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NU 308 Pharmacology > Exam 5 Endocrine > Flashcards

Exam 5 Endocrine Flashcards

1
Q

What is the action of levothyroxine?

A

that increase
metabolic rate, protein synthesis, cardiac
output, renal perfusion, oxygen use, body
temperature, blood volume, and growth
processes

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2
Q

What are indicatinos of levothyroxine?

A
  • hypothyroidism
  • for the emergency treatment of myxedema coma
    (IV), a severe deficiency of thyroid hormone
    with loss of homeostasis
  • cretinism
  • simple goiter
  • maintenance of thyroid hormone levels after
    surgery or radiation of the thyroid
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3
Q

What do we teach pts on levothyroxine?

A

Take daily 30 minutes before
breakfast
 Do not stop without provider knowing
 Treatment is lifelongW

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4
Q

What are adverse effects of levothyroxine?

A

Thyrotoxicosis
 Afib
 Bone loss leading to fracture
 Increased risk of dysrhythmias

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5
Q

What is hypothyroidism?

A

Underactive thyroid -> not producing enough hormone (disease or destruction of gland)

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6
Q

What are typical lab values for hypothyroidism?

A

high TSH, low T3, T4

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7
Q

What causes hypothyroidism?

A

Hashimoto’s thyroiditis (autoimmune disease characterized by inflammation of
gland)
 Other causes -> treatment for hyperthyroidism; radiation; surgery; amiodarone therapy, lithium or iodine

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8
Q

What are s/s of hypothyroidism?

A

Decreased CO, HR, and BP; cardiac enlargement and HF;
anemia
 Apathy; lethargy; emotional dullness; slow speech; dullness;
mental sluggishness; drowsy
 Cold intolerant
 Weight gain; decreased appetite; constipation
 Weak; fatigue
 Dry, course, thick skin, hair and nails

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9
Q

What is hyperthyroidism?

A

Overactive thyroid-> thyroid gland produces too much hormone (Thyroxine

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10
Q

What causes hyperthyroidism?

A

Grave’s Disease which is an
autoimmune disorder where antibodies produced by immune system stimulate thyroid to produce
too much T4

Nodular thyroid goiter -> one or more adenomas (a portion of the gland that has walled itself off
from the rest of the gland) of the thyroid produce too much T4 -> This type is increased as
people age and where there is dietary iodine deficiency
 Overtreatment for hypo

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11
Q

What are lab values for hyperthyroidism?

A

ow TSH, high T3, T4

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12
Q

What are s/s of hyperthyroidism?

A
  • Unintentional weight loss; altered (increased) appetite; Abdominal cramps, diarrhea, N and V
  •  Tachycardia/palpitations, increased cardiac output, dysrhythmias, HF
  •  Nervous, emotional instability, restless, anxiety, insomnia
  •  Heat intolerance; fever; diaphoresis ; soft hair and nails; exopthalamus
  •  THYROID STORM: Thyrotoxic crisis -> rare but serious; typically if poorly treated or undiagnosed or if treated well bu
  • body in stress
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13
Q

What are adverse effects of methimazole?

A

Overmedication can result hypothyroidism​

Agranulocytosis –severe ↓ WBC (sore throat, fever)​

Liver injury, hepatitis

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14
Q

What do we teach pts on methimazole?

A

Oral admin.

Monitor vital signs, weight, and I&O at baseline and periodically.

Monitor thyroid levels before, during, and after therapy.

Monitor for s/s of hyperthyroidism (indicating inadequate medication)

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15
Q

What do we give pts with hyperthyroidism for tremors and tachycardia?

A

Clients who have hyperthyroidism may be given a beta-adrenergic antagonist (propranolol) to decrease tremors and tachycardia

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16
Q

What are s/s of cretinism?

A

sluggish
pale/gray, cool skin
nonpitting myxedema
constipation
large tongue
poor muscle tone
mental retardation
dry, brittle hair

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17
Q

What are indications for propylthiouracil?

A

hyperthyroidism
Graves’ disease

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18
Q

What do we teach pts on propylthiouracil?

A

Therapeutic effects can take 1 to 2 weeks to be evident, while full benefit can take 3 to 12 weeks

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19
Q

What are s/s of Graves’ disease?

A

bulging eyes
enlarged thyroid
heat intolerance
anxiety

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20
Q

What are advers effects of iodine?

A

Radiation Sickness
Bone marrow depression-leukemia may be induced
Hypothyroidism

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21
Q

What are indications for radioactive iodine?

