Thyroid And Parathyroid Agents

Question 1

Use of thyroid and parathyroid agents across the lifespan of children

Answer 1

For hypothyroidism: Levothyroxine is used- monitoring growth and development & thyroid labs
*children need higher doses than adults

For hyperthyroidism: Methimazole is used-
DONT USE Propylthiouracil (PTU) because it can cause severe liver impairment
DONT USE radioactive agents because it can affect chromosomes in developing cells

For Hypercalcemia: typically only seen in children with cancer (rare)
Bisphosphonates are used- monitor calcium levels

Question 2

Use of thyroid and parathyroid agents across the lifespan of adults

Answer 2

thyroid replacement therapy is lifelong
Hypothyroidism:
Levothyroxine is drug of choice -monitor thyroid labs (for pregnancy/lactation too)

Hyperthyroidism:
Methimazole- bone marrow suppression greater GI and CNS effects
Sodium Iodine should not be used in reproductive years because it can affect fertility
For pregnancy: Propylthiouracil (can cause cretinism in fetus)
^ do not use in lactation

Hypercalcemia:
Osteoporosis -Monitor calcium levels
-Calcium and Vitamin D supplements
For pregnancy: do not use bisphosphates

Question 3

Use of thyroid and parathyroid agents across the lifespan of older adults

Answer 3

a lot of the symptoms f hypothyroidism are also seen as signs of aging

Hypothyroidism:
Screen regularly
Start low go slow
Drug of choice: Levothyroxine - monitor thyroid levels, cardiac effects

Hyperthyroidism:
Drug of choice: Sodium Iodine - it has less adverse effects - monitor for hypothyroidism

Hypercalcemia:
Dietary deficiencies: calcium & vitamin D supplements
Osteoporosis: Bisphosphonates can help move calcium back into the bones
Renal impairment before starting treatment
Monitor calcium levels throughout therapy

Question 4

Drug class: Thyroid hormones
What are the drug names in this class?

Answer 4

-Levothyroxine
-Liothyronin
-Liotrix
-Thyroid desiccated

Question 5

Drug class: Thyroid hormones
What are the actions?

Answer 5

Increases cellular metabolism
*increases oxygen consumption, respirations, heart rate increases rate of fat, protein, and carbohydrates metabolism - ultimately affecting our growth and maturation

Question 6

Drug class: Thyroid hormones
What are the indications?

Answer 6

-Hypothyroidism
-Myxedema coma (severe hypothyroidism that leads to decreased mental status, hypothermia, and other symptoms r/t the slowing of functioning in multiple organs- IS a medical emergency)
-Pituitary TSH suppression in the treatment of euthyroid goiters
-Management of thyroid cancer
-Thyrotoxicosis in conjunction with other therapy

Question 7

Drug class: Thyroid hormones
What are the contraindications?

Answer 7

-Known allergy
-If they’re having an acute heart attack
-Thyrotoxicosis (meds are given in conjunction with other anti-thyroid meds)

Question 8

Drug class: Thyroid hormones
What are the cautions?

Answer 8

Hypoadrenal conditions: Addisons disease because the body can’t handle the drug effects

Question 9

Drug class: Thyroid hormones
What are the adverse effects?

Answer 9

*none if taken in the correct dose
Skin reactions: hair loss (at the beginning of treatment)
Symptoms of hypothyroidism is they’re getting a little bit too much of the drug
Cardiac stimulations: arrhythmias & hypertension
CNS effects: insomnia, anxiety, headache

Question 10

Drug class: Thyroid hormones
What are the drug-drug interactions?

Answer 10

-Oral anticoagulants (increased risk of bleeding)
-Digoxin (decreased digoxin level)
-Theophylline

Question 11

Thyroid hormones: The nursing process
Assessment:

Answer 11

-Hx: allergy, cautions/contraindications like heart attack, hypoadrenal states, thyrotoxicosis, family history (can run in families- more common in females than males)
-Phys: assess skin, orientation and affect, vitals and EKG for cardiac
-Labs: monitoring thyroid function tests

Question 12

Thyroid hormones: The nursing process
Nursing diagnoses:

Answer 12

-Decreased cardiac output r/t cardiac effects
-Imbalanced nutrition: less than body requirements r/t changes in metabolism
-Ineffective tissue perfusion r/t thyroid activity
-Deficient knowledge regarding drug therapy

Question 13

Thyroid hormones: The nursing process
Implementation:

Answer 13

*Administration:
-single day dose before breakfast each day to keep our therapeutic blood levels consistent
-administer with a full glass of water
-do not administer other drugs at the same time
-monitor response carefully when beginning therapy (esp cardiac response)
-arrange for periodic blood tests
-patient teaching (can take 6 weeks to reach therapeutic levels)

Question 14

Thyroid hormones: The nursing process
Evaluation:

Answer 14

-response to the drug and adverse effects
-effectiveness of teaching plan
-effectiveness of comfort and safety measures
-compliance with regimen

Question 15

Drug class: Antithyroid agents
What are the drug names in this class?

