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WVC pharm book 37
WVC Pharm chpt 37 thryroid meds
| Question | Answer |
|---|---|
| Iodine-131 is NOT the treatment of choice for patients who are | pregnant |
| thyroid gland function is regulated by the | hypothalamus and the anterior pituitary gland↓ |
| The hypothalamus secretes, __________-_______________ _____________which stimulates the anterior pituitary gland to release ___________- ____________ ______________ | thyrotropin-releasing hormone (TRH) : thyroid-stimulating hormone (TSH) |
| Thyroid-stimulating hormone stimulates the thyroid gland to release its hormones, | triiodothyronine (T3) and thyroxine (T4). |
| Imbalance in thyroid hormone production may also interfere with the following body functions: | growth and maturation, carbohydrate, protein, and lipid metabolism, thermal regulation, cardiovascular function, lactation, and reproduction. |
| Myxedema is | hypothyroidism that occurs during adult life |
| S/S of myxedema | slowness in motion, speech, and mental processes, lethargy, sedentary habits, ↓ appetites, ↑weight, constipation, cold intolerance, weak, and fatigue easily. temp ↓normal, dry/coarse/thickened skin, puffy face,↓BP &↓HR, anemia ↑Cholesterol. |
| cretinism | congenital hypothyroidism. |
| Diagnostic tests for hypothyroidism | circulating T3 and T4 hormones. |
| Disorders that may cause hyperactivity of the thyroid gland are | Graves’ disease, nodular goiter, thyroiditis, thyroid carcinoma, overdoses of thyroid hormones, and tumors of the pituitary gland |
| S/S of ↑thyroidism | ↑PLS(sleep2)/enlgd hrt/palpitns/dysrhyms/nervs/ agitatn/tremors/↓fever,/weight ↓/↑appetite./↑reflexes/insomnia/Heat intol/warm/ flushed/moist skin, ↑sweating, exophthalmos/amenorrhea,/dyspnea w- minor exertion,/hoarse, ↑speech/↑ infection |
| Excessive formation of thyroid hormones and their secretion into the circulatory system causes hyperthyroidism, also known as | thyrotoxicosis |
| S/S of thyrotoxicosis | ↑metabolic rate, ↑pulse rate (to perhaps 140 beats/min), ↑body temperature, restlessness, nervousness, anxiety, sweating, muscle weakness and tremors, and a sensation of feeling too warm. |
| How is thyrotoxicosis treated | antithyroid drugs or surgical removal of the thyroid gland |
| Three types of treatment can be used to reduce the hyperthyroid state | subtotal thyroidectomy, radioactive iodine, and antithyroid medications |
| In treating the elderly who have hypothyroidism, be careful to monitor | increased frequency of angina or symptoms of heart failure |
| Thyroid hormone replacements available are | levothyroxine (T4), liothyronine (T3), liotrix, and thyroid, USP |
| Antithyroid agents include | radioactive iodides, propylthiouracil, and methimazole |
| When assessing hx of a pt with a thyroid disorder, be sure to ask | specific information regarding treatment for any cardiac disease or adrenal insufficiency ;meds &OTC drugs. Pt to explain symptoms over past 2-3 months |
| Review labs for | (TT4) and (TT3), (FT4) and (FT3) tests, TSH levels, TRH stimulation test, thyroid autoantibodies, thyroglobulin, calcitonin assay, ultrasound, fine-needle biopsy, radioactive iodine uptake, electrocardiography, and thyroid scan. |
| Nursing planning for the hypothyroid individual | provide a warm, quiet, structured environment that supports the patient's needs |
| Nursing planning for the hyperthyroid individual | provide a cool, quiet, structured environment because the patient lacks the ability to respond to change and anxiety-producing situations and has an intolerance to heat. |
| __________ _______________ is now considered to be the drug of choice for hormone replacement in hypothyroidism. | Synthetic levothyroxine (T4) |
| ____________________is a synthetic form of the natural thyroid hormone T3 | Liothyronine, rapid than that of levothyroxine (used when needed immediately). Not recommended for patients with cardiovascular disease unless a rapid onset of activity is deemed essential. |
| ___________is a synthetic mixture of levothyroxine and liothyronine in a ratio of 4:1, respectively | Liotrix |
| ________________is derived from pig, beef, and sheep thyroid glands | Thyroid, USP (desiccated thyroid), oldest & least expensive |
| Premedication nursing implementations | baseline stats, teach the pt to assess for s/s of hyperthyroidism daily. |
| The initial dose and the interval of time necessary before increasing the dosage is determined by | age of the patient, severity of hypothyroidism, and other concurrent medical conditions. Hypothyroid patients are sensitive to replacement of thyroid hormones. Monitor patients closely for adverse effects. |
