Hormonal Disorder And Meds Flashcards
The nurse is caring for a pt receiving intranasal desmopressin (DDAVP) in a pt who has diabetes insipidus.
Which of the following assessments would the nurse make to determine effectiveness of the medication?
A) increased insulin levels
B) decreased diarrhea
C) improved nasal patency
D) decreased thirst
D
Sign that medication is working
What is a specific indication of vasopressin?
Tx of pulse less cardiac arrest
What is the main effect of the medications vasopressin’s and desmopressin?
And what is a common AE that happens in response?
(ADH hormone)
Vasoconstrictive effect
Which often leads to hypertension
What are the main actions of the antidiuretic hormone medications vasopressin’s and desmopressin?
Causes water retention, decreases urine output, decreases thirst , and increase urine concentration
What are some medication interactions that increase the antidiuretic effect of vasopressin and desmopressin?
Interacts and increase antidiuretic effect with : carbamazepine and fudrocortisone
What are some medication interactions that decrease antidiuretic effect of desmopressin and vasopressin?
Decreased effect with : norepinephrine, lithium and alcohol
What is important to monitor with the medication tx of vasopressin and desmopressin?
Monitor fluid and electrolyte levels
What are some contraindications with the administration of vasopressin and desmopressin?
- acute or chronic illness
- migraine
- headaches
- asthma
- epilepsy
Thé nurse is reviewing the med list for a pt who will be starting therapy with somatropin (GH replacement).
Which type of drug would raise a concern that needs to be adresses before starting somatropin therapy?
A) NSAIDs for arthritis
B) antidepressant therapy
C) penicillin
D) glucocorticoid
D
A pt is experiencing severe diarrhea, flushing, and life threatening hypotension associated with carcinoid crisis.
The nurse will prepare to administer which drug?
A) ocreotide acetate
B) vasopressin
C) somatropin (humatrope)
D) cosyntropin
A
A pt is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to help in the diagnosis of this condition?
A) ocreotide acetate
B) vasopressin
C) somatropin (humatrope)
D) cosyntropin
D
A pt who is about to be given ocreotide acetate is also taking a diuretic, IV heparin, ciproflaxin hydrochloride, and an opioid PRN for pain.
The nurse will monitor for which potential interaction?
A) hypokalemia due to the diuretic
B) decreased anticoagulation with heparin
C) prolonged QT interval with ciproflaxin
D) increased sedation with the opioid
C
What is the name of the thyroid hormone replacement medication ?
Levothyroxine (synthroid)
What are some foods that decrease levothyroxine absorption ?
- soybeans
- flour
- cotton seed
- walnuts
- calcium
- dietary fibers
When and how should levothyroxine be taken?
Should be taken at the same time everyday
Best taken in the morning without food
So best taken in the morning 30-60min before breakfast
What is the most worrisome AE of levothyroxine?
Cardiac dysrhythmias
Can be life threatening
What are some drug interactions that can occur with levothyroxine?
- increase anticoagulant effect
- decrease serum digoxin
- need higher hypoglycemic drug doses
- decrease effect of both meds with cholestyramine
The pharmacy has called a pt to notify her that her current brand of thyroid replacement hormone is on back order. The pt calls the clinic to ask what she should do. What is the best response on the part of the nurse?
A) «go ahead and take the other brand that the pharmacy has available for now»
B) «you can stop the medication until your current brand is available»
C) «you can split the thyroid pills that you have left so that they will last longer»
D) « you may require additional testing of thyroid hormone levels with a change in drug»
D
When assessing an older adult pt, which nonspecific symptoms of hypothyroidism should the nurse keep in mind?
A) leukopenia, anemia
B) loss of appetite, polyuria
C) weight loss, dry cough
D) cold intolerance, depression
D
To help with the insomnia associated with thyroid hormone replacement therapy, which strategy should the nurse teach the pt to do?
A) take half the dose at lunchtime and the other half 2 hrs later
B) use a sedative to help fall asleep
C) take the dose upon awakening in the morning
D) reduce the dosage as needed if sleep is impaired
C
The nurse is teaching a pt who has a new prescription for the antithyroid drug propylthiouracil.
Which statement by the nurse is correct?
