week 8- Thyroid and Adrenal Drugs

Question 1

Secretes three hormones essential for proper regulation of metabolism

Answer 1

T3
T4
CALCITONIN

Question 2

Thyroid hormones are required for normal growth and development and energy metabolism. They;

Answer 2

PROMOTE GROWTH AND DEVELOPEMNT

ENERGY USE

INCREASE IN HEART RATE, FORCE ON CONTRACTION, AND CO

Question 3

Common Signs and Symptomsof Hypothyroidism

Answer 3

Sleepiness, Fatigue, Lethargy
Loss of Memory, Trouble Concentrating
Unusually Dry, Coarse Skin
Goiter (Enlarged Thyroid)
Gradual Personality Change, Depression
Increase in Weight, Bloating or Puffiness (Edema)
Sensitivity to Cold
Hair Loss, Sparseness of Hair

Question 4

Hyperthyroidism

Answer 4

CVS ↑BMR, ↑ HR, ↑CO
CNS nervousness, anxiety, insomnia
Metabolic wt loss, intolerance to heat
GI ↑ appetite, diarrhea, weight loss
MS weakness, fatigue, muscle atrophy flushing, soft nails
Reproductive amenorrhea
Misc dyspnea, localized edema around eyeballs—exophthalmos, ↑ susceptibility to infection

Question 5

Nursing Implications (levothyroxine)

Answer 5

Obtain baseline VITAL SIGNS, WEIGHT
Monitor pulse for RATE, RHYTHM

Observe for TREMORS, ANXIETY
Assess APPEITITE, SLEEP PATTERN
Monitor SERUM THYROID FUNCTION
Assess for therapeutic effect/adverse effects

Question 6

Patient Teaching (levothyroxine)

Answer 6

Drug therapy is LIFE LONG
Take once daily AC TO PREVENT INSOMINIA

Take at the SAME TIME EVERYDAY
Do not switch brands without physician approval
Take 4 hrs apart from antacids, iron or calcium supplements
Full therapeutic effect may take 1-3 WEEKS
Notify physician immediately of CHEST PAIN, ANXIETY, INSOMINA, WEIGHT LOSS

Question 7

Adrenal medulla secretes:

Answer 7

Epinephrine

Norepinephrine

Question 8

Adrenal cortex secretes

Answer 8

corticosteroids

Question 9

Hormones produced by the ADRENAL CORTEX that

Answer 9

affect almost every body system—therefore, monitor the use of corticosteroid drugs very closely because these drugs produce profound THERAPEUTIC and ADVERSE effects.

Question 10

Glucocorticoids—

Answer 10

important in metabolic, inflammatory and immune processes—body secretes this hormone in the MORNING

what the drug is given for but still has some mineralocorticoid effects so will have some water retension

Question 11

Mineralcorticoids—

Answer 11

important in maintaining FLUID AND ELECTROLYTE BALANCE

primarily aldosterone

Question 12

Adrenocortical Hormones over and undersecretion

Answer 12

Oversecretion leads to CUSHINGS SYNDROME

Undersecretion leads to ADDISONS DISEASE

Question 13

Mechanism of Action- Glucocorticoid activity

Answer 13

 CHO and PRO metabolism→↑gluconeogenesis
 Lipid metabolism→redistribute body fat
 ↓immune response—given after organ transplant
 ↓inflammatory response—given for arthritis, asthma, lupus, IBD, allergic rhinitis
 musculoskeletal→can cause muscle atrophy and ↓bone mineralization and growth
 GI system→↓viscosity (protective quality) of gastric mucous

Question 14

Mechanism of Action- Mineralcorticoid activity (especially in larger doses)

Answer 14

Electrolyte/fluid balance→conserve NA and water and eliminate K

Question 15

Important to note:

Answer 15

administration of corticosteroid drugs for >2 weeks suppresses the secretion of naturally occurring (endogenous) adrenal corticosteroids. Abruptly discontinuing glucocorticoid drugs will result in a CRISIS

Question 16

Adverse Effects of adrenal

Answer 16

Corticosteroids rarely cause side effects when used for a short-term or replacement therapy. To decrease adverse effects from long-term therapy, patients are given the LOWEST possible effective dose, often on an ALTERNATIVE schedule, for the SHORTEST effective time. In addition, long-term use is reserved for LIFE- THREATENING conditions or severe disabling conditions.

Question 17

Adverse Effects-Potent effects on all body systems

Answer 17

 Cardiovascular
○ Heart failure, fluid retention, hypertension, weight gain—all due to electrolyte imbalances ↑Na, ↓K
Nursing actions: monitor daily weight, BP, electrolytes, report weight gain of over 1kg/day, 2.25kg/week
 CNS
○ mood swings, insomnia, aggravation of pre-existing psychiatric disorders
Nursing actions:
 Endocrine
○ Growth suppression, Cushing’s syndrome, menstrual irregularities, hyperglycemia
Nursing actions:
 GI
○ Peptic ulcers, abdominal distention, ↑appetite, diarrhea, constipation
Nursing actions: Give with food and a glass of water to help. Monitor weight,
 Integumentary
○ Fragile skin, petechiae (little red dots, bleeding), ecchymosis, facial erythema, poor wound healing, hirsutism
Nursing actions:
 Musculoskeletal
○ Muscle weakness, loss of muscle mass, osteoporosis
Nursing actions:
 Other
○ ↑ susceptibility to infection
○ Acute adrenal insufficiency—anorexia, nausea, fever, weakness, hypotension, shock
○ cataract formation
Nursing actions: watch for stressors, wash your hands and get them to wash theirs

Question 18

glucocorticoid and mech of action and children

Answer 18

growth (will hault child’s growth. Will probably give it in a short window of time (I think 2 weeks) so it doesn’t effect height)

Question 19

Contraindications/Precautions of adrenal drugs

Answer 19

 Drug allergies
 Serious infections – it inhibits immune system. Will most likely die from sepsis
 Diabetes – blood sugars
 Peptic ulcer – decrease viscosity of mucus in stomach which protects the stomach. Will be more likely to produce an ulcer
 CHF, hypertension, renal insufficiency – fluid overload

Question 20

Mechanism of Action- Glucocorticoid activity

Answer 20

 Carbohydrate and PRO metabolism→↑gluconeogenesis (blood sugar checks should be done every day. Especially with someone with brain cancer or something)
 Lipid metabolism→redistribute body fat
 ↓immune response—given after organ transplant
 ↓inflammatory response—given for arthritis, asthma, lupus, IBD, allergic rhinitis
 musculoskeletal→can cause muscle atrophy and ↓bone mineralization and growth (will hault child’s growth. Will probably give it in a short window of time (I think 2 weeks) so it doesn’t effect height)
 GI system→↓viscosity (protective quality) of gastric mucous

Question 21

lowest dose for the shortest affected time

Answer 21

for cortico. only given long term if life threatening. one of the side effects will be stopping growth. also monitor weight. if pnt goes up one 1 kilo per day or 2.5 per week is bad.

Question 22

perdisone will increase serum levels of potassium

Answer 22

false because it increase sodium levels not potassium.