pharm-drugs thyroid Flashcards
symptoms of Hypothyroidism
Slowed motion,
speech, mental
process
symptoms of Thyrotoxicosis
Increased temperature, pulse, BP, increased appetite, and weight loss
two classes of drugs for thyroid disease
Thyroid replacement hormones (hypothyroid) and Antithyroid agents (hyperthyroid)
If surgery is planned for hypothyroidism then?
Order tracheostomy set at bedside, consider risk of Respiratory distress, and Tetany; have IV calcium available at bedside
most common thyroid replacement drug
Levothyroxine
levothyroxine action
Replace deficient T3 and T4 hormones
Levothyroxine interactions
Warfarin, Digoxin, Estrogens, and Cholestyramine
what does levothyroxine need?
increased dosage of anticoagulants and decreased dose of digoxin
what requires you to wear latex gloves and watch for personnel allergies?
iodine 131
how long does it take to see the full effect of iodine 131?
3-6 months
name a sign of hyperthyroidism
hyperglycemia
what does diabetes lead to?
retinopathy, cardiomyopathy, and neuropathic complications
diabetes is a higher incidence in…?
African Americans, Hispanics, American Indians, Native Alaskans, and women.
type 1 diabetes is caused by
autoimmune destruction of the beta cells in the pancreas (Pancreas can no longer secrete insulin)
what does type 1 diabetes require?
Requires insulin for the rest of their life
define exogenous
Originating or produced from outside a cell, tissue, or organism
what are the symptoms of type 1 diabetes?
Polydipsia, Polyphagia, Polyuria, and Weight loss
90% to 95% of pt’s with diabetes are?
type 2
Supplemental insulin or oral antidiabetic drugs are prescribed to these pt’s
Type 2
<100 mg/dL
normal fasting glucose
≥100 mg/dL
impaired fasting glucose
a glucose of <126 mg/dL demonstrates
impaired fasting glucose
Microvascular complications(Destruction of capillaries) Causes…
blindness, renal failure, and neuropathies
with macrovascular complications what can occur?
atherosclerosis, stroke, and myocardial infarction
diabetic pt’s are more susceptible to…?
infection
postprandial hyperglycemia
an exaggerated rise in blood sugar following a meal
Patient should check blood glucose level before
each meal and at bedtime
make sure your pt. has food on the
unit or in front of them…
before administering insulin
physical indicators of diabetes
Hyperglycemic or hypoglycemic episodes
diabetic laboratory study
Hemoglobin A1c
To detect vascular changes
check vision frequently
what is the importance of foot care?
because of neuropathy the nurse needs to check for infection
Patient Education
Maintain blood pressure control, Maintain normal blood lipids, and Maintain BMI <25 kg/m2
Somatrin
a growth hormone, treats growth hormone deficiencies, such as turners syndrome
Hydrocortizone
a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison’s disease.
glucagon
a hyperglycemic that treats severe hypoglycemia from insulin toxicity
desmopressin
antidiuretic hormone that treats diabetes insipidus
hydrocortisone is identical to cortisol, the primary…
glucocorticoid the adrenal cortex generates
does a diabetic pt need carbs?
yes (45% to 65%)
Monitor glucose level
before, during, and after exercise
what causes hypoglycemia?
too much insulin, insufficient food
intake, vomiting and diarrhea, and excessive
exercise
symptoms of hypoglycemia
Nervousness, tremors, headache,
apprehension, sweating, cold and clammy skin, and
hunger
treatments for hypoglycemia
Administering food/liquids if able to swallow
If unable to swallow, administer glucagon or IV fluids with 50% dextrose
what causes hyperglycemia?
nonadherence, overeating, acute illness, or infection
symptoms of hyperglycemia
Headache, nausea and vomiting,
abdominal pain, dizziness, rapid pulse, rapid
shallow respirations, and acetone odor to breath
treatment for hyperglycemia
Administration of IV fluids; insulin;
monitoring blood glucose, ketones, and
potassium
insulin is needed so that…
glucose can enter skeletal muscle and fat, needed for protein and lipid metabolism
adverse effects of insulin
Hyperglycemia, hypoglycemia, and allergic reactions
insulin can cause death due to hypoglycemia. What else does the nurse need to remember?
site infection
should you shake insulin?
no, roll vial gently in palm of hand to warm and resuspend
what two insulins should not be mixed?
short and rapid acting
glucagon drug action
Breaks down stored glycogen to glucose
drug use of glucagon
treatment of hypoglycemic reactions
adverse of effects of glucagon
Nausea and vomiting
glucagon administration
SC, IM, or IV. Should respond in 5 to 20 minutes; if not, 1 to 2 additional doses
metformin drug action
Decreases hepatic glucose production (increases insulin sensitivity)
adverse effects of metformin
abdominal cramps, flatulence (Numerous drug/alcohol interactions)
metformin is used when
diet and exercise alone are not effective
metformin will not cause
hypoglycemia
IV radiopaque dyes can induce temporary
renal insufficiency; metformin should be
discontinued …
24 to 48 hours before
procedures and 2 to 3 days after procedure
until normal renal function
Sulfonylurea action
Stimulate release of insulin from beta cells of pancreas
Sulfonylurea use
for type 2 diabetes mellitus
Sulfonylurea adverse effects
Hypoglycemia, vomiting, and abdominal cramps
if a Patient is allergic to sulfonamides they may be allergic to
sulfonylureas
Acarbose (Precose) drug action
Controls diabetes by inhibiting the enzymes that break down starches and carbohydrates in the intestines, lowering the necessity for insulin.
Acarbose will not cause
hypoglycemia
what does insulin do in the body?
insulin attaches to the cell and allows glucose to come in to make atp
what is the opposite medication to insulin?
glucagon
does a pt with gestational diabetes get insulin?
yes
what type of insulin has the shortest duration?
rapid acting
what is an example of a long acting insulin?
lantis
what should a nurse be concerned about with a pt suffering from hypoglycemia?
confusion
the pancreas is the biggest factor in both
types of diabetes
when you maintain a diabetics blood glucose you are maintaining their…
homeostasis
insulin must be taken by
injection
a pt needs multiple injections a day because….
it balances the multiple meals
warfarin causes…
hypoglycemia
40 degree angle for a very
thin pt
type 1 medication tells
cells to open up
type 2 medication tells
body to be more receptive to insulin
Sulfonylureas
glipizide, glimepride, and glyburide
always give insulin to a type 1 diabetic if your not sure never…
hold it
avandia (Rosiglitazone)
increases insulin sensitivity
you do not put a pt back on metformin until what is done ?
any kind of renal test
a pt is NPO but glucose levels are low. What do you do?
give glucagon
educate a pt that they wont be stuck on insulin if they are administered it because?
they only need the insulin while in that sick state. When they recover they can return their usual regimen
a important nursing intervention for diabetic pt’s is…
patient education
quickest way to determine someone is a diabetic is?
fasting glucose
if a diabetic pt is sick do they need more insulin?
it depends on the situation