A) «there are no food restrictions while on this drug»
B) «you need to avoid foods high in iodine, such as iodized salt, seafood, and soy products»
C) «this drug is given to raise the thyroid hormone levels in tir blood»
D) «take this drug in the morning on an empty stomach»
B
When teaching a pt who has a new for thyroid hormone, the nurse will instruct the pt to notify the health care provider if which AE are noted? Select all that apply
A) palpitations
B) weight gain
C) angina
D) fatigue
E) cold intolerance
A, C
How should the corticosteroids be taken in relation to adrenal problems?
And what should be avoided?
Methylprednisone, hydrocortisone and prednisone
- take in the morning
- not to be taken with alcohol, caffeine, aspirin or NSAIDs (cause increased risk for GI bleeds)
- don’t stop abruptly, tapper down to stop
- take with food or milk to decrease GI upset
- if taken by inhaler, rinse mouth after to prevent fungal infection
What are some signs and symptoms that need to be reported to the HCP when taken corticosteroids therapy?
Methylprednisone, hydrocortisone or prednisone
Report any flu like symptoms like:
- sore throat
- fever
- new cough
What are some signs and symptoms of complete adrenal insufficiency or Addisons disease?
- fatigué
-headache - confusion
- fever
- nausea and vomiting
- abdominal pain
- tachy❤️
- diaphoresis
- dehydration
- hypotension
What are the three main properties of corticosteroids?
Methylprednisone, hydrocortisone, and prednisone
- immunosuppressive effects
- anti inflammatory effect
- maintenance of BP (due to vasoconstrictive properties)
What are some contraindications to corticosteroid therapy?
What is one that is specific to Methylprednisone (solumedrol)?
- kda
- cataract
- glaucoma
- pregnancy
- peptic ulcer disease
- mental health problems
- diabetes
- serious active infections
Caution in HF
Methylprednisone:
- children younger than 28 say
- pregnancy
What are some common AE with corticosteroid therapy?
- hyperglycaemia
- moon face
- fluid retention
Serious:
- glucocorticoid renal suppression
Which statement is correct about corticosteroids ?
A) they have a few AE
B) they are often used for their anti- inflammatory effects
C) they may be administered only by inhalant dosage forms
D) they may be used long term without major complications
B
What are some effects that can occur with long term corticosteroid therapy?
- ## osteoporosis
The nurse has provided teaching about oral corticosteroid therapy for a pt. Which statement from the pt shows a need for more teaching?
A) “I will report any fever or sore throat symptoms”
B) “I will stay away from anyone who has a cold or infection”
C) “ Ican stop this medication if I have severe AE”
D) “ i will take this drug with food or milk”
C
This medication should not be stopped abruptly
Needs to be taken as prescribed
During long term corticosteroid therapy, the nurse will monitor the pt for Cushing’s syndrome, which is manifested by which symptoms?
A) weight loss
B) moon faciès
C) hypotension
D) thickened hair growth
B
When teaching a pt who has been prescribed a daily dose of prednisone, the nurse knows that the pt will be told to take the medication at which time of day to help reduce adrenal suppression?
A) in the morning
B) at lunchtime
C) at dinner time
D) at bedtime
A
Which teaching is appropriate for a pt who is taking an inhaled glucocorticoid for asthma?
A) “exhale while pushing in on the canister of the inhaler”
B) “blow your nose after taking this medication”
C) “ rinse your mouth thoroughly after taking the medication”
D) “do not eat immediately after taking the medication”
C
The nurse will monitor the pt’s lab results for which AE that can occur during long-term corticosteroid therapy?
Select all that apply
A) increased serum potassium levels
B) decreased serum potassium levels
C) increased sodium levels
D) decreased sodium levels
E) hyperglycaemia
F) hypoglycemia
B, C, E
What are some contraindications to the use of levothyroxine (synthroid)?
- KDA
- MI, adrenal insufficiency, hyperthyroidism
- celiac disease
- lactose intolerance
What are some drug interactions with levothyroxine (synthroid)?
- Increase effect: oral anticoagulant
- decrease effect of: hypoglycaemic drugs
- decrease serum digoxin
Can you switch brands of the thyroid replacement therapy?
No, each brand requires a different dose so cannot change brands
What are some AE that need to be reported to the HCP when on levothyroxine therapy?
Any:
- weight loss
- tachy❤️
- nervousness
- tremors
- hypertension
- headache
- insomnia
- cardiac irregularities
- menstrual irregularities
