Endocrine Pharmacology

Question 1

Endocrine Disorders Overview

Answer 1

1) endocrine system is made up of glands that secrete hormones, which act on specific receptor sites
2) hormones target receptor sites to regulate response to stress, growth, metabolism, and homeostasis
3) endocrine disorder usually involves oversecretion or undersecretion of hormones, or altered response by target area or receptor

Question 2

Thyroid Hormone

Answer 2

• synthetic form of thyroxine (T4) that increases metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume, and growth process
• thyroid hormone replacement for treatment of hypothyroidism (all ages/types)
• Levothyroxine (Synthroid, Levothroid)

Question 3

Signs of hyperthyroidism

Answer 3

1) anxiety
2) tachycardia
3) palpitations
4) altered appetite
5) abdominal cramping
6) heat intolerance
7) fever
8) diaphoresis
9) weight loss
10) menstrual irregularities

Question 4

Thyroid Hormone: nursing actions

Answer 4

1) obtain baseline vitals and weight. monitor periodically throughout treatment
2) monitor and report signs of cardiac excitability (angina, palpitations, dysrhythmias)
3) monitor T4 and TSH levels
4) instruct client to take daily on empty stomach before breakfast
5) instruct client to take pulse daily and record
6) instruct client to seek immediate medical treatment for angina or palpitation
7) provide client education regarding importance of lifelong replacement, even after improvement of symptoms. advise clients not to discontinue medication w/o checking w/ provider
8) instruct clients to check w/ provider before switching brands of levothyroxine
9) use cautiously in clients who have cardiovascular problems due to cardiac stimulant effects
10) monitor prothrombin time (PT) and INR when on warfarin (Coumadin). Levothyroxine can increase anticoagulant effect

Question 5

Antithyroid Medications/Propylthiouracil

action and therapeutic uses

Answer 5

1) blocks synthesis of thyroid hormones
2) blocks conversion of T4 into T3
3) prevents oxidation of iodide
4) used for treatment of Graves’ disease
5) produces euthyroid state prior to thyroid removal surgery
6) used in emergency treatment of thyrotoxicosis
7) propylthiouracil (PTU)

Question 6

Signs of hypothyroidism

Answer 6

1) drowsiness
2) depression
3) weight gain
4) edema
5) bradycardia
6) anorexia
7) cold intolerance
8) dry skin
9) menorrhagia

Question 7

Antithyroid Medications/Propylthiouracil: Nursing Actions

Answer 7

1) monitor vital sings and weight at baseline and periodically throughout treatment.
2) advise clients that therapeutic effects may take several weeks to be evident
3) administer medication several times per day due to short half-life
4) instruct clients to take medication at consistent times each day and w/ meals to maintain consistent therapeutic level and decrease gastric distress.
5) instruct client to report signs of overmedication (signs of hypothyroidism) to provider
6) instruct client to monitor for early signs of agranulocytosis (sore throat, fever) and report them promptly to provider
7) monitor blood counts at baseline and periodically
8) instruct client not to discontinue medication abruptly

Question 8

Antithyroid Medications/Radioactive Iodine

Answer 8

• radioactive iodine is absorbed by thyroid and destroys some thyroid producing cells
• high dose
  a. hyperthyroidism
  b. thyroid cancer
• lower doses
  a. used in thyroid function studies to diagnose thyroid disorders

Question 9

Antithyroid Medications/Radioactive Iodine: complications

Answer 9

1) radiation sickness
2) bone marrow suppression
3) hypothyroidism

Question 10

Antithyroid Medications/Radioactive Iodine: nursing actions

Answer 10

1) monitor for symptoms of radiation sickness (hematemesis, epistaxis, intense nausea, vomiting)
2) monitor for anemia, leukopenia, and thrombocytopenia
3) instruct client to report signs of hypothyroidism to provider
4) instruct client that it will take several weeks for effects of medication to be seen. Reduction of thyroid function is gradual
5) Instruct client regarding radioactivity precautions:
- limit contact w/ other persons to 30 min/day/person
- avoid contact w/ infants and small children
- increase fluid intake to 2-3 L/day
- dispose of body wastes per protocol
- void frequently to avoid irradiation of gonads

