Thyroid/Endocrine Flashcards
Thyroid Binding Globulin (TGB)
- Binds to T3 and T4
- T4 is 99.96% bound
- T3 is 99.7% bound
- Measure the free t3 and t4 to test for hypothyroidism or hypothyroidism
Calcitonin
- Secreted by the thyroid
- Responds to high circulating calcium levels
- Increases calcium storage in the bone
- Increases renal excretion of calcium and phosphorus
Calcitonin
-used for
Medication used for osteoporosis
Thyroid Replacing Medications
-Indication
- Hypothyroidim
- Myxedema coma & goiters
- Well tolerated w/ very little adverse reactions
Thyroid Replacement Medications
-Contraindication
- During acute MI or angina
Thyroid Replacement Medications
-Drug Interactions
- Cholestyamine (binding)
- Oral anticoagulants (potency)
- Digitalis (decrease effectiveness)
- Theophylline (decreased clearance)
Thyroid Replacement Medications
-Adverse Effects
Well tolerated w/ correct dosing
Hypothydoidism
- Slowing of mind and body
- Weak heartbeat
- constipation
- HIGH LDL
- dry skin / hair thinning
- Depression “schizophrenia” irritability
Thyroid Storm
- Life threatening
- Easily treatable
- Symptoms:
- Severe tachycardia / HF & shock / Hyperthermia / seizures /
- N/V/D
Thyroid Storm
-Treatment
- Hydration
- Temp reduction
- Reducing thyroid levels
- Elimination of stressor
Antithyroid Medication
- Used when there is too much circulating thyroid hormone
- Decreases T4 and T3 hormone
- Propylthiouracil (PTU)
Hyperthyroidism
-S/S
- Graves
- Sweating
- Neurotic anxiety
- Fine tremor (paper test)
- brisk reflexes
Antithyroid Medication
-Contraindications
Pt’s w/ pulmonary edema & TB (iodine preparations)
Antithyroid Medication
-Drug Interactions
- hyperkalemia w/ SSKI and K+ replacements
Antithyroid Medication
-Adverse Effects
- Hypothyroidism S/S
- GI disturbance w/ PTU
- Iodine solutions can:
- stain teen
- cause oral discomfort
- give a metallic taste
Antithyroid Medication
-Nursing Implications/Teaching
- Divide doses for even dosing around the clock for PTU
- Watch for S/S of “iodism”
- Take iodine solution through a straw
- Watch for S/S of hypothyroidism
- Withdrawal gradually, NEVER ABRUPTLY
Parathyroid Glands
- Parathyroid increases PTH release when calcium falls
- PTH is controlled by feedback loop
- PTH rises when calcium falls, and increases calcium
- PTH falls when calcium rises, and decreases calcium
Hypercalcemic Medication
- Works to lower serum calcium
- Decreases bone reabsorption
- Helps prevent complications from hypercalcemia
- cardiac dysfunction
- GI disturbances
Hypercalcemic Medication
-Medications
- Calcitonin
- Bisphosphonate-etidronate (Didronel)
- Alendronate (Fosamax)
Hypercalcemic Medication
-Contraindication
- Bisphosphonate and gallium w/ renal dysfunction
- Bisphosphonate w/ acidosis & Heart Block
- Calcitonins and salmon and fish allergies
Hypercalcemic Medication
-Drug Interactions
- Multiple vitamins, iron and antacids
2. Nephrotoxic antibiotics
Hypercalcemic Medication
-Adverse Effects
- Facial flushing
- Nausea
- Renal failure
Hypercalcemic Medication
-Nursing Implications/Teaching
- Given Orally, IV or nasal spray
- Encourage fluid intake
- Watch for EKG changes
- Watch for signs of hypocalcemia and teach pt to report these signs immediately
Hypercalcemia
-S/S
- Fatigue
- Depression
- Confusion
- N/V/C
- Renal stones, increased urination
- Cardiac arrhythmias
Hypocalcemia
-S/S
- Tetany / increased neural excitability
- Check for Trousseau’s sign
-development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes - Check for Chvostek’s sign
(twitching facial muscles when the facial nerve is tapped anterior to the ear)
Hypocalcemia
-Trousseau’s Sign
- Development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes
Hypocalcemia
-Chvostek’s Sign
- Twitching facial muscles when the facial nerve is tapped anterior to the ear
Glucocorticoid Therapy
- Any disease that increases inflammation or where inflammation goes out of control
Glucocorticoid Therapy
-Used for
- Simple: Poison Oak
- Complex and deadly: Pulmonary Inflammation (Pneumonitis)
- Painful: Neuritis