A

High doses:
Hyperthyroidism
Thyroid cancer
Clients who have not responded to other antithyroid treatments

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22
Q

What are adverse effects of radioactive iodine?

A

Radiation Sickness
Bone marrow depression-leukemia may be induced
Hypothyroidism

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23
Q

What are contraindications for radioactive iodine?

A

Use is contraindicated in pregnancy (Pregnancy Risk Category X), clients of childbearing age/intent, and during lactation

24
Q

What are pt teaching points for radioactive iodine?

A

Instruct clients to report manifestations of hypothyroidism to the provider
Discontinue use of other antithyroid medications for a week prior to therapy
Clients and secretions will be radioactive until the iodide decays

25
Q

What is important to remember after administering radioactive iodine?

A

Clients and secretions will be radioactive until the iodide decay

26
Q

What is the action of Lugol’s solution?

A

Nonradioactive iodine creates high levels of iodide that will reduce iodine uptake (by the thyroid gland), inhibit thyroid hormone production, and block the release of thyroid hormones

27
Q

What are indications for Lugol’s solution?

A

emergency treatment of thyrotoxicosis

28
Q

What hormone does levothyroxine mimic?

A

T4

29
Q

What is the antidote for Lugol’s solution?

A

Sodium Thiosulfate

30
Q

What are teaching points for lugol’s solution?

A

Avoid foods high in iodine
Dilute strong iodine solution with juice to improve taste.
Take at the same time each day to maintain therapeutic levels

31
Q

What are nursing implications for lugol’s solution?

A

Monitor for iodism (brassy taste in mouth, burning sensation in mouth, sore teeth).

32
Q

What hormone does the anterior pit gland reduce?

A

GH (somatotropin

33
Q

What hormone does the posterior pit gland produce?

A

Antidiuretic hormone (ADH)/Vasopressin

34
Q

What hormone does the hypothalamus produce?

A

Growth hormone–releasing hormone (GHRH

35
Q

What does defficient growth hormone result in?

A

dwarfism

36
Q

What does excessive growth hormone result in?

A

acromegaly

37
Q

What does ADH do?

A

Functions to regulate water balance

38
Q

What happenes during during diabetes insipidus when there is low ADH?

A

kidneys filter water but do not reabsorb

39
Q

What are indications for somatropin?

A

Used totreat growth hormonedeficiencies​
AIDS wastingsyndrome​
Pediatric growth failure

40
Q

What are adverse effects of somatropin?

A

Hyperglycemia
Inactivation
Hypercalciuria and Renal Calculi
HA, Weakness

41
Q

What are adverse effects of somatropin?

A

Teach clients to monitor for flank pain, fever, and dysuria, and report these to the provider

42
Q

What are contraindications for somatropin?

A

glucocorticoids can counteract

43
Q

What is the action of octreotide?

A

Suppresses growth hormone release

44
Q

What are indications for octreotide?

A

Gigantism in children, acromegaly in adults

45
Q

What are adverse reactions to octreotide?

A

(usually subside 1-2 wks)
GI disturbances
Cholesterol gallstones can develop within a year
Nausea, cramps, diarrhea, flatulence, ileus
Hypo/hyperglycemia

46
Q

How do we administer octreotide?

A

Give injections without food or at HS

47
Q

What do we teach pts on octreotide?

A

Teach clients proper technique for subcut injection

48
Q

What are indications for ADH?

A

vasopressin is sometimes used during CPR to temporarily decrease blood flow to the periphery and increase flow to the brain and heart.
Desmopressin can be used for nocturnal enuresis(decreases the production of urine) and hemophilia (promote release of certain clotting factors)

49
Q

What are adverse effects of ADH?

A

Water intoxication (retention of too much water

50
Q

What are other ADH meds?

A

Desmopressin
Diabetes Insipidus: an uncommon disorder that causes an imbalance of fluids in the body. This imbalance leads you to produce large amounts of urine. There is no cure

51
Q

How do we know ADH worked?

A

Reduction in the large volumes of urine output associated with diabetes insipidus to normal levels of urine output (1.5 to 2 L/24 hr)
Cardiac arrest survival

52
Q

What are s/s of syndrome of inappropriate ADH?

A

hyponatremia, mild cramping, nausea, vomiting leading to confusion, seizures, and coma

53
Q

How do you treat SIADH?

A

Fluid restriction

54
Q

What causes SIADH?

A

ADH, too much water retention

55
Q

What do we monitor with somatropin?

A

the pts baseline height and weight

56
Q
A

NU 308 Pharmacology (23 decks)

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