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Thyroid And Parathyroid Agents Flashcards

1
Q

Use of thyroid and parathyroid agents across the lifespan of children

A

For hypothyroidism: Levothyroxine is used- monitoring growth and development & thyroid labs
*children need higher doses than adults

For hyperthyroidism: Methimazole is used-
DONT USE Propylthiouracil (PTU) because it can cause severe liver impairment
DONT USE radioactive agents because it can affect chromosomes in developing cells

For Hypercalcemia: typically only seen in children with cancer (rare)
Bisphosphonates are used- monitor calcium levels

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2
Q

Use of thyroid and parathyroid agents across the lifespan of adults

A

thyroid replacement therapy is lifelong
Hypothyroidism:
Levothyroxine is drug of choice -monitor thyroid labs (for pregnancy/lactation too)

Hyperthyroidism:
Methimazole- bone marrow suppression greater GI and CNS effects
Sodium Iodine should not be used in reproductive years because it can affect fertility
For pregnancy: Propylthiouracil (can cause cretinism in fetus)
^ do not use in lactation

Hypercalcemia:
Osteoporosis -Monitor calcium levels
-Calcium and Vitamin D supplements
For pregnancy: do not use bisphosphates

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3
Q

Use of thyroid and parathyroid agents across the lifespan of older adults

A

a lot of the symptoms f hypothyroidism are also seen as signs of aging

Hypothyroidism:
Screen regularly
Start low go slow
Drug of choice: Levothyroxine - monitor thyroid levels, cardiac effects

Hyperthyroidism:
Drug of choice: Sodium Iodine - it has less adverse effects - monitor for hypothyroidism

Hypercalcemia:
Dietary deficiencies: calcium & vitamin D supplements
Osteoporosis: Bisphosphonates can help move calcium back into the bones
Renal impairment before starting treatment
Monitor calcium levels throughout therapy

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4
Q

Drug class: Thyroid hormones
What are the drug names in this class?

A

-Levothyroxine
-Liothyronin
-Liotrix
-Thyroid desiccated

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5
Q

Drug class: Thyroid hormones
What are the actions?

A

Increases cellular metabolism
*increases oxygen consumption, respirations, heart rate increases rate of fat, protein, and carbohydrates metabolism - ultimately affecting our growth and maturation

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6
Q

Drug class: Thyroid hormones
What are the indications?

A

-Hypothyroidism
-Myxedema coma (severe hypothyroidism that leads to decreased mental status, hypothermia, and other symptoms r/t the slowing of functioning in multiple organs- IS a medical emergency)
-Pituitary TSH suppression in the treatment of euthyroid goiters
-Management of thyroid cancer
-Thyrotoxicosis in conjunction with other therapy

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7
Q

Drug class: Thyroid hormones
What are the contraindications?

A

-Known allergy
-If they’re having an acute heart attack
-Thyrotoxicosis (meds are given in conjunction with other anti-thyroid meds)

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8
Q

Drug class: Thyroid hormones
What are the cautions?

A

Hypoadrenal conditions: Addisons disease because the body can’t handle the drug effects

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9
Q

Drug class: Thyroid hormones
What are the adverse effects?

A

*none if taken in the correct dose
Skin reactions: hair loss (at the beginning of treatment)
Symptoms of hypothyroidism is they’re getting a little bit too much of the drug
Cardiac stimulations: arrhythmias & hypertension
CNS effects: insomnia, anxiety, headache

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10
Q

Drug class: Thyroid hormones
What are the drug-drug interactions?

A

-Oral anticoagulants (increased risk of bleeding)
-Digoxin (decreased digoxin level)
-Theophylline

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11
Q

Thyroid hormones: The nursing process
Assessment:

A

-Hx: allergy, cautions/contraindications like heart attack, hypoadrenal states, thyrotoxicosis, family history (can run in families- more common in females than males)
-Phys: assess skin, orientation and affect, vitals and EKG for cardiac
-Labs: monitoring thyroid function tests

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12
Q

Thyroid hormones: The nursing process
Nursing diagnoses:

A

-Decreased cardiac output r/t cardiac effects
-Imbalanced nutrition: less than body requirements r/t changes in metabolism
-Ineffective tissue perfusion r/t thyroid activity
-Deficient knowledge regarding drug therapy

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13
Q

Thyroid hormones: The nursing process
Implementation:

A

*Administration:
-single day dose 30-60 mins before breakfast each day to keep our therapeutic blood levels consistent
-administer with a full glass of water
-do not administer other drugs at the same time
-monitor response carefully when beginning therapy (esp cardiac response)
-arrange for periodic blood tests
-patient teaching (can take 6 weeks to reach therapeutic levels)

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14
Q

Thyroid hormones: The nursing process
Evaluation:

A

-response to the drug and adverse effects
-effectiveness of teaching plan
-effectiveness of comfort and safety measures
-compliance with regimen

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15
Q

Drug class: Antithyroid agents
What are the drug names in this class?

