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Pharmacology for Advanced Practice Nurses > Endocrine Deck 4 > Flashcards

Endocrine Deck 4 Flashcards

1
Q

Thyroid Hormones ADR

A

Symptoms of hyperthyroidism
Cardiovascular (CV): angina, blood pressure increase, flushing, palpitations
Central nervous system: anxiety, headache, insomnia

Long-term thyroid replacement associated with decreased bone density in hip/spine in postmenopausal women

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2
Q

Thyroid hormone drug interactinos

A

Bile-acid sequestrants, iron salts, and antacids decrease absorption; estrogens may decrease response.

Drugs may decrease action of warfarin, digoxin, and beta blockers

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3
Q

hypothyroidism

Treatment is indicated

A

in patients with TSH levels greater than 10 μIU/mL or in patients with TSH levels between 5 and 10 μIU/mL in conjunction with goiter or positive antithyroid peroxidase antibodies (or both).

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4
Q

Thyroxine replacement is typically

A

lifelong

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5
Q

Consult with pediatric endocrinologist before

A

treating a pediatric patient with thyroid hormone

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6
Q

subclinical hypothyroidism

A

is controversial on whether or treat it or not

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7
Q

T4 Dosing

For patients with no known CV disease

A

Initial dose can be started at 50 mcg/day for 2 to 4 weeks and may be increased in increments of 25 mcg/day.

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8
Q

Average full replacement of T4

A

100 to 125 mcg/day

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9
Q

what are you monitoring regarding t4

A

lab work and patient response

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10
Q

T4 Dosing

For patients 50+ years with CV disease or with long-standing hypothyroidism

A

Initial dosage of T4 is 12.5 to 25 mcg/day.

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11
Q

T4 Dosing

For patients 50+ years with CV disease or with long-standing hypothyroidism – an increase of

A

An increase of 12.5 to 25 mcg increments at approximately 1-month intervals avoids rapid increases in cardiac workload and symptoms of ischemic heart disease.

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12
Q

T4 if exacerbations of angina

A

pectoris occurs, the previous dosage regimen should be administered and titrated up in smaller increments.

start low and increase slowly

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13
Q

t4 rational drug selection

A

T4 is drug of choice for thyroid replacement and suppression therapy.

In older adults with no cardiac disease, consider consulting with endocrinologist regarding using T3 and T4 or liotrix.

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14
Q

TSH level should be measured

A

in 6 to 8 weeks, and the T4 dose should be adjusted as necessary.

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15
Q

The target tsh level should be between

A

0.3 and 3.0 μIU/mL

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16
Q

Once a stable TSH level is achieved

A

annual examination is appropriate (or if they have symptoms)

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17
Q

T4 monitor for

A

for osteoporosis in high-risk populations.

Many drugs affect TSH levels.

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18
Q

If you are on a natural version of t4 like naturethroid or armourthroid you need monitor

A

T3 and T4 because the t3 is unpredictable

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19
Q

t4 patient education

A

Take medication each day in the morning, preferably before breakfast because absorption is increased on an empty stomach.

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20
Q

T4 ADR

A

ADRs: Learn how to measure heart rate.

Lifestyle management is important

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21
Q

one of the biggest treatments for subclinical hypothyroidism

A

diet and exercise.

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22
Q

Antithyroid Agents

A

Propylthiouracil (PTU), methimazole (Tapazole)

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23
Q

Antithryroid agent block

A

Both block synthesis of T4 and T3.

Neither drug treats the underlying pathology in hyperthyroidism.

24
Q

Antithryroid relapse rate

A

exist but are less likely if treated for 18 to 24 months

25
Q

Antithyroid

Absorption

A

rapidly absorbed after oral dosing, peaking within 1 hour; 85% to 95% bioavailability

26
Q

PTU is

A

75% to 80% protein bound; methimazole is NOT protein bound

27
Q

PTU and methimazole are both

A

metabolized in the liver; both have short half-life; excreted in urine: 35% of PTU, 80% of methimazole

28
Q

Takehome for methimazole

A

it is an antithyroid agent that does not cure the disease. There is a very high relapse rate, but are less likely if treated for 18 to 24 months. Once patient stopts takeing this they will likey go back to their hyperthroid state.

29
Q

Antithyroid Agents

Precautions and contraindications

A

Pregnancy major concern: readily cross the placenta
Recommend that patient not get pregnant while on these drugs.
High concentrations in breast milk
PTU not recommended in children

30
Q

PTU is not

A

reommended in childern.

31
Q

Antithryoid agents ADR and reactions

A

ADRs: agranulocytosis, drowsiness, headache, alopecia, skin rashes, renal/hepatic failure

Drug reaction: lithium, warfarin

32
Q

Rational drug selection

Antithyroid Agents

A

Check guidelines, as use in pregnancy and children varies frequently.

33
Q

Antithyroid Agents

Monitoring

A

Thyroid studies, complete blood count (CBC), liver/renal panels before starting drug
Recheck in 1 to 2 months after starting drug.

34
Q

Antithyroid Agents VERY IPORTANT

A

to NOT miss doses; if dose is missed, patient should NOT make up dose.

35
Q

Antithyroid Agents

Teach about

A

hypothyroid symptoms; prolonged subclinical hyperthyroidism is associated with bone loss, atrial fibrillation, and impaired left ventricular diastolic filling

36
Q

Antithyroid Agents

Dietary sources of iodine

A

should be reduced because they interfere with action of drugs.

37
Q

Antithyroid Agents WATCH USE OF

A

over-the-counter cold medicines.

38
Q

if patient misses a dose of antithryoid

A

skip it and start back the following day

39
Q

Pancreatic Enzym uses

A

cystic fibrosis and pancreatitis
Some bariatric procedures require supplements
Enzymes for digestion output less than 10% of normal then these enzymes are needed

40
Q

Posthyperthyroid Treatment

A

Patients need to expect that they will become hypothyroid.
This may not occur for several months.
Patients must take thyroid supplements for life.

41
Q

Pancreatic Enzymes Inactivated by pH values less than

A

Inactivated by pH values less than 4; do not crush or chew

42
Q

Pancreatic enzyme are used for

A

digestion

43
Q

Pancreatic enzyme Sprinkled

A

on food if powder form

Often enteric coated to withstand the low ph of the stomach

44
Q

pancreatic enzyme main work occurs in the

A

in the duodenum and upper jejunum (digestion)

45
Q

pancreatic enzyme Pharmacokinetics

Absorption

A

none, because it acts locally in gastrointestinal (GI) tract

46
Q

pancreatic enzyme excretion

A

feces

47
Q

pancreatic enzymes precations

A

antacids decrease effectiveness, decreases absorption of oral iron

48
Q

Pancrelipase made from

A

pork

49
Q

pancreatin made from

A

pork, beef, or vegetable sources

50
Q

Pancreatic Enzymes do not

A

crush or chew

51
Q

Pancreatic Enzymes avoid

A

leaving in mouth

52
Q

Pancreatic Enzymes enteric coated

A

formulations should not be mixed with alkaline foods prior to ingestion

53
Q

Pancreatic Enzymes if powered spills

A

wash off skin immediately

54
Q

Pancreatic Enzymes with infants

A

watch for aspiration, inhalation

55
Q

Pancreatic Enzymes lifestyle management

A

follow dietary guidelines

Pharmacology for Advanced Practice Nurses (50 decks)

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