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Pharmacology Test #4 > Medications for Endocrine Disorders > Flashcards

Medications for Endocrine Disorders Flashcards

1
Q

What is synthetic thyroid hormone used for?

A

treatment of hashimotos (hypothyroidism related to immune system disorder) or other forms of hypothyroidism

synthetic throxine (T4)

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2
Q

What is the therapeutic outcome of levothyroxine (synthroid), a synthetic thyroid hormone (T4)?

A

to decrease TSH levels and normalize T3 and T4 levels.

AND RESOLUTION OF SYMPTOMS

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3
Q

Is synthetic thyroid hormone a cure for hypothyroidism?

A

NO NO NO

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4
Q

Where is TSH produced?

A

The pituitary gland

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5
Q

What does TSH do?

A

tell the thyroid to secrete T4

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6
Q

How does T4 become T3?

A

By attaching to proteins and forming thyroxine-binding-globulins becomes T3 at target cells

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7
Q

With hypothyroidism, what are our T3/4 and TSH levels like?

A

TSH - high

T3/T4 - low

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8
Q

In what type of patients should we be cautious about administering thyroid hormone?

A

patients with cardiovascular problems (tachycardia, CAD, ect…)
this medication stimulates cardiovascular system (thyroid stimulation)

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9
Q

When should thyroid hormone be taken?

A

on an empty stomach before breakfast (poorly absorbed, and stimulates body)

usually scheduled for 7am (during shift change), nurses need to be proactive about giving this before breakfast comes. Night nurse needs to be proactive in letting day nurse know about 7am medication during shift change.

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10
Q

How can thyroid hormone be administered?

A

usually PO

but can be given IV for emergency situations (myxedema coma)

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11
Q

What can happen with overmedication of thyroid hormone? What are some signs of this?

A

hyperthyroidism

anxiety, tachycardia, palpitations, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities, abd cramping, increased appetite

MONITOR AND REPORT SIGNS OF THIS

TEACH PATIENT ABOUT SIGNS AND HAVE THEM MONITOR AND REPORT THEM

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12
Q

What are signs of HYPOthyroidism?

A

edema, weight gain, cold intolerance, bradycardia, ect…..

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13
Q

What medications should not be given at the same time as synthroid? When should they be given?

A

antacids, iron supplements, calcium supplements (all will delay absorption)

should be be given after 3 hour delay between medications

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14
Q

Are there many drug-drug interactions with synthroid? What are some drugs?

A

YES YES YES

including warfarin, antiseizure, and antidepressant medications.

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15
Q

What lab values would need to be monitored while taking synthroid?

A

T4 and TSH levels

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16
Q

What is the therapeutic outcome of PTU (antithyroid) medication? What is it used to treat?

A

blocks the synthesis of thyroid hormone, blocks conversion to T4 to T3

used to treat graves disease, an autoimmune form of hyperthyroidism.

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17
Q

How is PTU administered?

A

orally

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18
Q

What is the evidence of outcome for PTU (antithyroid)?

A

a decrease in T4 levels

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19
Q

What can happen with overmedication of PTU (antithyroid)? what are some signs of this?

A

hypothyroidism - drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia

MONITOR FOR SIGNS OF THIS AND REPORT

TEACH THE PATIENT THE SIGNS OF THIS AND HAVE THEM MONITOR AND REPORT THEM

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20
Q

How long can it take for PTU (antithyroid) and thyroid medications to reach their full therapeutic effect?

A

a few weeks

21
Q

What is a big adverse effect that can happen with PTU (antithyroid)? How can we watch out for this?

A

agranulocytosis - decreased WBC count

monitor WBC count and look out for signs of infection

22
Q

What is a medication that can be given to increase WBC count?

A

neupogen (Filgrastim)

colony stimulating factor (immune stimulant)

23
Q

When is PTU (antithyroid) contraindicated?

A

immunocompromised patients

24
Q

What is a big thing to teach the patients related to the adverse effect of agranulocytosis as well as monitoring the therapeutic outcome of the PTU (antithyroid)?

A

keep lab appointments

25
Q

What organ is PTU (antithyroid) specifically toxic to? What is a nursing consideration for this?

A

The liver (hepatotoxic)

monitor and report signs of liver failure and educate the patient on signs of liver failure and tell them to report them

26
Q

What pregnancy category is PTU (antithyroid)?

A

Cat D

27
Q

When should PTU (antithyroid) be administered?

A

with meals at the same time every day (maintain blood levels)

28
Q

Should you stop taking PTU (antithyroid) abruptly?

A

NO NO NO

rebound hyperthyroidism

29
Q

What is the therapeutic outcome of RAI (antithyroid)? What is it used to treat?

