Thyroid & Anti-thyroid, Antidiabetic, & Adrenal Drugs Flashcards
Thyroid Replacement Thyroid Drug
Levothyroxine
Replaces thyroid hormone
- Increases T4 levels
(Indication): Hypothyroidism
Levothyroxine
Teachings for (Levothyroxine)
- Taken on an empty stomach & 30 minutes before breakfast
- Warn foods with Vitamin K (Fruits & Veggies) = Inhibits thyroid secretion
- Therapeutic range (>1 month)
Implementation for (Levothroxine)
- Dosed in mcg (>200mcg = error)
- Monitor vital signs & weight (Hyperthyroidism = High BP, HR, & T, & rapid weight loss)
What drug causes the destruction of the thyroid gland?
- Orangish-reddish color
- Can stain teeth
Radioactive Iodine
Teachings for (Radioactive Iodine)
- Drink it through a straw & avoid contact with the teeth
- Propylthiouracil (PTU)
- Methimazole
Antithyroid drugs (Thioamide drugs)
Inhibit the incorporation of iodine molecule into tyrosine (Process of making T4 & T5)
(Indications): Hyperthyroidism
- Propylthiouracil (PTU)
- Methimazole
What antithyroid drug can be used during the 2nd and 3rd trimester?
Methimazole
What can antithyroid drugs cause in fetus & their mother?
Hepatotoxicity
- Bone Marrow Toxicity
- Hepatotoxicity
- Agranulocytosis
- Leukemia
- Thrombocytopenia
- Anemia
Sides effects of what drugs?
Anti-thyroid drugs
- Propylthiouracil (PTU)
- Methimazole
Assessments for (Antithyroid drugs)
- Assess S/s of thyroid crisis (Tachycardia, dysrhythmias, fever, heart failure, confusion)
- Assess for Hypotension & Vascular collapse
Teaching for (Antithyroid drugs)
- If taking radioactive iodine (avoid iodized salts & shellfish)
- Do not abrupty stop antithyroid drugs (Hyperthyroid symptoms can reoccur)
- Report S/s of hyperthyroidism
Substitute for endogenous insulin
- Binds to insulin receptors of cells (Allows glucose to be actively transported into cells)
Insulin
- Insulin aspart
- Insulin Lispro
- Insulin Glulisine
Rapid acting insulin
- NPH (Basal Insulin)
Intermediate Insulin
- Insulin Glargine
- Insulin Determir
Long-acting insulin
- Regular insulin
Fast-acting insulin
Rapid-acting insulin & regular insulin are considered what?
Meal-Time insulin
Insulin are dosed in what?
Units
Patient is Hangry & Sweaty
What does the patient have? And what should you give them?
Hypoglycemia
- Give them candy
Patient is experiencing polyuria, polyphagia (a lot of eating), & polydipsia (A lot of drinking) they are also hot & dry.
What does the patient have?
Hyperglycemia
What are used to draw up insulin and what color is the caps?
Insulin syringes
- Orange caps
What insulin can be given IV?
- Rapid-Acting Insulin
- Regular Insulin
What insulin cannot be given IV?
- Intermediate Insulin (NPH)
- Long-acting Insulin
Assessments for (Insulin)
- Assess blood glucose & Hgb A1c
Normal fasting blood glucose range
60-110
Fasting blood glucose goal for (Diabetics)
80-130
Hemoglobin A1C goal for (Diabetics)
<7
Implementation for (Insulin)
- Double check insulin dosage
- Label w/ expiration date (28 days after vial was opened)
- Inject air equal to the amount to be given into the insulin (Prior to drawing up insulin)
- Follow steps for mixing insulin
Steps for mixing (Rapid-acting insulin) & NPH (Intermediate insulin)
- Roll NPH (DONT SHAKE) until it turns cloudy
- Clean top of both the clear insulin (Rapid or fast-acting insulin) & Cloudly insulin (NPH)
- Inject air equal to amount of insulin to be administered (Cloudy insulin first) then (Clear insulin)
- Draw up correct amount of (Clear insulin)
- Draw up correct amount of (Cloudy insulin)
Teaching for (Insulin)
- Reports of Hypoglycemia & Hyperglycemia
- Don’t keep insulin in hot places or freezing places
- Discard opened insulin after 28 days (Never use expired insulin)
- Label w/ expiration date once vial is opened
- Inspect insulin before usage (Should always be clear & never cloudy)
- Metformin
- Sulfonylureas
Oral Antidiabetic drugs
- Decreases hepatic production of glucose (Stored glycogen)
- Decreases absorption of glucose (Small Intestines)
- Diminish increased serum levels after meal
- Increases insulin receptors & peripheral glucose uptake (Cellular level)
Metformin
- Renal Disease
- Hepatic Disease
- Severe heart failure
These are the contraindications of what drug?
Metformin
What does the creatinine clearance level have to be in order to take metformin
> 30mL/min
How long should metformin be held prior to surgery & after surgery?
48 hours
Stimulate pancreatic beta cells to secrete more insulin
First-Generation Sulfonylureas
Stimulate pancreatic beta cells to secrete more insulin & increase tissue sensitivity to insulin
Second-Generation Sulfonylureas
Assessment for (Metformin)
- Assess for renal & hepatic dysfunction
- Ask about alcohol intake (Increase risk for lactic acidosis)
Implementation for (Oral Antidiabetic drugs)
- Monitor blood glucose levels
- Monitor Hemoglobin A1C levels (every 6 months)
Teachings for (Oral Antidiabetic drugs)
- Do not drink alcohol (Causes: Hypoglycemic reactions)
- If (hypoglycemia occurs): eat candy, orange juice, soda
If a patient is conscious & talking to you and their blood glucose is less than 60 what should you give them?
Oral form of glucose
- 4oz of orange juice
- Hard candy
If a patient is unconscious & their blood glucose is less than 60, & has access to an IV, what should you give them?
Dextrose 50% in water (wait 20 minutes, recheck blood sugar, Call HCP)
If a patient is unconscious & their blood glucose is less than 60, & has no access to an IV, what should you give them?
Glucagon subcutaneously or intramuscularly
- Can cause pt to vomit (Turn pt on their side to prevent aspiration of their emesis)
- Prednisone
- Methylprednisone
Glucocorticoids
Suppresses inflammation (Steroid) “-one”
Glucocorticoids
- Fungal infections
- Peptic ulcer disease
- Diabetes mellitus
- Mental health disorder
These are contraindications of what drug?
Glucocorticoids
- Prednisone
- Methylprenisone
Assessments for (Glucocorticoids)
- Lab test: (Electrolytes & blood glucose levels): K can decrease & blood glucose can increase
- Assess medical history (Glaucoma, cataracts, diabetes, peptic ulcer
Implementation for (Glucocorticoids)
- VS: increased BP related to (Increase Na & H20 retention)
- IV Push (Give over 3-15 minutes)
- Monitor weight (report 5lb gain)
- Monitor S/s of hypokalemia (weakness, irregular HR, Abnormal distention, & paralytic ileus)
- Taper dose (Assess for adrenal crisis)
How should you administer 250mg of Glucococorticoids IV?
Infusion pump
- over 30-60 minutes
- Anorexia
- Nausea
- Weakness
- Fatigue
- Dyspnea
- Hypotension
- Hypoglycemia
These are S/s of what?
Adrenal Crisis
Teaching for (Glucocorticoids)
- Take as prescribed (Don’t stop abruptly; leads to adrenal crisis)
- Avoid sick people
- Take with food
- Increase potassium-rich food (vitamin K)
