Exam 5 chapter 49 Flashcards by Kelli Greer

What drug is used for thyroid hormone replacement

levothyroxine

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What drugs interact with levothyroxine?

warfarin, digoxin, some vitamins and supplements

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How does warfarin affect levothyroxine?

increases effect (monitor PT/INR and s/s of bleeding)

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How does digoxin affect levothyroxine

decreases affect (monitor s/s of heart failure like sob, edema, crackles)

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How do vitamins and supplements affect thyroid hormone replacement?

decreases the absorption

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How long before vitamins and supplements should we take levothyroxine

4 hrs before

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Adverse effects of levothyroxine?

overmedication and over treatment –> leads to hyperthyroidism, aFIB, and increased risk of bone loss

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Patient teaching for levothyroxine

take 30-60 mins before breakfast on empty stomach, only take with water, wear medic alert bracelet, keep list of meds on you, check medication labels, do not stop abruptly, monitor weight

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We should teach our patients to not administer levothyroxine if their HR is

greater than 100

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what are the antithyroid drugs?

methimazole and propylthiouracil

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Propylthiouracil has a black box warning for

severe hepatic toxicity

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the biggest side effect of our antithyroid drugs is?

hypothyroidism

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For our patients on antithyroid drugs, we need to monitor

vital signs (especially HR), daily weight, T3 T4 and TSH hormones, CBC, s/s of infection, s/s of hypothyroidism

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why do we monitor s/s of infection with antithyroid drugs

causes agranulocytosis (extremely low white blood cell levels)

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What can we administer if our patient on antithyroid drugs shows signs of agranulocytosis

filgrastim to increase neutrophils

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what can occur if we abruptly stop taking our antithyroid drugs

thyroid crisis/storm

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What are s/s of thyroid crisis

tachycardia, fever, flushed skin, restlessness, confusion, behavior changes

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what should we teach our patients on antithyroid drugs to do?

take at same time each day with meals, take caution with OTC meds, wear medic alert ID, take their pulse, report symptoms of infection, report symptoms of hypothyroidism

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If our patient has increased TSH, they will have

hypothyroidismi

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If our patient has decreased TSH and increased T3 and T4, our patient will have

hyperthyroidism

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What drugs are the antidiuretic hormones/

vasopressin and desmopressin

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What are the indications of antidiuretic hormones

diabetes insipidus

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Nursing interventions of antidiuretic hormones

monitor for overhydration, reduce fluid intake, use smallest effective dose, s/s of MI go to ed, monitor vs/labs/daily weights/water intoxication, ECG, IV site for extravasation

What are the adverse effects of desmopressin and vasopressin

reabsorption of too much water, MI, hyponatremia

Antidiuretic hormones have a black box warning for

severe hyponatremia

Intranasal desmopressin starts with a

bedtime dose

Why should we monitor urine specific gravity in our patients on antidiuretic hormones

will show how concentrated the urine is

Evaluation of effectiveness for antidiuretic hormone drugs

decreased urine output, dehydration, thirst. Increased urine specific gravity

what drug is used to treat hyperparathyroidism

calcitonin-salmon

Side effects of calcitonin salmon

GI disturbances, skin rash, flushing, nasal irritation

Adverse effects calcitonin salmon

hypocalcemia (leads to tetany and seizures)

How to recognize biphosphates

end in -dronate

Indications for biphosphates

postmenopausal osteoporosis, male osteoporosis, osteoporosis caused by glucocorticoids, Paget disease

Patient teaching for biphosphates

take on empty stomach with 8 oz water, take acetaminophen/analgesic, remain upright for 30 minutes afterwards, report visual changes, report GI issues if they're preventing intake, stop medicine before dental work/avoid it, perform weight bearing exercises, eat a diet high in calcium and vitamin D

What drugs are corticosteroids?

dexamethasone, prednisone, fluticasone, betamethasone, methylprednisolone, prednisolone, triamcinolone

What are the indications for corticosteroids

Addison's disease, RA, lupus, chrohns

Corticosteroids can cause ____ so we should?

suppression of adrenal gland function (use alternate day dosing)

Longterm use of corticosteroids can cause ______. Manifestations of this include?

Cushing's syndrome : moon face, buffalo hump, purple striae, muscle weakness

Our patients taking longterm corticosteroids need bone density screenings because?

it can cause osteoporosis and bone loss

How do corticosteroids affect blood sugar?

causes hyperglycemia (diabetics need to monitor blood glucose closely)

How do corticosteroids affect the muscles?

causes myopathy and muscle weakness

How do corticosteroids affect our stomach

causes peptic ulcer disease (avoid NSAIDs, take with food, report GI bleeding)

Those on corticosteroids should monitor signs and symptoms of?

infection

children taking corticosteroids may experience

growth suppression (monitor height and weight weeklyO

Common fluid and electrolyte disturbances of corticosteroids include

fluid and weight gain, ankles for edema, hypokalemia,

Patient teaching for corticosteroids?

take with food, wear medical ID, carry extra doses, take it every other morning, avoid NSAIDs and report signs of bleeding, perform weight bearing exercises, eat a diet high in vitamin D and calcium, report infection muscle weakness and cushings, monitor BG, DO NOT STOP ABRUPTLY

What are symptoms of adrenal insufficiency that patients should report?

anorexia, hypoglycemia, lethargy, nausea, restlessness and weakness

Mineralcorticoids are involved in?

salt and water balance

Fludrocortisone is a mineralocorticoids, what are adverse effects?

HTN, edema, HF, hypokalemia

Patients on fludrocortisone should report?

weight gain, peripheral edema, muscle weakness, irregular pulse

When stopping corticosteroids, we have to

taper them off

Illnesses and stress with corticosteroids may neccesitate

the need for higher doses

corticosteroids are contraindicated in

those with active fungal infections and live virus vaccines

a serious complication of long term corticosteroid use is

osteoporosis

those taking longterm corticosteroids should take their dose

every other day in the morning