Exam 2 Medications Flashcards
1
Q
radioactive iodine therapeutic use
A
iodine-131
- antithyroid drugs/radioactive iodine
- hyperthyroidism (Graves’ disease)
- Thyroid cancer
2
Q
radioactive iodine adverse reactions
A
- Hypothyroidism (expected for most clients, but still requires drug therapy)
- Bone marrow depression (rare)
- Radiation sickness (rare)
3
Q
radioactive iodine nursing interventions
A
- Monitor thyroid function.
- Monitor for indications of thyroid dysfunction (drowsiness, depression,
weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin,
menorrhagia). - Monitor CBC and platelet count at baseline and periodically thereafter.
- Monitor for indications of anemia, leukopenia, and thrombocytopenia.
- Monitor for manifestations of radiation sickness (hematemesis, epistaxis, intense nausea, vomiting).
4
Q
radioactive iodine medication administration
A
- Give orally.
- Obtain a negative pregnancy test before administration.
- Measure baseline vital signs and weight and monitor periodically thereafter.
- Dosage is miniscule for thyroid disorders, larger for thyroid cancers
- Initiate radiation precautions for large doses (limited contact, increased fluids, body waste disposal per facility protocol).
5
Q
radioactive iodine client education
A
- Watch for and report anxiety, drowsiness, depression, weight gain,
swelling, slow heart rate, appetite loss, cold intolerance, dry skin. - Report fever, sore throat, weakness, or fatigue.
- Report bloody vomit, nosebleeds, or severe nausea and vomiting.
6
Q
radioactive iodine contraindications
A
- Pregnancy: teratogenic effects
- Lactation
7
Q
radioactive iodine precautions
A
- Children prior to puberty
8
Q
radioactive iodine interactions
A
- Other antithyroid drugs reduce uptake.
9
Q
propylthiouracil (PTU) therapeutic use
A
- antithyroid drugs/propylthiouracil
- Hyperthyroidism (Graves’ disease)
- Thyrotoxic crisis
- Suppression of thyroid hormone production in preparation for thyroid- ectomy
10
Q
propylthiouracil (PTU) adverse reactions
A
- Hypothyroidism
- Agranulocytosis
- Hepatotoxicity
- Aplastic Anemia
- Rash
- Arthralgia, headache
- Vertigo, drowsiness, headache
11
Q
propylthiouracil (PTU) nursing interventions
A
- Monitor thyroid function.
- Monitor for indications of hypothyroidism (fatigue and weakness, weight
gain, cold intolerance, dry skin, and listlessness). - Recommend a reduced dosage for clients who develop these effects.
- Monitor CBC at baseline and periodically thereafter (leukocytes, neutrophils).
- Monitor for indications of agranulocytosis; for these symptoms, stop
therapy. - Monitor integumentary status.
- Monitor for joint and muscle pain and headache.
12
Q
propylthiouracil (PTU) medication administration
A
- Give orally at regular intervals, such as every 8 hr.
- Measure baseline vital signs and weight and monitor periodically thereafter.
- Monitor T3 and T4 levels.
13
Q
propylthiouracil (PTU) client education
A
- Watch for and report signs of hyperthyroidism and hypothyroidism
- Report fever or sore throat.
- Report rash.
- Report joint or muscle pain or headache.
- Report any OTC meds, herbal remedies, and supplements to the provider.
14
Q
propylthiouracil (PTU) contraindications
A
- hypersensitivity
15
Q
propylthiouracil (PTU) precautions
A
- immunosuppression
- bone marrow depression
- infection
- liver dysfunction
- pregnancy
16
Q
propylthiouracil (PTU) interactions
A
- Concurrent use with antineoplastics or radiation therapy can lead to
additional bone marrow depression. - Increased antithyroid effects noted when taken with lithium or potassium iodide.
- Risk of agranulocytosis increases with concurrent use of phenothiazines.
17
Q
levothyroxine (Synthroid) therapeutic use
A
- thyroid replacements
- hypothyroidism
18
Q
levothyroxine (Synthroid) adverse reactions
A
- Thyrotoxicosis, Hyperthyroidism (from excessive doses)
- Headache, irritability, insomnia
- Abdominal cramping, diarrhea
- Tachycardia, arrhythmia
- Heat intolerance, diaphoresis
- Menstrual irregularities
19
Q
levothyroxine (Synthroid) nursing interventions
A
- Monitor thyroid function.
- Monitor for indications of hyperthyroidism (anxiety, tachycardia, palpitations, tremors, altered appetite, heat intolerance, fever, diaphoresis,
weight loss)
20
Q
levothyroxine (Synthroid) medication administration
A
- Give orally to treat hypothyroidism and IV to treat myxedema coma.
- Give daily on an empty stomach (at least 30–60 min before breakfast
with full glass of water). - Measure baseline vital signs, weight, and height, and monitor periodically thereafter.
- Monitor for cardiac excitability (angina, chest pain, palpitations, dysrhythmias).
- Monitor T4 and TSH levels.
