Chapter 6 Medications

Question 1

Thyroid hormones controls (3)

Answer 1

• metabolic rate
• Stimulates heart
• in Childhood has role in growth and development

Question 2

What is the Drug for Hypothyroidism

Answer 2

Levothyroxine

Question 3

what is the other name of levothyroxine?

Answer 3

Synthroid

Question 4

What is the class of levothyroxine (Synthroid)

Answer 4

Synthetic preparation of thyroxine (T4)

Question 5

What is the MOA of Levothyroxine (Synthroid)

Answer 5

Identical action to naturally occurring hormone (regulates metabolism, stimulates heart, promotes growth and development)

Question 6

What is the indication of Levothyroxine (Synthroid)

Answer 6

Used to treat all forms of hypothyroidism

Question 7

What is the pharmacokinetics of Levothyroxine (Synthroid)

Answer 7

Highly protein bound so half life is 7 days, 1 month to plateau!
** Takes long time to have effect, important for patient education**

Question 8

What are the adverse effects of Levothyroxine (Synthroid) (2)

Answer 8

• At appropriate doses no adverse effect
• If doses is too high then symptoms of thyrotoxicosis can occur ( tachycardia, angina, nervousness, insomnia, hyperthermia etc. )

Question 9

What is the drug interaction of Levothyroxine (Synthroid)

Answer 9

Anything that changes the pH of stomach must be given 4 hours apart

Question 10

Levothyroxine (Synthroid) IS AVAILABLE IN WHAT FORMS?

Answer 10

PO and IV forms

Question 11

When should you administer Levothyroxine (Synthroid)? why?

Answer 11

• On an empty stomach (30-60 mins before eating)

- Because anything that changes the pH of stomach affects absorption

Question 12

What does diabetic people have to do when taking Levothyroxine (Synthroid) ?

Answer 12

• They have to increase their insulin requirement

- Energy use increases = consuming more glucose when metabolism picks up

Question 13

What lab works do we need for Levothyroxine (Synthroid) ?

Answer 13

Regular lab work to monitor T4 and T3

Question 14

What are the patient education for Levothyroxine (Synthroid)? (3)

Answer 14

• Teach patient about S&S of thyrotoxicosis
• Length of time to take effects
• Life long treatment

Question 15

What is the drug for Hyperthyroidism? (2)

Answer 15

Methimazole and Propanolol

Question 16

Methimazole Class?

Answer 16

Thionamides

Question 17

Methimazole MOA

Answer 17

Suppresses synthesis of thyroid hormones

Question 18

Methimazole Indication (3)

Answer 18

• Treatment of Graves disease
• prior to surgery/radiation
• Thyroid crisis

Question 19

Methimazole Adverse effects (3)

Answer 19

• Hazardous to pregnant/breastfeeding women
• Agranulocytosis
• Hypothyrodism

Question 20

what is Agranulocytosis (3)

Answer 20

• dangerous low level of granulocytes
• Happens in first 2 months
• Sore throat and fever

Question 21

What are other precautions nurses (female) have to do with Methimazole?

Answer 21

• wear gloves due to hazardous effects on pregnancy and breastfeeding.

Question 22

Methimazole drug interactions?

Answer 22

none :)

Question 23

how long does the treatment (met) last?

Answer 23

• Treatment usually for 1-2 years and then discontinue of hormone levels stay within normal range
• If levels still rise then restart or do other permanent treatments

Question 24

Methimazole available in what form?

Answer 24

PO

Question 25

when do you take Methimazole? why?

Answer 25

- Take at same time everyday with meals | - We want the levels to stay stable and prevent GI upset

Question 26

What do we need to monitor (lab) for Methimazole?

Answer 26

Monitor T3 and T4

Question 27

What do we need to educate the patient regarding Methimazole?

Answer 27

- Educate regarding signs of hypothyroidism | - Monitor weight, pulse, mood

Question 28

What is the class of propanolol?

Answer 28

Beta- Adenergic Blocker

Question 29

What is the MOA of propanolol?

Answer 29

Non-Selective Beta blocker with negative inotropic chronotropic, dromotropic properties.

Question 30

What is the Indication of propanolol?

Answer 30

Controls tachycardia in hyperthyroidism (many other uses)

Question 31

What is the adverse effects of propanolol? (5)

Answer 31

- Bradycardia - Hypotention - dizziness - Heart failure - Bronchoconstriction

Question 32

Who should you avoid giving propanolol to? why?

