Thyroid and Parathyroid Agents Flashcards
What are the functions of the thyroid gland?
- Regulate rate of metabolism
- Affect heat production and body temperature
- Affect oxygen consumption, cardiac output, and blood volume
- Affect enzyme system activity
- Affect metabolism of carbohydrates, fats, and proteins
- Regulate growth and development
What nutrient is essential to help produce thyroid hormones?
Iodine
Hypothyroidism
Causes, S/S
Causes:
* Absence of a thyroid gland
* Lack of sufficient iodine in the diet to produce the needed level of thyroid hormone
* Lack of sufficient functioning thyroid tissue due to a tumor or autoimmune disorders
* Lack of TRH related to tumor or disorder of the hypothalamus
* Lack of TSH due to pituitary disease
Signs and Symptoms:
* vague
* weight gain
* extreme fatigue
* decreased body temperature
* dry skin
* muscle aches and weakness
* constipation
* intolerance to cold
* Bradycardia
Hyperthyroidism
Causes and S/S
Causes:
* Excessive amounts of thyroid hormones usually caused by Grave’s Disease
Signs and Symptoms:
* Increased body temperature
* Tachycardia
* Bulging Eyes
* Facial Flushing
* Diarrhea
* Tremors
* Increased SBP
* Weight Loss
* Muscle Wasting
Lifespan considerations for Thyroid and Parathyroid Agents
In Children
Hypothyroidism
* USE: Levothyroxine
* Higher doses
* Monitor thyroid labs
* Monitor Growth and Development
Hyperthyroidism:
* USE: Methimazole
* DON’T USE: Propylthiouracil, Radioactive agents
Hypercalcemia:
* Rare
* USE: Biphosphonates
* Monitor Calcium levels
Lifespan considerations for Thyroid and Parathyroid Agents
In Adults
Hypothyroidism:
* Lifelong
* Monitor thyroid levels
* Pregnancy & Lactation: USE: Levothyroxine
Hyperthyroidism:
* Side effects worse with Methimazole
* Sodium Iodide can affect fertility
* Pregnancy: USE Propylthiouracil
* Do NOT use in lactation
Hypercalcemia:
* Osteoporosis
* Monitor calcium levels
* Calcium and Vitamin D supplements
* Pregnancy: Do not use biphosphonates
Lifespan considerations for Thyroid and Parathyroid Agents
In Older Adults
Hypothyroidism:
* Screen regularly
* Start low and go slow
* USE: Levothyroxine
* Monitor response: thyroid levels, cardiac effects
Hyperthyroidism:
* USE: Sodium Iodide (less adv. effects)
* Monitor for hypothyroidism
Hypercalcemia:
* Dietary deficiencies: Calcium and Vit. D. supplements
* Osteoporosis: Biphosphonates
* Renal Impairment
* Monitor calcium levels
Thyroid Hormones
Drug Names
Levothyroxine
Liothyronine
Liotrix
Thyroid Desiccated
Thyroid Hormones
Mechanism of Action
- Increases cellular metabolism in all areas of the body
Thyroid Hormones
Indications
- Hypothyroidism
- Myxedema coma: severe hypothyroidism
- Pituitary TSH suppression in the treatment of euthyroid (normal thyroid) goiters
- Management of thyroid cancer
- Thyrotoxicosis in conjunction with other therapy
Thyroid Hormones
Contraindications
Absolute:
* Allergy
Relative:
* Acute MI
* Thyrotoxicosis - never use by itself
Caution:
* Hypoadrenal conditions
Thyroid Hormones
Adverse Effects
- NONE in correct dose
- Rare: Hair loss
- Symptoms of hyperthyroidism
- Cardiac stimulation
- CNS effects
Thyroid Hormones
Drug Interactions
