week 8- Thyroid and Adrenal Drugs Flashcards
Secretes three hormones essential for proper regulation of metabolism
T3
T4
CALCITONIN
Thyroid hormones are required for normal growth and development and energy metabolism. They;
PROMOTE GROWTH AND DEVELOPEMNT
ENERGY USE
INCREASE IN HEART RATE, FORCE ON CONTRACTION, AND CO
Common Signs and Symptomsof Hypothyroidism
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
Hyperthyroidism
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
Nursing Implications (levothyroxine)
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
Patient Teaching (levothyroxine)
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
Adrenal medulla secretes:
Epinephrine
Norepinephrine
Adrenal cortex secretes
corticosteroids
Hormones produced by the ADRENAL CORTEX that
affect almost every body system—therefore, monitor the use of corticosteroid drugs very closely because these drugs produce profound THERAPEUTIC and ADVERSE effects.
Glucocorticoids—
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
Mineralcorticoids—
important in maintaining FLUID AND ELECTROLYTE BALANCE
primarily aldosterone
Adrenocortical Hormones over and undersecretion
Oversecretion leads to CUSHINGS SYNDROME
Undersecretion leads to ADDISONS DISEASE
Mechanism of Action- Glucocorticoid activity
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
Mechanism of Action- Mineralcorticoid activity (especially in larger doses)
Electrolyte/fluid balance→conserve NA and water and eliminate K
Important to note:
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
Adverse Effects of adrenal
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.
Adverse Effects-Potent effects on all body systems
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
glucocorticoid and mech of action and children
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)
Contraindications/Precautions of adrenal drugs
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
Mechanism of Action- Glucocorticoid activity
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
lowest dose for the shortest affected time
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.
perdisone will increase serum levels of potassium
false because it increase sodium levels not potassium.
