Thyroid / Calcium Flashcards
What are the different types of Antihypercalcemia agents?
Biophosphonates (end in -onate)
Calcitonin (calcitonin salmon)
How to Antihypercalcemia agents work?
They decrease the Ca++ in the blood
What are the Indications for Antihypercalcemia’s?
Osteoporosis
Paget’s Disease
- Biophosphonates: used for hypercalcemia R/T cancer
- Calcitonins: used for emergency treatment of hypercalcemia
What are the Indications for Biophosphonates?
They’re used for hypercalcemia R/T cancer
What are the Indications for Calcitonins?
They’re used for emergency treatment of hypercalcemia
What are the Contraindications/Cautions for: Calcitonins?
- Pregnancy
- Renal Dysfunction
- Pernicious Anemia
What are the Contraindications/Cautions for: Biophosphonates?
- Hypocalcemia
- Pregnancy & Lactation
- GI disease
- Renal dysfunction
What are the Adverse Effects of: Calcitonins?
- Skin flushing (face and hands)
- Rash
- N/V
- Injection site inflammation
- Urinary Frequency
What are the Adverse Effects of: Biophosphonates?
- HA
- N/D
- Bonepain
- Paget’s Disease
What are the D/D’s for: Biophosphonates?
- Antacids
- Ca++ products
- Iron
- Multivitamins
- Aspirin
Decrease absorption of Biophosphonate.
What are the D/D’s for: Calcitonins?
No known Allergies
What are our Nursing Considerations for Antihypercalcemia agents?
- Will complete an abdominal exam
- Will do labs for: Ca++, phosphorous, magnesium, and renal functioning
Education:
- Take with fluid and must sit upright for 30-60mins after
- Ensure adequate hydration
What are the actions of: Biophosphonates?
They act on serum levels to inhibit bone reabsorption
What are the actions of: Calcitonins?
These are hormones secreted by the thyroid to balance and inhibit bone reabsorption
what are the indications for biophosphonates and calcitonins?
osteoporosis
pagets disease
- biophosphonates can be used for hypercalcemia R/T cancer
- calcitonins are emergency tx for hypercalcemia
what are the contra/cautions of biophosphonates?
hypocalcemia
pregnancy and lact
GI disease
renal dysfunction
what are the contra/cautions of calcitonins
pregnancy
renal dysfunction
pernicious anemia
what are the adverse effects of biophosphonates?
HA
N/V
bone pain
Pagets disease
what are the adverse effects for calcitonins
skin flushing of the face/hands rash N/V urinary frequency injection site inflammation
what are the drug-drugs for biophosphonates
antacids, calcium products, iron, multivitamins, apririn: decrease bio absorption
what are the drug-drug for calcitonins
NKA
what are the nursing considerations for biophosphonates and calcitonins?
abdominal exams
labs: calcium, phosphorous, magnesium, renal function
ensure adequate hydration
take biophosphonates with water and SIT UP RIGHT FOR 30-60 MINS AFTER ADMIN
what are the antihypocalcemic agents?
teriparatide
calcitriol (vit d)
parathyroid hormon
how do antihypocalcemic’s work
they stimulate osteoclasts to release calcium
increase absorption of calcium in the small intestine
increase ca reabsorption in kidneys and produce calcitrol
what are the indications of antihypocalcemic
low calcium in the blood R/T chronic renal dialysis
hypoparathyroidism
what are contra/cautions for antihypocalcemic
allergy
hypercalcemia
vitamin d toxicity
HX renal stones
what are the adverse effects of antihypocalcemic
GI: N//V, metallic taste, constipation
CNS: weakness, increased sleeping, HA, irritability
what are the drug-drug for antihypocalcemic’s
magnesium antacids: increase magnesium
digoxin: with hypercalcemia can increase digoxin toxicity
what are the nursing considerations for antihypocalcemic?
labs: calcium serum, magnesium, alkaline phosphate, and LFTs
want x-rays for possible breaks
want to ensure good calcium serum levels
increase risk for injury with falls
what are our iodine solutions
sodium iodid i131
strong iodine solution
potassium iodide
how does sodium iodide i131 work
enters and destroys thyroid cells with radiation
how do strong iodine solution and potassium iodide work?
saturate thyroid cells to decrease hormone
what are the indications for sodium iodide i131
hyperthyroidism
radiation emergencies
what are the indications for strong iodide solutions and potassium chloride
hyperthyroidism
radition emergencies
suppression of gland before surgery
acute thyrotoxicosis
what are the contraindications of iodine solutions?
allergy
what are the adverse effects of iodine solutions
hypothyroidism
iodism (iodine toxicity)
- sore mouth/teeth, burning mouth, metallic taste,
excessive salivation, HA/confusion
what are the drug-drug for iodine solutions
PO anticoagulants
theophylline
beta blockers
digoxin
what are the nursing considerations for iodine solutions
- sodium iodide i131: only for infertile women and older adults who cannot go through surgery
want ECG and vitals with baselines labs: thyroid levels pregnancy tests if crushing PO, use straw to avoid staining on teeth educate of S/S for iodine toxicity
what are our thioamides
propythiouracil (PTU)
methimazole
how do thioamides work
prevent the formation of thyroid hormone
slows all functions
what are the indications for thioamides
hyperthyroidism
what are the contra/cautions for thioamides
allergy
PTU: liver impairment
what are the adverse effects of thioamides
hypothyroidism
methimazole: bone marrow suppression
PTU: severe liver toxicity
what are the drug-drug for thioamides
PO anticoagulants
theophylline
beta blockers
digoxin
what are our nursing considerations for thioamides
obtain ECG and vitals for baselines
labs: thyroid levels, CBC (methimazole), liver (PTU)
pregnancy test
PTU admin is 3 times a day
what are the drugs used for hypothyroidism
levothyroxine
liothyronine
liotrix
thyroid desiccated (pork product)
how do hypothyroidism medications work
they increase the metabolic rate in all areas of the body
what are the indications for hypothyroidism meds
hypothyroidism
myxedema coma (extreme hypothyroidism/emergency)
euthyroid goiter: used to suppress the thyroid gland
thyrotoxicosis (used as adjunct therapy)
what are the contra/cautions for hypothyroidism meds
allergy
acute MI
thyrotoxicosis
hypo adrenal conditions (addisons)
what are the adverse effects of hypothyroidism meds
none with long term/proper use
@ first, can have skin reactions, symptoms of hyperthyroidism, cardiac stimulation, CNS effects (anxiety/HA), hairloss (common in kids)
what are the drug-drug for hypothyroidism meds
PO anticoagulants: increases bleeding
digoxin: decreases digoxin
theophylline: decreases clearance of thyophylline
what are the nursing considerations for hypothyroidism meds
dont use thyroid desiccated for religious/vegan patients are they in a hypoadrenal state? hypothyroidism more common in women obtain vitals/EKG and thyroid labs monitor for CO issues ADMIN BEFORE BREAKFAST AT SAME TIME DAILY WITH WATER takes 6weeks to reach therapeutic levels S/S hypo/hyperthyroidism