A

*Thiomides
• Propylthiouracil (PTU)
• Methimazole

*Iodine Solutions
• Strong iodine solution
• Potassium iodide
• Sodium iodide I131 and I123

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16
Q

Drug class: Antithyroid agents
What are the actions?

A

Thiomides action: prevent formation of thyroid hormone within the thyroid cells thus lowering serum levels

Iodine solutions action:
Sodium iodide I131 and I12:
enters thyroid cells and destroys them by giving off radiation

Strong iodine solution & potassium iodide:
high doses saturate the thyroid cells preventing thyroid
hormone formation

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17
Q

Drug class: Antithyroid agents
What are the indications?

A

*Thiomides: hyperthyroidism

*Iodine solutions:

Sodium iodide I131 and I12:
Low dose- diagnosis/ evaluate thyroid function
High dose- hyperthyroidism, radiation emergencies

Strong iodine solution & potassium iodide:
hyperthyroidism, radiation emergencies, suppression
of thyroid gland before surgery, acute thyrotoxicosis

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18
Q

Drug class: Antithyroid agents
What are the contraindications?

A

-Known allergy

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19
Q

Drug class: Antithyroid agents
What are the adverse effects?

A

All: hypothyroidism
Methimazole: bone marrow suppresoon
PTU: severe liver toxicity
Iodine solutions: Iodism (iodine toxicity)

20
Q

Drug class: Antithyroid agents
What are the cautions?

A

PTU: liver impairment

21
Q

Drug class: Antithyroid agents
What are the drug-drug interactions?

A

-Oral anticoagulants (increased bleeding risk)
-Theophylline
-Beta-blockers
-Digoxin

22
Q

Antithyroid agents: Nursing considerations
Assessment:

A

-Hx: allergy, liver impairment
-Phys: assess skin, orientation and affect, vitals and EKG
-Labs: monitor thyroid function tests, CBC for Methimazole because of the bone marrow suppression, liver function and pregnancy for PTU

23
Q

Antithyroid agents: Nursing considerations
Nursing diagnoses:

A

-decreased cardiac output r/t to cardiac effects because were slowing everything down
-imbalanced nutrition: more than body requirements r/t to changes in metabolism
-risk for injury r/t bone marrow suppression
-deficient knowledge regarding drug therapy

24
Q

Antithyroid agents: Nursing considerations
Implementation:

A

• Administer methimazole and PTU three times a day around the clock in order to maintain consistent therapeutic levels in the blood
• Give iodine solution through a straw (can stain teeth); tablets can be crushed.
• Arrange for periodic blood tests
• Assess patients receiving iodine solution for any sign of iodism
(s/s sore mouth, teeth can hurt, burning mouth, gum soreness, headache, confusion, excessive watering of the mouth, metallic taste)
• Provide thorough patient teaching

