory function. Anabolic steroids are derivatives of testosterone, and have strong genitotropic effects. There is published evidence indicating that anabolic steroids increases sexual desire however, the frequency of erectile dysfunction is also increased. Treatment with the antidepressant fluoxetine has been associated with sexual side effects including delayed or nonexistent ejaculation and hyposexuality. Mice treated in utero with the anideukemic agent 5-aza-2/-deoxycytidine exhibit abnormal reproductive behavior and low reproductive capacity. 

Normal sexual activity is associated with ovulation in most female mammals. Compounds affecting this process can adversely affect female libido. Ovarian failure induced by xenobiotic compounds has been associated with a decrease in libido in women. Certain types of oral contraceptives as well as drugs of abuse (methadone, cannabis, alcohol) cause decreases in female libido. The treatment for hirsutism, excessive growth of hair in both normal and abnormal locations, is the compound cyproterone acetate. It is an antiandrogen that has the side effect of severely decreasing libido in women. 

The affective and other behavioral disturbances category of adverse drug reactions included Depression, Psychotic Depression, Emotional lability, Euphoria, Hostility, Personality disorder, and Decreased libido. ... 

The mechanisms by which thiazides affect erectile dysfunction or libido are unclear, but it has been suggested that they have a direct effect on vascular smooth muscle cells or reduce the response to catecholamines. Sexual dysfunction does not appear to be mediated by either a low serum potassium concentration or a low blood pressure. Since sexual dysfunction can adversely affect the quality of life of hypertensive patients, physicians or health-care providers should take an accurate baseline sexual history and monitor sexual status for changes during therapy. If there are significant changes in sexual function, diuretic therapy can be withdrawn and an alternative drug class substituted. However, not uncommonly sexual dysfunction will persist despite withdrawal of the diuretic, suggesting that elements of the hj pertensive state itself contribute to the process. 

These drugs are sedating, and have a variety of untoward effects. The most commonly seen major adverse effect is postural hypotension. Other adverse effects include anticholinergic effects (e.g., dry mouth, constipation, urinary retention, paralytic ileus, and tachycardia), blurred vision, increased intraocular pressure, gynecomastia, galactorrhea, and changes in libido. Glucose tolerance may also be affected. 

Tricyclics modify peripheral sympathetic effects in two ways through blockade of norepinephrine reuptake at neuroeffector junctions and through alpha adrenoceptor blockade. Sedation and atropine-like side effects are common with tricyclics, especially amitriptyline. In contrast to sedative-hypnotics, tricyclics lower the threshold to seizures. The answer is (B). Selective serotonin reuptake inhibitors cause sexual dysfunction in some patients, with changes in libido, erectile dysfunction, and anorgasmia. Tricyclic antidepressants may also decrease libido or prevent ejaculation. Of the heterocyclic antidepressants bupropion is the least likely to affect sexual performance. The drug is also used in withdrawal from nicotine dependence. The answer is (B). 

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