Chapter 6 Medications Flashcards
Thyroid hormones controls (3)
- metabolic rate
- Stimulates heart
- in Childhood has role in growth and development
What is the Drug for Hypothyroidism
Levothyroxine
what is the other name of levothyroxine?
Synthroid
What is the class of levothyroxine (Synthroid)
Synthetic preparation of thyroxine (T4)
What is the MOA of Levothyroxine (Synthroid)
Identical action to naturally occurring hormone (regulates metabolism, stimulates heart, promotes growth and development)
What is the indication of Levothyroxine (Synthroid)
Used to treat all forms of hypothyroidism
What is the pharmacokinetics of Levothyroxine (Synthroid)
Highly protein bound so half life is 7 days, 1 month to plateau!
** Takes long time to have effect, important for patient education**
What are the adverse effects of Levothyroxine (Synthroid) (2)
- At appropriate doses no adverse effect
- If doses is too high then symptoms of thyrotoxicosis can occur ( tachycardia, angina, nervousness, insomnia, hyperthermia etc. )
What is the drug interaction of Levothyroxine (Synthroid)
Anything that changes the pH of stomach must be given 4 hours apart
Levothyroxine (Synthroid) IS AVAILABLE IN WHAT FORMS?
PO and IV forms
When should you administer Levothyroxine (Synthroid)? why?
- On an empty stomach (30-60 mins before eating)
- Because anything that changes the pH of stomach affects absorption
What does diabetic people have to do when taking Levothyroxine (Synthroid) ?
- They have to increase their insulin requirement
- Energy use increases = consuming more glucose when metabolism picks up
What lab works do we need for Levothyroxine (Synthroid) ?
Regular lab work to monitor T4 and T3
What are the patient education for Levothyroxine (Synthroid)? (3)
- Teach patient about S&S of thyrotoxicosis
- Length of time to take effects
- Life long treatment
What is the drug for Hyperthyroidism? (2)
Methimazole and Propanolol
Methimazole Class?
Thionamides
Methimazole MOA
Suppresses synthesis of thyroid hormones
Methimazole Indication (3)
- Treatment of Graves disease
- prior to surgery/radiation
- Thyroid crisis
Methimazole Adverse effects (3)
- Hazardous to pregnant/breastfeeding women
- Agranulocytosis
- Hypothyrodism
what is Agranulocytosis (3)
- dangerous low level of granulocytes
- Happens in first 2 months
- Sore throat and fever
What are other precautions nurses (female) have to do with Methimazole?
- wear gloves due to hazardous effects on pregnancy and breastfeeding.
Methimazole drug interactions?
none :)
how long does the treatment (met) last?
- Treatment usually for 1-2 years and then discontinue of hormone levels stay within normal range
- If levels still rise then restart or do other permanent treatments
Methimazole available in what form?
PO
when do you take Methimazole? why?
- Take at same time everyday with meals
- We want the levels to stay stable and prevent GI upset
What do we need to monitor (lab) for Methimazole?
Monitor T3 and T4
What do we need to educate the patient regarding Methimazole?
- Educate regarding signs of hypothyroidism
- Monitor weight, pulse, mood
What is the class of propanolol?
Beta- Adenergic Blocker
What is the MOA of propanolol?
Non-Selective Beta blocker with negative inotropic chronotropic, dromotropic properties.
What is the Indication of propanolol?
Controls tachycardia in hyperthyroidism (many other uses)
What is the adverse effects of propanolol? (5)
- Bradycardia
- Hypotention
- dizziness
- Heart failure
- Bronchoconstriction
Who should you avoid giving propanolol to? why?
- People with asthma or COPD
- Due to bronchoconstriction effect
Adrenal gland is controlled by?
Hypothalamus and anterior pituitary gland
Cortex secretes what?
Conticosteroids
- Glucocorticoids
- mineral corticoids
- Androgens
Corticosteroids controls what? (6)
- carbohydrate
- protein
- fat metabolism
- integrity of vascular system
- sat and water balance
- Expression of sexual characteristics
What is the drug for adrenal hormone excess (Cushings)?
- No specific drugs for this disorder
- Treatment usually involves removing source of excess stimulation (ACTH or cortisol secreting tumours) or removing exogenous cortisol
What is the drug for Adrenal Hormone Insufficiency (Addisons)?
Hydrocortisone
what is the other name for hydrocortisone?
Cortef
Hydrocortisone (Cortef) MOA
same action as cortisol ( stress hormone )
Hydrocortisone (Cortef) class
Glucocorticoids but also have some mineral corticoids actions
Hydrocortisone (Cortef) indication
- Adrenal insufficiency - low dose
- Severe inflammation - high dose (IBD, asthma, SLE, UC, TB)
Hydrocortisone (Cortef) Adverse effect
- Low dose: no adverse effects
- Chronically high doses - adrenal suppression and cushing’s syndrome
Hydrocortisone (Cortef) forms?
PO, IM, IV
Cortif PO should be given with what? why?
With food or milk to avoid GI problems
When should Hydrocortisone (Cortef) be taken? why?
- Given in AM and early afternoon to mimic natural production of cortisol.
What does a person do when theres extra stress while taking Hydrocortisone (Cortef)?
- Take extra dose with stress (3x3)
- carry cortisol all the time just incase there is stress
What does nurses have to monitor? Hydrocortisone
- BP, HR, I & O
- Cushing’s or sign of infection
What labs do we have to monitor for Hydrocortisone (Cortef)?
- K+
- Blood glucose
- Urine glucose
Patient teaching for Hydrocortisone (Cortef)
- Never stop medication without tapering
- Wear medical bracelet
Why cant we stop Hydrocortisone (Cortef) abruptly?
adrenal glands shrinks with the use of exogenous corticosteroids so stopping the drug abruptly will not give adrenal glands time to excrete enough/ decent amount of corticosteroids.
What does posterior pituitary secrete?
- Oxytocin and Antidiuretic hormone (ADH)
Where is Oxytocin and Antidiuretic hormone (ADH) synthesized?
- In the hypothalamus
When too much ADH is produced what happens?
SIADH ( very little urine being formed and a lot of water being retained)
When too little ADH is produced what happens?
- Diabetes insipidus ( excessive diuresis to dehydration)
What is the treatment for SIADH?
- treat underlying cause of the disorder
- No drugs
What is the drug for Pituitary Insufficiency (DI) ?
Antidiuretic Hormone (Vasopressin)
What is the class of Antidiuretic Hormone (vasopressin)
pituitary hormone
What is the MOA of Antidiuretic Hormone (vasopressin)
Acts on kidneys to cause reabsorption of water, can also stimulate contraction of vascular and GI smooth muscle (high doses)
What is the indication of Antidiuretic Hormone (vasopressin)
Treatment of diabetes insipidus, cardiac arrest ( increase blood flow to the heart and brain)
What is the adverse effect of Antidiuretic Hormone (vasopressin)
- water intoxication ( drowsiness, listlessness, and headache)