- Oral anticoagulants: inc. risk of bleeding
- Digoxin: decreased dig levels
- Theophylline: decreased clearance of theophylline w/hypothyroidism - may need to increase theophylline as thyroid hormone levels increase
Thyroid Hormones
Assessment
History:
* Check for allergy, family history, acute MI, thyrotoxicosis, and hypoadrenal conditions
Physical:
* Skin
* CNS
* Vitals
* ECG
Labs:
* Thyroid hormone levels
Thyroid Hormones
Nursing Diagnoses
- Altered Cardiac Output (r/t cardiac effects)
- Malnutrition risk: less than body requirements (r/t changes in metabolism)
- Altered tissue perfusion (r/t thyroid activity)
- Knowledge Deficit
Thyroid Hormones
Implementation/Patient Teaching
- Single daily dose
- Administer 30-60 minutes BEFORE breakfast
- Administer with a full glass of water
- Do not administer other drugs at the same time
- Labs 6 weeks after beginning therapy
- Monitor response closely - especially cardiac response
- Takes several weeks to take effect
- Arrange for periodic blood tests
Antithyroid Agents
Drug Names
Thiomides:
* Propylthiouracil (PTU)
* Methimazole
Iodine Solutions:
* Stong iodine solution
* Potassium iodide
* Sodium iodide I(131) and I(132)
Antithyroid Hormones
Mechanism of Action
Thiomides
* Prevents formation of thyroid hormone within the thyroid cells
Sodium Iodide I(131) and I(132)
* Enters thyroid cells and destroys them by giving off radiation
Strong iodine solution and potassium iodide
* High doses saturate the thyroid cells preventing thyroid hormone formation
Antithyroid Hormones
Indications
Thiomides:
* Hyperthyroidism
Sodium Iodide I(131) and I(132):
* Low Dose: Diagnosis/evaluation of thyroid function
* High Dose: Hyperthyroidism, radiation emergencies
Strong iodine solution & Potassium Iodide:
* Hyperthyroidism
* Radiation emergencies
* Suppression of thyroid gland before surgery
* Acute thyrotoxicosis
Antithyroid Hormones
Contraindications
Absolute:
* Allergy
Caution:
* PTU: Liver Impairment
Antithyroid Hormones
Adverse Effects
- ALL: Hypothyroidism
- Methimazole: Bone marrow suppression
- PTU: Severe liver toxicity
- Iodine Solutions: Iodism
Antithyroid Hormones
Drug Interactions
- Oral anticoagulants
- Theophylline
- Beta-Blockers
- Digoxin
Antithyroid Hormones
Assessment
History:
* Check for allergy, liver impairment
Physical:
* Skin
* CNS
* Vitals
* ECG
Labs:
* Thyroid function, CBC, liver function, pregnancy test
Antithyroid Hormones
Nursing Diagnoses
- Altered cardiac output
- Malnutrition risk: More than body requirements
- Injury Risk/infection and bleeding risk
- Knowledge deficit
Antithyroid Hormones
Implementation/Patient Teaching
- Administer Methimazole and PTU three times a day around the block
- Give iodine solution through a straw: tablets can be crushed
- Arrange for periodic blood tests
- Assess patients receiving iodine solution for any sign of iodism (sore mouth)
What is Hypoparathyroidism?
- The absence of parathormone (Parathyroid hormone)
- Most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery
What is Hyperparathyroidism?
- The excessive production of parathormone
- Can occur as a result of a parathyroid tumor or certain genetic disorders
What two hormones regulate calcium in the body?
