Thyroid and parathyroid agents

Question 1

What does the thyroid gland produce?

Answer 1

-Thyroxine(T4)
-Tri-iodothyronine(T3)
-Calcitonin
-Regulates metabolism
-Requires iodine to produce needed substances
-Production and release regulated by TSH
TSH regulated by TRH

Question 2

What are the functions of the thyroid?

Answer 2

-Carbohydrate and lipid metabolism
-Growth and development
-Heat regulation
-Cardiac regulation
-Neuromuscular function

Question 3

What is hypothyroidism?

Answer 3

-Lack of sufficient thyroid hormone
-Lack of necessary iodine
-Tumor or auto-immune disease
-Pituitary or hypothalamus disease
-Radiation to thyroid
-Surgery
-LowT4 and elevated TSH

Question 4

What are disease that are caused by hypothyroidism?

Answer 4

-Myxedema- often gradual
-Hashimotos disease-autoimmune
-Treat with replacement of thyroid hormone therapy
suppresses overproduction of TSH

Question 5

**Treatment of hypothyroidism
What is levothyroxine (Synthroid, Levothroid, Levoxine)

Answer 5

-Common drug treatment for hypothyroidism
-Synthetic T4

Question 6

What are contradictions when taking levothyroxine (Synthroid, Levothroid, Levoxine)?

Answer 6

**Treatment of hypothyroidism

-Allergy
-During thyrotoxicosis, acute myocardial infraction

Question 7

What should cautions be when taking levothyroxine (Synthroid, Levothroid, Levoxine)?

Answer 7

**Treatment of hypothyroidism
-Lactation because it can enter humans milk and could suppress infants thyroid production
- Monitor for hyper thyroidism
-Hypoadrenal conditions like addisions cause body will not be able to deal with drug effects
-caution with older adults because they will require low doses to become euthyroid

Question 8

What are nursing concerns with thyroid replacement medication?

Answer 8

-Assess cardiovascular status, may need med adjustment
-Assessment for overdose (hyperthyroidism)
-Take regularly in AM, empty stomach
-May need diabetic med adjustments
-Oral anticoagulant effect increased
-Decrease effectiveness of digitalis
-Periodic blood tests for thyroid function
-Older adults ─ screen for co-morbidities, start low
-Pregnancy ─ does not cross placenta, caution with lactation
-Children ─ levothyroxine used

Question 9

Describe hyperthyroidism

Answer 9

-Excessive amounts of thyroid hormone produced and circulated
-Goiter which can happen due to increase of thyroid
-Graves disease (autoimmune dz) ─ over production of thyroid hormone, most common cause of hyperthyroidism
-Labs –> Low TSH and high T4

Question 10

What do Antithyroid meds do?

Answer 10

-Block formation of thyroid hormones in thyroid gland, treat hyperthyroidism

Question 11

What are drug names of anti-thyroid meds?

Answer 11

Thioamides
**prophylthiouricil (PTU)
**methimazole (Tapazole)

Iodine products ─ iodine needed to produce thyroid hormone, large doses block this function
-Potassium iodide
-Sodium iodine I131 -thyroid cells destroyed by radioactivity

Question 12

What does Thioamides do?
propylthiouracil (PTU)
**methimazole (Tapazole)

Answer 12

**Anti-thyroid drugs

-Prevent the formation of thyroid hormones in the thyroid cells , which lowers the serum levels of the thyroid hormone

Question 13

What are contras with Thioamides meds?
**propylthiouracil (PTU)
**methimazole (Tapazole)

Answer 13

**Anti-thyroid drugs

Pregnancy/lactation(develop of thyroid being mot being developed in baby)

Question 14

What cautions should you have when taking Thioamides?
**propylthiouracil (PTU)
**methimazole (Tapazole)

Answer 14

-Monitor for over suppression of thyroid ─ lethargy, bradycardia, n/v/d
-Changes serum levels of some drugs as metabolism slows ─ anticoags, beta blockers

Question 15

What are contras with Iodine solutions ?

Answer 15

Pregnancy

Question 16

What are cautions to have with iodine solutions?

Answer 16

-Monitor for hypothyroidism, begin replacement therapy
-GI distress n/v/d, teeth staining with liquids
-Monitor serum levels of some drugs

Question 17

Describe the parathyroid

Answer 17

-Gland located behind thyroid, regulates calcium levels
-Dysfunction related to absence of PTH (hypoparathyroidism) or overproduction of PTH (hyperparathyroidism)

-Leads to hyper or hypcalcemia
-Calcium *.8-10.4 mg/dl
Nerve conduction and muscle contraction

Question 18

**Antihypocalcemic Agents
Deficient levels of PTH  hypocalcemia
What mediation helps with these issues?

Answer 18

**calcitriol (Rocaltrol)-Vit. D

Question 19

What is the function of calcitriol (Rocaltrol)-Vit. D?

Answer 19

**Antihypocalcemic Agents

-Regulates calcium absorption from small intestines
-Increases calcium levels, decreases phosphorous

Question 20

What are contras of calcitriol (Rocaltrol)-Vit. D?

Answer 20

**Antihypocalcemic Agents

Allergy, hypercalcemia

Question 21

What are cautions to have with calcitriol (Rocaltrol)-Vit. D?

Answer 21

**Antihypocalcemic Agents

Renal stones, watch for n/v/ constipation
-Increasing calcium levels so look out for kidney stones and if thye have history of kidney sgtones they are more at risk for kidneys stones

Question 22

What do Antihypercalcemic Agents do?

Answer 22

Drugs act on serum levels of calcium not on PTH

Question 23

What is a Antihypercalcemic medication?

Answer 23

Bisphosphonates
**alendronate (Fosamax)

Question 24

What does Bisphosphonates
**alendronate (Fosamax) do?

Answer 24

Antihypercalcemic
Slows bone resorption, lower serum calcium levels, does not prevent bone formation

Question 25

What are contras of Bisphosphonates
**alendronate

Answer 25

Antihypercalcemic
Not in pregnancy, hypocalcemia

Question 26

What are cautions with Bisphosphonates
**alendronate

Answer 26

Antihypercalcemic
Renal and upper GI disease
Upright x 30 min, AM dosing, full glass of water

Question 27

Antihypercalcemic Agents
What are calcitonins?

Answer 27

-Hormones secreted by thyroid gland to balance PTH
-Inhibit bone resorption, lower calcium, promote excretion

Question 28

what is a type of calcitonin medication?

Answer 28

**calcitonin salmon (Fortical, Miacalcin)

Question 29

What are contras of **calcitonin salmon (Fortical, Miacalcin)?

Answer 29

Pregnancy, lactation, allergy to fish

Question 30

What are cautions of calcitonin salmon (Fortical, Miacalcin)?

Answer 30

Renal disease, injection site irritation

Question 31

How should you take Bisphosphonates?

Answer 31

Take on empty stomach, full glass of water, sit upright x 30 minutes