Thyroid and Parathyroid Agents

Question 1

Drug Names of thyroid hormones

Answer 1

Levothyroxine
Liothyronine
Liotrix
Thyroid Desiccated

Question 2

Action of thyroid hormones?

Answer 2

increase cellular metabolism in all areas of the body

Question 3

Indication?

why would you use a thyroid hormone?

Answer 3

Hypothyroidism

Myxedema coma

Pituitary TSH suppression in tx of euthyroid goiters

Management of thyroid cancer

Thyrotoxicosis (hyperthyroidism w s/sx) in conjunction with other therapy

Question 4

Adverse Effects of thyroid hormones?

Answer 4

*NONE if taking the correct dose

skin reaction

sx of hyperthyroidism

cardiac stimulation

CNS effects

Question 5

Contraindications for thyroid hormones

Answer 5

Known allergy

acute MI

thyrotoxicosis

Question 6

Caution for thyroid Hormones

Answer 6

Hypo-adrenal conditions (Addisons disease- body would not be able to handle drug effects)

Question 7

drug/ drug interactions for thyroid hormones?

Answer 7

oral anticoagulants
digoxin
theophylline

Question 8

Nursing Diagnosis for thyroid hormones

Answer 8

Decreased CO- tachycardia

imbalanced nutrition: less than body req.- increased metabolism

ineffective tissue perfusion- decreased CO

deficient knowledge

Question 9

Assessment for thyroid hormones?

Answer 9

cautions/contraindications
family hx
skin, vitals, CNS, ECG before and during therapy

Labs: thyroid fx test

Question 10

Implementation for thyroid hormones

Answer 10

Single daily dose before breakfast w/ full glass of water
monitor cardiac response
periodic blood testing

Can take 6 weeks to take effect

Question 11

Evaluation

Answer 11

Is the metabolism returning to normal?

are we preventing/ reducing goiter?

Question 12

Drug Names of ANTI thyroid hormones

Answer 12

thiomides-
propylthiouracil PTU
Methimazole

iodine solutions-
strong iodine solution
sodium iodine 131
potassium iodine

Question 13

Action of ANTI thyroid hormones

Answer 13

Thiomides-
prevent formation of thyroid hormone within thyroid cells
(lowers serum levels)

sodium iodine 131-
enters thyroid cell and destroys by giving off radiation

strong iodine and potassium iodine-
increased doses saturate thyroid cells preventing thyroid hormone formation

Question 14

Indication?

why would you use ANTI thyroid hormones?

Answer 14

thiomides-
hyperthyroidism

sodium iodine 131-
hyperthyroidism, radiation emergencies

strong iodine solution & potassium iodine-
hyperthyroidism, radiation emergencies, suppression of thyroid gland before surgery, acute thyrotoxicosis

Question 15

Adverse Effects of ANTI thyroid hormones

Answer 15

All: hypothyroidism
Methimazole: Bone Marrow Suppression
PTU: severe liver toxicity
iodine solutions: iodism (iodine toxicity)

Question 16

Contraindications of ANTI thyroid hormones

Answer 16

known allergy

Question 17

cautions of ANTI thyroid hormones

Answer 17

PTU: liver impairment

Question 18

drug/ drug interactions for ANTI thyroid hormones

Answer 18

oral anticoagulants
theophylline
beta blockers
digoxin

Question 19

nursing diagnosis for ANTI thyroid hormones

Answer 19

decreased Cardiac output r/t slowing everything down

imbalanced nutrition: more than body req. r/t changes in metabolism

risk for injury r/t bone marrow suppression

deficient knowledge

Question 20

Assessment for ANTI thyroid hormones

Answer 20

cautions
skin, vitals, CNS, ECG

Labs:
Methimazole: CBC- BMS
thyroid fx test
PTU: pregnancy test, liver fx

Question 21

Implementation for ANTI thyroid hormones

Answer 21

PTU: 3x a day around the clock
Give iodine solution with a straw
tablets should be taken whole or crushed
periodic blood test
assess for iodism
pt teaching: metalic taste

Question 22

evaluation for ANTI thyroid hormones

Answer 22

decreased thyroid hormone levels?

improvements of sx: increased HR coming down

Question 23

Drug names for ANTI hypocalcemic agents

Answer 23

Teriparatide

Calcitrol (Vitamin D)

Parathyroid Hormone
*limited access - need to show need to get it

Question 24

Action for ANTI hypocalcemic agents

Answer 24

stimulate osteoclast to release calcium from bone into the blood stream

increase intestinal absorption of calcium

increase calcium resorption from the kidneys

stimulation of cells in kidney to produce calcitrol (vitamin D)

Question 25

indication? | why would you use ANTI hypocalcemic agents?

