Thyroid and Parathyroid Agents Flashcards
Drug Names of thyroid hormones
Levothyroxine
Liothyronine
Liotrix
Thyroid Desiccated
Action of thyroid hormones?
increase cellular metabolism in all areas of the body
Indication?
why would you use a thyroid hormone?
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
Adverse Effects of thyroid hormones?
*NONE if taking the correct dose
skin reaction
sx of hyperthyroidism
cardiac stimulation
CNS effects
Contraindications for thyroid hormones
Known allergy
acute MI
thyrotoxicosis
Caution for thyroid Hormones
Hypo-adrenal conditions (Addisons disease- body would not be able to handle drug effects)
drug/ drug interactions for thyroid hormones?
oral anticoagulants
digoxin
theophylline
Nursing Diagnosis for thyroid hormones
Decreased CO- tachycardia
imbalanced nutrition: less than body req.- increased metabolism
ineffective tissue perfusion- decreased CO
deficient knowledge
Assessment for thyroid hormones?
cautions/contraindications
family hx
skin, vitals, CNS, ECG before and during therapy
Labs: thyroid fx test
Implementation for thyroid hormones
Single daily dose before breakfast w/ full glass of water
monitor cardiac response
periodic blood testing
Can take 6 weeks to take effect
Evaluation
Is the metabolism returning to normal?
are we preventing/ reducing goiter?
Drug Names of ANTI thyroid hormones
thiomides-
propylthiouracil PTU
Methimazole
iodine solutions-
strong iodine solution
sodium iodine 131
potassium iodine
Action of ANTI thyroid hormones
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
Indication?
why would you use ANTI thyroid hormones?
thiomides-
hyperthyroidism
sodium iodine 131-
hyperthyroidism, radiation emergencies
strong iodine solution & potassium iodine-
hyperthyroidism, radiation emergencies, suppression of thyroid gland before surgery, acute thyrotoxicosis
Adverse Effects of ANTI thyroid hormones
All: hypothyroidism
Methimazole: Bone Marrow Suppression
PTU: severe liver toxicity
iodine solutions: iodism (iodine toxicity)
Contraindications of ANTI thyroid hormones
known allergy
cautions of ANTI thyroid hormones
PTU: liver impairment
drug/ drug interactions for ANTI thyroid hormones
oral anticoagulants
theophylline
beta blockers
digoxin
nursing diagnosis for ANTI thyroid hormones
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
Assessment for ANTI thyroid hormones
cautions
skin, vitals, CNS, ECG
Labs:
Methimazole: CBC- BMS
thyroid fx test
PTU: pregnancy test, liver fx
Implementation for ANTI thyroid hormones
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
evaluation for ANTI thyroid hormones
decreased thyroid hormone levels?
improvements of sx: increased HR coming down
Drug names for ANTI hypocalcemic agents
Teriparatide
Calcitrol (Vitamin D)
Parathyroid Hormone
*limited access - need to show need to get it
Action for ANTI hypocalcemic agents
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)
indication?
why would you use ANTI hypocalcemic agents?
low calcium in the blood - raised calcium
management of hypocalcemia in pt undergoing chronic renal dialysis
tx of hypoparathyroidism
Adverse effects of ANTI hypocalcemic agents
GI (metallic taste, N/V/C)
CNS (weakness, HA, somnolence, irritability)
Contraindications for ANTI hypocalcemic agents
allergy
vitamin D toxicity
hypercalcemia
Caution for ANTI hypocalcemic agents
hx of renal stones
drug/ drug interactions for ANTI hypocalcemic agents
magnesium containing antacids
digoxin toxicity w/ hypercalcemia
monitor calcium and digoxin levels (0.5-2)
nursing diagnosis for ANTI hypocalcemic agents
Acute pain r/t GI and CNS
imbalanced nutrition: less than body req. r/t GI
deficient knowledge
Assessment for ANTI hypocalcemic agents
cautions and contraindications
assess skin, CNS
labs: serum calcium magnesium LFTs alkaline phosphate levels xray bones
Implementation for ANTI hypocalcemic agents
monitor calcium serum levels
supportive measures for ADE
nutritional consult if GI ADE
Labs:
calcium levels
evaluation for ANTI hypocalcemic agents
serum calcium level is normal
4.5-5.8 or 8.5-10.5
Drug names for ANTI hypercalcemic Agents
Biophosphonates "onate" Etidronate Ibandronate Pamidronate Risedronate Alendronate
Calcitonins
Calcitonin Salmon
Action for ANTI hypercalcemic Agents
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
Indication?
why would we use ANTI hypercalcemic Agents ?
osteoporosis
pagets disease
Biophosphonates:
hypercalcemia in cancer
Calcitonins:
emergency tx of hypercalcemia
Adverse Effects for ANTI hypercalcemic agents
Biophosphonates:
HA, N/D
Bone pain w/ pagets disease
Calcitonin: flushing of face/hands skin rash, N/V urinary frequency local inflammation @ injection site
Contraindications for ANTI hypercalcemic agents
Biophosphonates: Hypocalcemia P/L Renal dysfunction Gi disease
Calcitonins:
pregnancy
renal dysfunction
pernicious anemia
drug/drug interactions for ANTI hypercalcemic agents
Biophosphonates: antacids calcium products iron or multiple vitamins asprin
Calcitonin:
none known
Nursing diagnosis for ANTI hypercalcemic agents
acute pain
imbalance nutrition: less than body req.
anxiety
deficient knowledge
Assessment for ANTI hypercalcemic agents
contraindications
assess skin for lesions, CNS
Abdominal examination
labs:
calcium phosphorus
magnesium levels renal function
implementation for ANTI hypercalcemic agents
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
evaluation for ANTI hypercalcemic agents
