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Pharmacology > Exam 5 chapter 49 > Flashcards

Exam 5 chapter 49 Flashcards

1
Q

What drug is used for thyroid hormone replacement

A

levothyroxine

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2
Q

What drugs interact with levothyroxine?

A

warfarin, digoxin, some vitamins and supplements

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3
Q

How does warfarin affect levothyroxine?

A

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

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4
Q

How does digoxin affect levothyroxine

A

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

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5
Q

How do vitamins and supplements affect thyroid hormone replacement?

A

decreases the absorption

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6
Q

How long before vitamins and supplements should we take levothyroxine

A

4 hrs before

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7
Q

Adverse effects of levothyroxine?

A

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

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8
Q

Patient teaching for levothyroxine

A

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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9
Q

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

A

greater than 100

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10
Q

what are the antithyroid drugs?

A

methimazole and propylthiouracil

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11
Q

Propylthiouracil has a black box warning for

A

severe hepatic toxicity

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12
Q

the biggest side effect of our antithyroid drugs is?

A

hypothyroidism

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13
Q

For our patients on antithyroid drugs, we need to monitor

A

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

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14
Q

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

A

causes agranulocytosis (extremely low white blood cell levels)

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15
Q

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

A

filgrastim to increase neutrophils

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16
Q

what can occur if we abruptly stop taking our antithyroid drugs

A

thyroid crisis/storm

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17
Q

What are s/s of thyroid crisis

A

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

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18
Q

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

A

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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19
Q

If our patient has increased TSH, they will have

A

hypothyroidismi

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20
Q

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

A

hyperthyroidism

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21
Q

What drugs are the antidiuretic hormones/

A

vasopressin and desmopressin

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22
Q

What are the indications of antidiuretic hormones

A

diabetes insipidus

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23
Q

Nursing interventions of antidiuretic hormones

A

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

24
Q

What are the adverse effects of desmopressin and vasopressin

A

reabsorption of too much water, MI, hyponatremia

25
Q

Antidiuretic hormones have a black box warning for

A

severe hyponatremia

26
Q

Intranasal desmopressin starts with a

A

bedtime dose

27
Q

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

A

will show how concentrated the urine is

28
Q

Evaluation of effectiveness for antidiuretic hormone drugs

A

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

29
Q

what drug is used to treat hyperparathyroidism

A

calcitonin-salmon

30
Q

Side effects of calcitonin salmon

A

GI disturbances, skin rash, flushing, nasal irritation

31
Q

Adverse effects calcitonin salmon

A

hypocalcemia (leads to tetany and seizures)

32
Q

How to recognize biphosphates

A

end in -dronate

33
Q

Indications for biphosphates

A

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

34
Q

Patient teaching for biphosphates

A

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

35
Q

What drugs are corticosteroids?

A

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

36
Q

What are the indications for corticosteroids

A

Addison’s disease, RA, lupus, chrohns

37
Q

Corticosteroids can cause ____ so we should?

A

suppression of adrenal gland function (use alternate day dosing)

38
Q

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

A

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

39
Q

Our patients taking longterm corticosteroids need bone density screenings because?

A

it can cause osteoporosis and bone loss

40
Q

How do corticosteroids affect blood sugar?

A

causes hyperglycemia (diabetics need to monitor blood glucose closely)

41
Q

How do corticosteroids affect the muscles?

A

causes myopathy and muscle weakness

42
Q

How do corticosteroids affect our stomach

A

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

43
Q

Those on corticosteroids should monitor signs and symptoms of?

A

infection

44
Q

children taking corticosteroids may experience

A

growth suppression (monitor height and weight weeklyO

45
Q

Common fluid and electrolyte disturbances of corticosteroids include

A

fluid and weight gain, ankles for edema, hypokalemia,

46
Q

Patient teaching for corticosteroids?

A

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

47
Q

What are symptoms of adrenal insufficiency that patients should report?

A

anorexia, hypoglycemia, lethargy, nausea, restlessness and weakness

48
Q

Mineralcorticoids are involved in?

A

salt and water balance

49
Q

Fludrocortisone is a mineralocorticoids, what are adverse effects?

A

HTN, edema, HF, hypokalemia

50
Q

Patients on fludrocortisone should report?

A

weight gain, peripheral edema, muscle weakness, irregular pulse

51
Q

When stopping corticosteroids, we have to

A

taper them off

52
Q

Illnesses and stress with corticosteroids may neccesitate

A

the need for higher doses

53
Q

corticosteroids are contraindicated in

A

those with active fungal infections and live virus vaccines

54
Q

a serious complication of long term corticosteroid use is

A

osteoporosis

55
Q

those taking longterm corticosteroids should take their dose

A

every other day in the morning

56
Q
A

Pharmacology (12 decks)

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