Answer 25

low calcium in the blood - raised calcium management of hypocalcemia in pt undergoing chronic renal dialysis tx of hypoparathyroidism

Question 26

Adverse effects of ANTI hypocalcemic agents

Answer 26

GI (metallic taste, N/V/C) | CNS (weakness, HA, somnolence, irritability)

Question 27

Contraindications for ANTI hypocalcemic agents

Answer 27

allergy vitamin D toxicity hypercalcemia

Question 28

Caution for ANTI hypocalcemic agents

Answer 28

hx of renal stones

Question 29

drug/ drug interactions for ANTI hypocalcemic agents

Answer 29

magnesium containing antacids digoxin toxicity w/ hypercalcemia monitor calcium and digoxin levels (0.5-2)

Question 30

nursing diagnosis for ANTI hypocalcemic agents

Answer 30

Acute pain r/t GI and CNS imbalanced nutrition: less than body req. r/t GI deficient knowledge

Question 31

Assessment for ANTI hypocalcemic agents

Answer 31

cautions and contraindications assess skin, CNS ``` labs: serum calcium magnesium LFTs alkaline phosphate levels xray bones ```

Question 32

Implementation for ANTI hypocalcemic agents

Answer 32

monitor calcium serum levels supportive measures for ADE nutritional consult if GI ADE Labs: calcium levels

Question 33

evaluation for ANTI hypocalcemic agents

Answer 33

serum calcium level is normal | 4.5-5.8 or 8.5-10.5

Question 34

Drug names for ANTI hypercalcemic Agents

Answer 34

``` Biophosphonates "onate" Etidronate Ibandronate Pamidronate Risedronate Alendronate ``` Calcitonins Calcitonin Salmon

Question 35

Action for ANTI hypercalcemic Agents

Answer 35

Both inhibit bone resorption Biophosphonates: act on serum levels of calcium not directly on parathyroid gland or PTH Calcitonins: hormone secreted by thyroid gland to balance effects of PTH

Question 36

Indication? | why would we use ANTI hypercalcemic Agents ?

Answer 36

osteoporosis pagets disease Biophosphonates: hypercalcemia in cancer Calcitonins: emergency tx of hypercalcemia

Question 37

Adverse Effects for ANTI hypercalcemic agents

Answer 37

Biophosphonates: HA, N/D Bone pain w/ pagets disease ``` Calcitonin: flushing of face/hands skin rash, N/V urinary frequency local inflammation @ injection site ```

Question 38

Contraindications for ANTI hypercalcemic agents

Answer 38

``` Biophosphonates: Hypocalcemia P/L Renal dysfunction Gi disease ``` Calcitonins: pregnancy renal dysfunction pernicious anemia

Question 39

drug/drug interactions for ANTI hypercalcemic agents

Answer 39

``` Biophosphonates: antacids calcium products iron or multiple vitamins asprin ``` Calcitonin: none known

Question 40

Nursing diagnosis for ANTI hypercalcemic agents

Answer 40

acute pain imbalance nutrition: less than body req. anxiety deficient knowledge

Question 41

Assessment for ANTI hypercalcemic agents

Answer 41

contraindications assess skin for lesions, CNS Abdominal examination labs: calcium phosphorus magnesium levels renal function

Question 42

implementation for ANTI hypercalcemic agents

Answer 42

``` ensure adequate hydration arrange vit D, calcium supplements, and hormone replacement therapy monitor injection site for inflammation monitor calcium serum regularly blood test for renal fx periodically ```

Question 43

evaluation for ANTI hypercalcemic agents