Answer 15

*Thiomides
• Propylthiouracil (PTU)
• Methimazole

*Iodine Solutions
• Strong iodine solution
• Potassium iodide
• Sodium iodide I131 and I123

Question 16

Drug class: Antithyroid agents
What are the actions?

Answer 16

Thiomides action: prevent formation of thyroid hormone within the thyroid cells thus lowering serum levels

Iodine solutions action:
Sodium iodide I131 and I12:
enters thyroid cells and destroys them by giving off radiation

Strong iodine solution & potassium iodide:
high doses saturate the thyroid cells preventing thyroid
hormone formation

Question 17

Drug class: Antithyroid agents
What are the indications?

Answer 17

*Thiomides: hyperthyroidism

*Iodine solutions:

Sodium iodide I131 and I12:
Low dose- diagnosis/ evaluate thyroid function
High dose- hyperthyroidism, radiation emergencies

Strong iodine solution & potassium iodide:
hyperthyroidism, radiation emergencies, suppression
of thyroid gland before surgery, acute thyrotoxicosis

Question 18

Drug class: Antithyroid agents
What are the contraindications?

Answer 18

-Known allergy

Question 19

Drug class: Antithyroid agents
What are the adverse effects?

Answer 19

All: hypothyroidism
Methimazole: bone marrow suppresoon
PTU: severe liver toxicity
Iodine solutions: Iodism (iodine toxicity)

Question 20

Drug class: Antithyroid agents
What are the cautions?

Answer 20

PTU: liver impairment

Question 21

Drug class: Antithyroid agents
What are the drug-drug interactions?

Answer 21

-Oral anticoagulants (increased bleeding risk)
-Theophylline
-Beta-blockers
-Digoxin

Question 22

Antithyroid agents: Nursing considerations
Assessment:

Answer 22

-Hx: allergy, liver impairment
-Phys: assess skin, orientation and affect, vitals and EKG
-Labs: monitor thyroid function tests, CBC for Methimazole because of the bone marrow suppression, liver function and pregnancy for PTU

Question 23

Antithyroid agents: Nursing considerations
Nursing diagnoses:

Answer 23

-decreased cardiac output r/t to cardiac effects because were slowing everything down
-imbalanced nutrition: more than body requirements r/t to changes in metabolism
-risk for injury r/t bone marrow suppression
-deficient knowledge regarding drug therapy

Question 24

Antithyroid agents: Nursing considerations
Implementation:

Answer 24

• Administer methimazole and PTU three times a day around the clock in order to maintain consistent therapeutic levels in the blood
• Give iodine solution through a straw (can stain teeth); tablets can be crushed.
• Arrange for periodic blood tests
• Assess patients receiving iodine solution for any sign of iodism
(s/s sore mouth, teeth can hurt, burning mouth, gum soreness, headache, confusion, excessive watering of the mouth, metallic taste)
• Provide thorough patient teaching

Question 25

Antithyroid agents: Nursing considerations
Evaluation:

Answer 25

• Patient response to drug and adverse effects
• Effectiveness of the teaching plan
• Effectiveness of comfort and safety measures
• Compliance to the regimen

Question 26

Drug class: Antihypocalcemic agents
What are the drugs in this class?

Answer 26

• Teriparatide
• Parathyroid hormone
• Calcitriol (Vitamin D)

Question 27

Drug class: Antihypocalcemic agents
What are the actions?

Answer 27

• Stimulation of osteoclasts to release calcium from the bone
(goes into our bloodstream and serum calcium levels increase)
• Increased intestinal absorption of calcium
• Increased calcium resorption from the kidneys
(keeps more calcium in the body instead of being urinated out)
• Stimulation of cells in the kidney to produce calcitriol
• Teriparatide: stimulates new bone formation

Question 28

Drug class: Antihypocalcemic agents
What are the indications?

Answer 28

*Low calcium in blood
• Management of hypocalcemia in patients undergoing chronic renal dialysis
• Treatment of hypoparathyroidism
• Teriparatide: treatment of osteoporosis

Question 29

Drug class: Antihypocalcemic agents
What are the contraindications?

Answer 29

Absolute: Allergy, Vitamin D toxicity
Relative: Hypercalcemia

Question 30

Drug class: Antihypocalcemic agents
What are the cautions?

Answer 30

History of renal stones (kidney stones are often made up of calcium- if we increase calcium that can increase renal stones)

Question 31

Drug class: Antihypocalcemic agents
What are the adverse effects?

Answer 31

• GI effects: metallic taste, nausea, vomiting, constipation
• CNS effects: weakness, headaches, somnolence, irritability

Question 32

Drug class: Antihypocalcemic agents
What are the drug-drug interactions?