| levothyroxine (Synthroid) (Levoxyl) | L-Thyroxine (l-T4), PO or SQ, ↑met. rate of body tissues. Foods/supplmts containing Ca2+, iron, Mg, or zinc may bind levothyroxine and prevent complete absorption. Assess for s/s ↑thyroidism. PO, SQ |
| liothyronine (Cytomel) | Liothyronine (T3), • Replacement /supplementation to endogenous thyroid hormones • Principal effect is increasing metabolic rate of body tissues, Alters the effectiveness of warfarin (INR will ↑ with thyroid hormone supplementation), monitor ↑thyroidism |
| liotrix (Thyrolar) | T4:T3 |
| thyroid, USP | Unpredictable T4:T3 ratio, Alters the effectiveness of warfarin (INR will increase with thyroid hormone supplementation), s/s ↑thryroidism, PO |
| S/S of hyperthyroidism | tachycardia, anxiety, weight loss, abdominal cramping and diarrhea, cardiac palpitations, dysrhythmias, angina pectoris, fever, and intolerance to heat. |
| Patients with hypothyroidism require increased dosage of | anticoagulants (Warfin), patient should have frequent PT/INR, observe closely for the development of petechiae, ecchymoses, nosebleeds, bleeding gums, dark tarry stools, and bright red or coffee ground emesis |
| Patients with hypothyroidism require a decreased dosage of | digoxin ; while receiving digoxin, a gradual increase in the glycoside will also be necessary |
| Estrogens increase thyroid binding globulin levels, which reduce the level of circulating | free T4. Patient may require an increased dose |
| To prevent binding of thyroid hormones by cholestyramine, administer doses | at least 4 hours apart. |
| Iodine-131 (131I) | RADIOACTIVE ISOTOPE, 3-6 MOS TIL EFFECTIVE, The liberated radioactive isotope destroys the hyperactive thyroid tissue, with essentially no damage to other tissues in the body |
| This radioactive isotope is most commonly used for treating hyperthyroidism in | older patients who are beyond the childbearing years, with severe complicating diseases, with recurrent hyperthyroidism after previous thyroid surgery, who are poor surgical risks, and who have unusually small thyroid glands. |
| Adverse effects of Iodine-131131l | Adverse effects include radioactive thyroiditis, which causes tenderness over the thyroid area and occurs during the first few days or few weeks after radioactive iodine therapy. PO |
| Drug interactions with Iodine-131131l | Lithium and iodine may cause synergistic hypothyroid activity |
| Propylthiouracil and methimazole are | antithyroid agents that act by blocking synthesis of T3 and T4 in the thyroid gland. They do not destroy any T3 or T4 already produced,PO |
| Propylthiouracil and methimazole may be used for | long-term treatment of hyperthyroidism or for short-term treatment before subtotal thyroidectomy. PO |
| The primary therapeutic outcome expected from propylthiouracil or methimazole is gradual return to | normal thyroid metabolic function. |
| Premed assessment with antithyroid agents | baseline vital signs, Wt & BM patterns (in alternate-day schedule) Assess s/s hypothrydsm. |
| What premed labs are done with antithyroid agents | CBC with differential; thyroid hormone, TSH, blood urea nitrogen [BUN], serum creatinine, liver enzyme levels) have been completed before administering the medicine. |
| The most common reaction (in 5% of all patients) that occurs with propylthiouracil therapy is | a purpuric maculopapular skin eruption. (w/I the 1st 2 weeks). If severe, a change to methimazole and the use of short-term oral steroids may be necessary |
| Other side effects of antithyroid agents | headaches, salivary gland and lymph node enlargement, and loss of taste. |
| major dangers of antithryoid agents | Bone Marrow Suppression, Lymph Node Enlargement. Stress the importance of returning for CBC w/diff work. Monitor the patient for the development of a sore throat, fever, purpura, jaundice, or excessive progressive weakness |
| The symptoms of hepatotoxicity are | anorexia, N/V, jaundice, hepatomegaly, splenomegaly, abn liver funct( ↑bilirubin, aspartate. AST, ALT, GGT, alkaline phosphatase levels; ↑INR |
| Nephrotoxicity | Monitor urinalyses/kidney func tests 4 abn results. Rept ↑BUN/ creatinine, ↓UO/↓specific gravity (despite amount of fluid intake), casts/protein in urine, frank blood/smoke-colored urine/RBCs > of 0 to 3 per high power field on the urinalysis report. |
| Iodine-131 is NOT the treatment of choice for patients who are | pregnant |
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