25
Antithyroid agents: Nursing considerations Evaluation:
• Patient response to drug and adverse effects • Effectiveness of the teaching plan • Effectiveness of comfort and safety measures • Compliance to the regimen
26
Drug class: Antihypocalcemic agents What are the drugs in this class?
• Teriparatide • Parathyroid hormone • Calcitriol (Vitamin D)
27
Drug class: Antihypocalcemic agents What are the actions?
• Stimulation of osteoclasts to release calcium from the bone (goes into our bloodstream and serum calcium levels increase) • Increased intestinal absorption of calcium • Increased calcium resorption from the kidneys (keeps more calcium in the body instead of being urinated out) • Stimulation of cells in the kidney to produce calcitriol • Teriparatide: stimulates new bone formation
28
Drug class: Antihypocalcemic agents What are the indications?
*Low calcium in blood • Management of hypocalcemia in patients undergoing chronic renal dialysis • Treatment of hypoparathyroidism • Teriparatide: treatment of osteoporosis
29
Drug class: Antihypocalcemic agents What are the contraindications?
Absolute: Allergy, Vitamin D toxicity Relative: Hypercalcemia
30
Drug class: Antihypocalcemic agents What are the cautions?
History of renal stones (kidney stones are often made up of calcium- if we increase calcium that can increase renal stones)
31
Drug class: Antihypocalcemic agents What are the adverse effects?
• GI effects: metallic taste, nausea, vomiting, constipation • CNS effects: weakness, headaches, somnolence, irritability
32
Drug class: Antihypocalcemic agents What are the drug-drug interactions?
• Magnesium containing antacids can lead to an increase in magnesium • Digoxin toxicity with hypercalcemia
33
Antigypocalcemic agents: Nursing process Assessment:
• Hx: allergy; hypercalcemia; vitamin toxicity (vitamin D); renal stones • Phys: assess skin, CNS, GI • Labs: serum calcium, magnesium, and alkaline phosphate levels, LFTs • Xrays of bones as appropriate (for breaks)
34
Antigypocalcemic agents: Nursing process Nursing diagnoses:
• Impaired comfort/Acute pain r/t GI or CNS effects • Malnutrition risk: less than body requirements r/t to GI effects • Knowledge deficit
35
Antigypocalcemic agents: Nursing process Implementation:
• Monitor serum calcium levels before and periodically during treatment • Provide comfort and safety measures • Arrange for a nutritional consultation if GI effects are severe • Provide thorough patient teaching
36
Antigypocalcemic agents: Nursing process Evaluation:
• Response to the drug • Adverse effects • Effectiveness of the teaching plan • Effectiveness of comfort and safety measures • Compliance with medication regimen
37
Drug class: Antihypercalcemic agents What are the drugs in this class?
* Bisphosphonates • Etidronate • Ibandronate • Pamidronate • Risedronate • Alendronate *Calcitonins • Calcitonin salmon
38
Drug class: Antihypercalcemic agents What are the actions?
*Bisphosphonates • These drugs act on the serum levels of calcium and not directly on the parathyroid gland or PTH • Inhibits bone resorption (helps lower serum calcium levels- but not inhibit normal bone formation and mineralization) * Calcitonins • Hormones secreted by the thyroid gland to balance the effects of PTH • Inhibits bone resorption (increases excretion of phosphate, calcium, and sodium from the kidneys)
39
Drug class: Antihypercalcemic agents What are the indications?
*Bisphosphates: Indications: osteoporosis, Paget’s disease, hypercalcemia in cance *Calcitonins: Indications: osteoporosis, Paget’s disease, emergency treatment of hypercalcemia
40
Drug class: Antihypercalcemic agents What are the contraindications?
Absolute: • Bisphosphonates- Allergy, hypocalcemia (these drugs lower calcium) • Calcitonins- Allergy to fish Relative: Bisphosphonates- renal dysfunction, GI disease (can exacerbate GI conditions because they’re are on the stomach and esophagus), prolonged use (5 years or more) • Calcitonins- Pregnancy, renal dysfunction, pernicious anemia
41
Drug class: Antihypercalcemic agents What are the adverse effects?
*Bisphosphates- • GI: abd pain, nausea, and diarrhea/constipation • Esophageal erosion • Bone pain with Paget’s disease *Calcitonins- • Flushing of face & hands, skin rash, nausea and vomiting, urinary frequency, local inflammation at injection site
42
Drug class: Antihypercalcemic agents What are the drug-drug interactions?
*giving other drugs at the same time can affect absorption • Bisphosphonates: other meds, aspirin • Calcitonins- None
43
Antihypercalcemic agents: Nursing process Assessment:
-Hx: assess for conditions that are cautions and contraindications -Phys: assess GI, skin, urinary system • Labs: calcium, phosphorus, vitamin D, magnesium levels, renal function
44
Antihypercalcemic agents: Nursing process Nursing diagnoses:
• Impaired comfort/Acute pain r/t GI or skin effects • Malnutrition: less than body requirements r/t GI effects • Knowledge deficit
45
Antihypercalcemic agents: Nursing process Implementation:
*Bisphosphonates: administer on an empty stomach with a full glass of water 30-60 minutes before other food or medication. Remain upright for 30 minutes after administration (can cause esophageal erosions or breakdown if it gets refluxed back up into the esophagus) • Ensure adequate hydration (because of excretion through the kidneys) • Arrange for concomitant vitamin D, calcium supplements, and HRT *Calcitonins: Rotate injection sites and monitor for inflammation • Monitor serum calcium regularly • Arrange for periodic blood tests of renal function • Provide comfort measures (analgesics for bone pain, skin care for injection site irritation) • Provide thorough patient teaching
46
Antihypercalcemic agents: Nursing process Evaluation:
• Patient response to the drug and adverse effects • Effectiveness of the teaching plan, comfort & safety measures • Compliance with medication regimen

Pharm Final (15 decks)

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