A

absorbed in the thyroid and destroys thyroid producing cells (high doses).

used to treat hyperthyroidism and thyroid cancer. Lower doses are used for thyroid function studies.

30
Q

How is RAI (antithyroid) administered?

A

orally

31
Q

What is the main concern of RAI (antithyroid) administration? What are some signs of this?

A

radiation sickness - hematemesis, epistaxis, intense nausea, vomiting

IF THESE SIGNS SHOW STOP TAKING/ADMINISTERING AND REPORT TO PROVIDER

32
Q

What is another adverse effect of RAI (antithyroid)? What are some nursing considerations and patient teaching points for this?

A

Bone marrow suppression - monitor CBC, watch out for signs of illness/infection, bruising, other signs of bleeding

33
Q

Why would we want to monitor the patients T4 levels while they are taking RAI (antithyroid)?

A

This medication can cause hypothyroidism so it is a good idea to monitor T4 levels to make sure they dont get too low.

MONITOR AND REPORT SIGNS OF HYPOTHYROIDISM

34
Q

What pregnancy category is RAI (antithyroid) in?

A

Cat X

35
Q

What are the radioactivity precautions that we must teach the patients?

A

increase fluid intake and void frequently - help secrete radioactive medication

limit contact with other people - dont want to expose other people

dispose body wastes per protocol - in hospital and
home

no breastfeeding, avoid pregnancy, and avoid pregnant and breastfeeding/lactating women

do these 2-3 days to even a week

36
Q

What is the therapeutic outcome of ADH? What is it used to treat?

A

promotes reabsorption of water within the kidneys

used to treat DI (diabetes insipidus) or any other process that affects ADH secretion or the kidneys response to ADH

37
Q

Will a patients urine be more dilute or less dilute when ADH is not being secreted or the kidneys arent responding? Will it be in large or small amounts?

A

The urine will be more dilute if ADH isnt working properly and it will be in large amounts.

38
Q

What can vasopressin also be used for? why?

A

To increase BP because it can cause vasoconstriction

39
Q

With what patients if desmopressin (DDVAP), an ADH hormone replacementy most commonly used?

A

in children (to prevent bed-wetting)

40
Q

How is desmopressin most commonly administered?

A

orally

41
Q

How is vasopressin most commonly administered?

A

intranasal

SQ

IV

42
Q

What can happen is ADH causes too much reabsorption of water? what are some signs of this? What should we teach patients in order to watch out for this?

A

water intoxication (causing hyponatremia) - sleepiness, HA, confusion, increase in blood pressure, decreased urine output

43
Q

What is another adverse effect of vasopressin other than water intoxication? What are some signs of this? How should this be monitored for?

A

MI - chest pain, tightness, and diaphoresis

Monitor ECG and blood pressure (from vasoconstrictive effects)

vasoconstriction can affect coronary arteries causing myocardial ischemia.

44
Q

Because of the risk for MI, what patients are contraindicated for vasopressin medication?

A

patients with heart disease

45
Q

What general things would we want to monitor in patients on ADH?

A

VS

I/O - urine output needs to be monitored

urine specific gravity - how concentrated is the urine, too high to much reabsorption (need to lower dose), too low patient is urinating too much (need to raise dose)

BUN/CR - kidney function

osmolality - serum osmolality checks how concentrated our serum is, too high means blood is too concentrated (need to raise dosage to dilute serum more), too low means serum is too dilute (need to lower dose)

labs (potassium, sodium) - potassium, sodium

46
Q

What can happen with vasopressin if given IV? What should the nurse do to help prevent this?

A

If it leaks into the surrounding tissue it can cause vasoconstriction leading to tissue necrosis

MONITOR THE IV SITE, CENTRAL LINE WOULD BE BEST

47
Q

What is the therapeutic outcome of adrenal hormone replacement (glucocorticoids)?

A

acute and chronic replacement therapy for adrenocortical insufficiency (addisons disease)

48
Q

What are some adverse effects of glucocorticoids and nursing considerations for them?

A

osteoperosis - monitor for this, advise patients to take calcium and vitamin D, may need to prescribe biphosphonates (maintain bone density), perform regular bone scans (long term use, usually this treatment is long term)

adrenal suppression - dont stop suddenly (can cause adrenal insufficiency)

peptic ulcers - (long term) - monitor and report signs of GI bleeding, avoid with alcohol and NSAIDS, gi pain, hematemesis

delayed wound healing - monitor and report

infection - report, avoid contact with sick people

49
Q

What are the signs of adrenal insufficiency that should be reported?

A

fever, muscle and joint pain, weakness, fatigue

Pharmacology Test #4 (8 decks)

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