Answer 32

- People with asthma or COPD | - Due to bronchoconstriction effect

Question 33

Adrenal gland is controlled by?

Answer 33

Hypothalamus and anterior pituitary gland

Question 34

Cortex secretes what?

Answer 34

Conticosteroids - Glucocorticoids - mineral corticoids - Androgens

Question 35

Corticosteroids controls what? (6)

Answer 35

- carbohydrate - protein - fat metabolism - integrity of vascular system - sat and water balance - Expression of sexual characteristics

Question 36

What is the drug for adrenal hormone excess (Cushings)?

Answer 36

- No specific drugs for this disorder - Treatment usually involves removing source of excess stimulation (ACTH or cortisol secreting tumours) or removing exogenous cortisol

Question 37

What is the drug for Adrenal Hormone Insufficiency (Addisons)?

Answer 37

Hydrocortisone

Question 38

what is the other name for hydrocortisone?

Answer 38

Cortef

Question 39

Hydrocortisone (Cortef) MOA

Answer 39

same action as cortisol ( stress hormone )

Question 40

Hydrocortisone (Cortef) class

Answer 40

Glucocorticoids but also have some mineral corticoids actions

Question 41

Hydrocortisone (Cortef) indication

Answer 41

- Adrenal insufficiency - low dose | - Severe inflammation - high dose (IBD, asthma, SLE, UC, TB)

Question 42

Hydrocortisone (Cortef) Adverse effect

Answer 42

- Low dose: no adverse effects | - Chronically high doses - adrenal suppression and cushing's syndrome

Question 43

Hydrocortisone (Cortef) forms?

Answer 43

PO, IM, IV

Question 44

Cortif PO should be given with what? why?

Answer 44

With food or milk to avoid GI problems

Question 45

When should Hydrocortisone (Cortef) be taken? why?

Answer 45

- Given in AM and early afternoon to mimic natural production of cortisol.

Question 46

What does a person do when theres extra stress while taking Hydrocortisone (Cortef)?

Answer 46

- Take extra dose with stress (3x3) | - carry cortisol all the time just incase there is stress

Question 47

What does nurses have to monitor? Hydrocortisone

Answer 47

- BP, HR, I & O | - Cushing's or sign of infection

Question 48

What labs do we have to monitor for Hydrocortisone (Cortef)?

Answer 48

- K+ - Blood glucose - Urine glucose

Question 49

Patient teaching for Hydrocortisone (Cortef)

Answer 49

- Never stop medication without tapering | - Wear medical bracelet

Question 50

Why cant we stop Hydrocortisone (Cortef) abruptly?

Answer 50

adrenal glands shrinks with the use of exogenous corticosteroids so stopping the drug abruptly will not give adrenal glands time to excrete enough/ decent amount of corticosteroids.

Question 51

What does posterior pituitary secrete?

Answer 51

- Oxytocin and Antidiuretic hormone (ADH)

Question 52

Where is Oxytocin and Antidiuretic hormone (ADH) synthesized?

Answer 52

- In the hypothalamus

Question 53

When too much ADH is produced what happens?

Answer 53

SIADH ( very little urine being formed and a lot of water being retained)

Question 54

When too little ADH is produced what happens?

Answer 54

- Diabetes insipidus ( excessive diuresis to dehydration)

Question 55

What is the treatment for SIADH?

Answer 55

- treat underlying cause of the disorder | - No drugs

Question 56

What is the drug for Pituitary Insufficiency (DI) ?

Answer 56

Antidiuretic Hormone (Vasopressin)

Question 57

What is the class of Antidiuretic Hormone (vasopressin)

Answer 57

pituitary hormone

Question 58

What is the MOA of Antidiuretic Hormone (vasopressin)

Answer 58

Acts on kidneys to cause reabsorption of water, can also stimulate contraction of vascular and GI smooth muscle (high doses)

Question 59

What is the indication of Antidiuretic Hormone (vasopressin)

Answer 59

Treatment of diabetes insipidus, cardiac arrest ( increase blood flow to the heart and brain)

Question 60

What is the adverse effect of Antidiuretic Hormone (vasopressin)

Answer 60

- water intoxication ( drowsiness, listlessness, and headache)