- Calcitonin (from the thyroid): released in response to HIGH serum calcium levels
- Parathyroid Hormone (from the parathyroid): Released in response to LOW serum calcium levels
AntiHYPOcalcemic Agents
Mechanism of Action
Raises Calcium levels in the blood
* Stimulates osteoclasts to release calcium from the bone
* Increases intestinal absorption of calcium
* Increases calcium resorption from the kidneys
* Stimulates cells in the kidney to produce calcitriol (Vitamin D3)
* Teriparatide: stimulates new bone formation
AntiHYPOcalcemic Agents
Indications
Low calcium in the blood
* Management of hypocalcemia in patients undergoing chronic renal dialysis
* Treatment of hypoparathyroidism
* Teriparatide: treatment of osteoporosis
AntiHYPOcalcemic Agents
Drug Names
Teriparatide
Parathyroid Hormone
Calcitriol (Vitamin D)
AntiHYPOcalcemic Agents
Contraindications
Absolute:
* Allergy
* Vitamin D toxicity
Relative:
* Hypercalcemia
Caution:
* History of renal stones
AntiHYPOcalcemic Agents
Adverse Effects
- GI effects: N/V, constipation
- CNS effects: somnolence, irritability
AntiHYPOcalcemic Agents
Drug Interactions
- Magnesium containing antacids
- Digoxin
AntiHYPOcalcemic Agents
Assessment
History:
* Check for allergy, vit. D toxicity, hypercalcemia, kidney stones
Physical:
* Skin
* CNS
* GI
Labs:
* Serum calcium levels
* Serum magnesium levels
* Alkaline phosphate levels
* Liver function tests
* Xrays of the bones as appropriate
AntiHYPOcalcemic Agents
Diagnoses/Conclusions
- Impaired Comfort/Acute Pain
- Malnutrition Risk: Less than body requirements
- Knowledge Deficit
AntiHYPOcalcemic Agents
Implementation/Patient Teaching
- Monitor serum calcium levels
- Provide comfort and safety measures
- Arrange for nutritional consult
AntiHYPERcalcemic Agents
Mechanism of Action
Biphosponates:
* Act on the serum levels of calcium and NOT directly on the parathyroid gland or PTH
* Inhibits bone resorption
Calcitonins:
* Hormones secreted by the thyroid gland to balance the effects of PTH
* Inhibits bone resorption
AntiHYPERcalcemic Agents
Indications
Biphosphonates:
* Osteoporosis
* Paget’s Disease
* Hypercalcemia in cancer
Calcitonins:
* Osteoporosis
* Paget’s Disease
* Emergency treatment of hypercalcemia
AntiHYPERcalcemic Agents
Drug names
Biphosphonates:
* Etidronate
* Ibandronate
* Pamidronate
* Risedronate
* Alendronate
Calcitonins:
* Calcitonin salmon
AntiHYPERcalcemic Agents
Contraindications
Absolute:
* Biphosphonates: allergy, hypocalcemia
* Calcitonins: allergy to fish
Relative:
* Biphosphonates: Renal dysfunction, GI disease, prolonged use
* Calcitonins: Pregnancy, renal dysfunction, pernicious anemia
AntiHYPERcalcemic Agents
Adverse Effects
Biphosphonates:
* GI: abdominal pain, nausea, diarrhea/constipation
* Esophageal erosion
* Bone pain with Paget’s disease
Calcitonins:
* Flushing of face and hands
* Skin rash
* Nausea and vomiting
* Urinary frequency
* Local inflammation at injection site
AntiHYPERcalcemic Agents
Drug Interactions
Biphosphonates:
* Other meds, aspirin
Calcitonins:
* None
AntiHYPERcalcemic Agents
Assessment
History:
* Check for allergy, hypocalcemia, allergy to fish, renal dysfunction, GI disease, pregnancy, pernicious anemia
Physical:
* GI
* Skin
* Urinary System
Labs:
* Calcium, phosphorous, Vitamin D, magnesium levels
* Renal function tests
AntiHYPERcalcemic Agents
Nursing Diagnoses/Conclusions
- Impaired Comfort/Acute Pain
- Malnutrition: less than body requirements
- Knowledge Deficit
AntiHYPERcalcemic Agents
Implementation
Biphosphonates:
* Administer on an EMPTY stomach with a FULL glass of water
* 30-60 minutes before other food or medication
* Stay upright for 30 minutes after administration
- Ensure adequate hydration
- Arrange for concomitant Vitamin D, calcium supplements, and HRT
Calcitonins:
* Rotate injection sites and monitor for inflammation
- Monitor calcium levels regularly
- Arrange for periodic blood tests of renal function