Question 11

Antithyroid Medications/Nonradioactive Iodine

Answer 11

• creates high levels of iodide
  a. reduces iodine uptake by thyroid gland
  b. inhibit thyroid hormone production
  c. block release of thyroid hormones into bloodstream
• development of euthyroid state
• reduction of thyroid gland size prior to thyroid removal surgery

1) Lugol’s solution (oral)
2) Sodium iodide (IV)
3) potassium iodide (oral)

Question 12

Antithyroid Medications/Nonradioactive Iodine: complications

Answer 12

Iodism symptoms due to corrosive property:

• metallic taste
• stomatitis
• sore teeth and gums
• gastric distress
• small bowel lesions

Question 13

Antithyroid Medications/Nonradioactive Iodine: nursing actions

Answer 13

1) thyroid-nonradioactive iodine can be used in conjunction w/ other therapy because effects are not usually complete or permanent
2) obtain baseline vitals and weight. monitor periodically throughout treatment
3) instruct client to drink through straw to prevent tooth discoloration
4) instruct client to dilute strong iodine solution w/ juice to improve taste
5) encourage client to increase fluid intake, unless contraindicated
6) instruct client to take medication w/ meals to reduce GI distress
7) monitor for sings of iodism
8) instruct client to reduce intake of food high in iodine

Question 14

Anterior Pituitary Hormones/Growth Hormones

Answer 14

• stimulates overall growth and production of protein and decreases uses of glucose
• used to treat growth hormone deficiencies (pediatric and adult deficiencies, Turner’s syndrome, Prader-Willi syndrome)

1) somatropin (Genotropin, Nutropin)
2) Somatrem (Protropin)

Question 15

Anterior Pituitary Hormones/Growth Hormones: Complications

Answer 15

1) hyperglycemia

2) hypothyroidism

Question 16

Anterior Pituitary Hormones/Growth Hormones: nursing actions

Answer 16

1) obtain baseline height and weight
2) monitor growth patterns during medication administration, usually monthly
3) reconstitute medication per directions. rotate gently and do not shake prior to administration
4) monitor for signs of hyperglycemia
5) monitor thyroid function

Question 17

Posterior Pituitary Hormones/Antidiuretic Hormones

Answer 17

• promote reabsorption of water within kidneys
• cause vasoconstriction due to contraction of vascular smooth muscle
• treat diabetes insipidus

1) desmopressin (DDAVP, Stimate)
2) vasopressin (Pitressin)–used during cardiac arrest

Question 18

Posterior Pituitary Hormones/Antidiuretic Hormones: complications

Answer 18

• reabsorption of too much water

- myocardial ischemia from vasoconstriction

Question 19

Posterior Pituitary Hormones/Antidiuretic Hormones: nursing actions

Answer 19

1) monitor vital signs, I&O, daily weight, and lab results (potassium, sodium, BUN, creatinine, specific gravity, osmolality)
2) monitor for headache, confusion, or other signs of water intoxication
3) with IV administration of vasopressin, monitor client’s IV site carefully because extravasation can lead to gangrene
4) advise client to notify provider of chest pain, chest tightness, or diaphoresis
5) instruct client to reduce fluid intake during therapy

Question 20

Adrenal Hormone Replacement

Answer 20

• mimics effect of natural hormones
• used for acute and chronic replacement therapy for adrenocortical insufficiency (Addison’s disease)

1) hydrocortisone (Hydrocortone, Solu-Cortef)
2) prednisone (Deltasone)
3) dexamethasone (Decadron)
4) fludrocortisone acetate (Florinef)

Question 21

Adrenal Hormone Replacement: complications

Answer 21

1) osteoporosis
2) adrenal suppression
3) peptic ulcer
4) infection
5) retention of sodium and water

Question 22

Adrenal Hormone Replacement: nursing actions

Answer 22

1) monitor weight, BP, and electrolytes (glucose, sodium, potassium)
2) give with food to reduce gastric distress
3) insturct client to observe for manifestations of peptic ulcer (coffee-ground emesis, bloody or tarry stools, abdominal pain) and to notify provider if they occur
4) instruct client to not stop taking medication suddenly. Dosage will need to be tapered off gradually
5) instruct client to notify the provider of symptoms of increased adrenal insufficiencies (fever, muscle and joint pain, weakness and fatigue)
6) instruct client to take calcium supplements and vitamin D due to increased risk of osteoporosis
7) instruct client to avoid contact with people who have a cold or communicable disease. monitor for signs of infection (ie. fever)