- Be aware that the various formulations of thyroxine are not interchangeable; instruct clients to notify the provider if a pharmacy dispenses a different levothyroxine product.
- Expect lifelong replacement therapy.
21
Q
levothyroxine (Synthroid) client education
A
- Watch for and report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and
chest pain.
22
Q
levothyroxine (Synthroid) contraindications
A
- Thyrotoxicosis
- Recent myocardial infarction
23
Q
levothyroxine (Synthroid) precautions
A
- Cardiovascular disorders (hypertension, angina pectoris, ischemic heart
disease) - Renal impairment
- Diabetes mellitus
- Older adults
24
Q
levothyroxine (Synthroid) interactions
A
- Cholestyramine (Questran), antacids, iron and calcium supplements,
and sucralfate (Carafate) reduce absorption, so clients should not take
levothyroxine within 4 hr of these drugs. - Food reduces absorption.
- Many antiseizure and antidepressant drugs, including carbamazepine
(Tegretol), phenytoin (Dilantin), phenobarbital, and sertraline (Zoloft),
decrease levels. - Anticoagulant effects of warfarin (Coumadin) increase.
- Cardiac response to catecholamines (such as epinephrine) increases.
25
hydrocortisone (Cortef, Solu-Cortef) therapeutic use
- glucocorticoids
* Replacement therapy for acute and chronic adrenocortical insufficiency
(Addison’s disease)
* NOTE: For detailed information about glucocorticoids that treat asthma,
refer to the Respiratory System module. For detailed information about
glucocorticoids that treat pain and inflammation refer to the Pain and
Inflammation module.
26
hydrocortisone (Cortef, Solu-Cortef) adverse reactions
Few at low, therapeutic levels
* Multiple at high levels needed to suppress inflammation and the immune system
* Adrenal insufficiency
* Cushing’s Syndrome
27
hydrocortisone (Cortef, Solu-Cortef) nursing interventions
* Monitor for side effects related to adrenal insufficiency
* Weight loss, hypotension, weakness, anorexia, nausea, vomiting, confusion, lethargy or restlessness
28
hydrocortisone (Cortef, Solu-Cortef) medication administration
* Give orally (with meals) for chronic adrenal insufficiency, as a total daily
dose in the morning right after waking up or in divided doses (two thirds
in the morning and one third in the early afternoon).
* Give IV for acute and emergency situations.
* Obtain CBC, electrolytes, glucose, and glucocorticoid levels at baseline
and periodically thereafter.
* Make sure clients wear a medical alert band and carry an emergency
supply of glucocorticoids.
* Taper the dose slowly to establish the lowest possible oral dose.
* Give supplemental doses as needed in times of stress
29
hydrocortisone (Cortef, Solu-Cortef) client education
* Report increased stress, as higher dosages are essential at such times
(generally three times the usual dose for three days).
* Avoid live vaccines
* Monitor and report weight gain, swelling, or vision changes
* Include a diet high in protein, potassium, calcium and low in sodium and
carbohydrates
30
hydrocortisone (Cortef, Solu-Cortef) contraindications
* When given in small doses – none
* Large doses: severe infection and live vaccines
31
hydrocortisone (Cortef, Solu-Cortef) precautions
* When given in small doses – none
32
hydrocortisone (Cortef, Solu-Cortef) interactions
* When given in small doses – none
* Large doses: oral contraceptives, phenytoin, phenobarbital, and rifampin
33
fludrocortisone therapeutic use
- mineralocorticoids
* Replacement therapy for acute and chronic adrenocortical insufficiency
(Addison’s disease-use caution as clients with Addison’s may have an
exaggerated response, primary hypoaldosteronism, congenital adrenal
hyperplasia), usually along with hydrocortisone
34
fludrocortisone adverse drug reactions
* Few at low, therapeutic levels
* At levels above that which is therapeutic, fluid and electrolyte imbalances that can lead to hypertension, edema, heart failure, hypokalemia
35
fludrocortisone nursing interventions
* Monitor for side effects related to inappropriate dosing
* Signs of excess dosing (increase in weight, fluid retention, increase in
blood pressure, hypokalemia).
* Signs of inadequate dosing (weight loss, poor appetite, fatigue, muscle
weakness, hypotension).
36
fludrocortisone medication administration
* Give orally daily or three times a week.
* Obtain CBC and electrolyte levels at baseline and periodically thereafter.
* Make sure clients wear a medical alert band.
* Expect lifelong therapy.
37
fludrocortisone client education
* Report weight gain or swelling (high sodium levels).
* Report weakness or palpitations (low potassium levels).
* Have blood pressure checked regularly.
* Follow a diet high in potassium
38
fludrocortisone contraindications
* Drug hypersensitivity
39
fludrocortisone precautions
* Heart failure
* Addison’s Disease
* OB
40
fludrocortisone interactions
INTERACTIONS * Rifampin (Rifadin) and Phenobarbital decrease levels
* Potassium-depleting diuretics, such as furosemide (Lasix), increase the
risk of hypokalemia.
* Salt and foods high in sodium - increases sodium retention and K loss