Answer 32

• Magnesium containing antacids can lead to an increase in magnesium
• Digoxin toxicity with hypercalcemia

Question 33

Antigypocalcemic agents: Nursing process
Assessment:

Answer 33

• Hx: allergy; hypercalcemia; vitamin toxicity (vitamin D); renal stones
• Phys: assess skin, CNS, GI
• Labs: serum calcium, magnesium, and alkaline phosphate levels, LFTs
• Xrays of bones as appropriate (for breaks)

Question 34

Antigypocalcemic agents: Nursing process
Nursing diagnoses:

Answer 34

• Impaired comfort/Acute pain r/t GI or CNS effects
• Malnutrition risk: less than body requirements r/t to GI effects
• Knowledge deficit

Question 35

Antigypocalcemic agents: Nursing process
Implementation:

Answer 35

• Monitor serum calcium levels before and periodically during treatment
• Provide comfort and safety measures
• Arrange for a nutritional consultation if GI effects are severe
• Provide thorough patient teaching

Question 36

Antigypocalcemic agents: Nursing process
Evaluation:

Answer 36

• Response to the drug
• Adverse effects
• Effectiveness of the teaching plan
• Effectiveness of comfort and safety measures
• Compliance with medication regimen

Question 37

Drug class: Antihypercalcemic agents
What are the drugs in this class?

Answer 37

• Bisphosphonates
  • Etidronate
  • Ibandronate
  • Pamidronate
  • Risedronate
  • Alendronate

*Calcitonins
• Calcitonin salmon

Question 38

Drug class: Antihypercalcemic agents
What are the actions?

Answer 38

*Bisphosphonates
• These drugs act on the serum levels of calcium and not directly on the parathyroid gland or PTH
• Inhibits bone resorption (helps lower serum calcium levels- but not inhibit normal bone formation and mineralization)

• Calcitonins
  • Hormones secreted by the thyroid gland to balance the effects of PTH
  • Inhibits bone resorption (increases excretion of phosphate, calcium, and sodium from the kidneys)

Question 39

Drug class: Antihypercalcemic agents
What are the indications?

Answer 39

*Bisphosphates: Indications: osteoporosis, Paget’s disease,
hypercalcemia in cance

*Calcitonins: Indications: osteoporosis, Paget’s disease,
emergency treatment of hypercalcemia

Question 40

Drug class: Antihypercalcemic agents
What are the contraindications?

Answer 40

Absolute:
• Bisphosphonates- Allergy, hypocalcemia (these drugs lower calcium)
• Calcitonins- Allergy to fish

Relative:
Bisphosphonates- renal dysfunction, GI disease (can exacerbate GI conditions because they’re are on the stomach and esophagus), prolonged use (5 years or more)
• Calcitonins- Pregnancy, renal dysfunction, pernicious anemia

Question 41

Drug class: Antihypercalcemic agents
What are the adverse effects?

Answer 41

*Bisphosphates-
• GI: abd pain, nausea, and diarrhea/constipation
• Esophageal erosion
• Bone pain with Paget’s disease

*Calcitonins-
• Flushing of face & hands, skin rash, nausea and vomiting, urinary frequency, local inflammation at injection site

Question 42

Drug class: Antihypercalcemic agents
What are the drug-drug interactions?

Answer 42

*giving other drugs at the same time can affect absorption
• Bisphosphonates: other meds, aspirin
• Calcitonins- None

Question 43

Antihypercalcemic agents: Nursing process
Assessment:

Answer 43

-Hx: assess for conditions that are cautions and contraindications
-Phys: assess GI, skin, urinary system
• Labs: calcium, phosphorus, vitamin D, magnesium levels, renal function

Question 44

Antihypercalcemic agents: Nursing process
Nursing diagnoses:

Answer 44

• Impaired comfort/Acute pain r/t GI or skin effects
• Malnutrition: less than body requirements r/t GI effects
• Knowledge deficit

Question 45

Antihypercalcemic agents: Nursing process
Implementation:

Answer 45

*Bisphosphonates: administer on an empty stomach with a full glass of water 30-60 minutes before other food or medication.
Remain upright for 30 minutes after administration (can cause esophageal erosions or breakdown if it gets refluxed back up into the esophagus)
• Ensure adequate hydration (because of excretion through the kidneys)
• Arrange for concomitant vitamin D, calcium supplements, and HRT

*Calcitonins: Rotate injection sites and monitor for inflammation
• Monitor serum calcium regularly
• Arrange for periodic blood tests of renal function
• Provide comfort measures (analgesics for bone pain, skin care for injection site irritation)
• Provide thorough patient teaching

Question 46

Antihypercalcemic agents: Nursing process
Evaluation:

Answer 46

• Patient response to the drug and adverse effects
• Effectiveness of the teaching plan, comfort & safety measures
• Compliance with medication regimen