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Pharmacology Exam #3 > Thyroid and Parathyroid Agents > Flashcards

Thyroid and Parathyroid Agents Flashcards

1
Q

What are the functions of the thyroid gland?

A
  • Regulate rate of metabolism
  • Affect heat production and body temperature
  • Affect oxygen consumption, cardiac output, and blood volume
  • Affect enzyme system activity
  • Affect metabolism of carbohydrates, fats, and proteins
  • Regulate growth and development
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2
Q

What nutrient is essential to help produce thyroid hormones?

A

Iodine

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3
Q

Hypothyroidism
Causes, S/S

A

Causes:
* Absence of a thyroid gland
* Lack of sufficient iodine in the diet to produce the needed level of thyroid hormone
* Lack of sufficient functioning thyroid tissue due to a tumor or autoimmune disorders
* Lack of TRH related to tumor or disorder of the hypothalamus
* Lack of TSH due to pituitary disease

Signs and Symptoms:
* vague
* weight gain
* extreme fatigue
* decreased body temperature
* dry skin
* muscle aches and weakness
* constipation
* intolerance to cold
* Bradycardia

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4
Q

Hyperthyroidism
Causes and S/S

A

Causes:
* Excessive amounts of thyroid hormones usually caused by Grave’s Disease

Signs and Symptoms:
* Increased body temperature
* Tachycardia
* Bulging Eyes
* Facial Flushing
* Diarrhea
* Tremors
* Increased SBP
* Weight Loss
* Muscle Wasting

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5
Q

Lifespan considerations for Thyroid and Parathyroid Agents
In Children

A

Hypothyroidism
* USE: Levothyroxine
* Higher doses
* Monitor thyroid labs
* Monitor Growth and Development

Hyperthyroidism:
* USE: Methimazole
* DON’T USE: Propylthiouracil, Radioactive agents

Hypercalcemia:
* Rare
* USE: Biphosphonates
* Monitor Calcium levels

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6
Q

Lifespan considerations for Thyroid and Parathyroid Agents
In Adults

A

Hypothyroidism:
* Lifelong
* Monitor thyroid levels
* Pregnancy & Lactation: USE: Levothyroxine

Hyperthyroidism:
* Side effects worse with Methimazole
* Sodium Iodide can affect fertility
* Pregnancy: USE Propylthiouracil
* Do NOT use in lactation

Hypercalcemia:
* Osteoporosis
* Monitor calcium levels
* Calcium and Vitamin D supplements
* Pregnancy: Do not use biphosphonates

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7
Q

Lifespan considerations for Thyroid and Parathyroid Agents
In Older Adults

A

Hypothyroidism:
* Screen regularly
* Start low and go slow
* USE: Levothyroxine
* Monitor response: thyroid levels, cardiac effects

Hyperthyroidism:
* USE: Sodium Iodide (less adv. effects)
* Monitor for hypothyroidism

Hypercalcemia:
* Dietary deficiencies: Calcium and Vit. D. supplements
* Osteoporosis: Biphosphonates
* Renal Impairment
* Monitor calcium levels

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8
Q

Thyroid Hormones
Drug Names

A

Levothyroxine
Liothyronine
Liotrix
Thyroid Desiccated

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9
Q

Thyroid Hormones
Mechanism of Action

A
  • Increases cellular metabolism in all areas of the body
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10
Q

Thyroid Hormones
Indications

A
  • Hypothyroidism
  • Myxedema coma: severe hypothyroidism
  • Pituitary TSH suppression in the treatment of euthyroid (normal thyroid) goiters
  • Management of thyroid cancer
  • Thyrotoxicosis in conjunction with other therapy
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11
Q

Thyroid Hormones
Contraindications

A

Absolute:
* Allergy

Relative:
* Acute MI
* Thyrotoxicosis - never use by itself

Caution:
* Hypoadrenal conditions

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12
Q

Thyroid Hormones
Adverse Effects

A
  • NONE in correct dose
  • Rare: Hair loss
  • Symptoms of hyperthyroidism
  • Cardiac stimulation
  • CNS effects
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12
Q
A
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13
Q

Thyroid Hormones
Drug Interactions

A
  • Oral anticoagulants: inc. risk of bleeding
  • Digoxin: decreased dig levels
  • Theophylline: decreased clearance of theophylline w/hypothyroidism - may need to increase theophylline as thyroid hormone levels increase
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14
Q

Thyroid Hormones
Assessment

A

History:
* Check for allergy, family history, acute MI, thyrotoxicosis, and hypoadrenal conditions

Physical:
* Skin
* CNS
* Vitals
* ECG

Labs:
* Thyroid hormone levels

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15
Q

Thyroid Hormones
Nursing Diagnoses

A
  • Altered Cardiac Output (r/t cardiac effects)
  • Malnutrition risk: less than body requirements (r/t changes in metabolism)
  • Altered tissue perfusion (r/t thyroid activity)
  • Knowledge Deficit
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16
Q

Thyroid Hormones
Implementation/Patient Teaching

A
  • Single daily dose
  • Administer 30-60 minutes BEFORE breakfast
  • Administer with a full glass of water
  • Do not administer other drugs at the same time
  • Labs 6 weeks after beginning therapy
  • Monitor response closely - especially cardiac response
  • Takes several weeks to take effect
  • Arrange for periodic blood tests
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17
Q

Antithyroid Agents
Drug Names

A

Thiomides:
* Propylthiouracil (PTU)
* Methimazole

Iodine Solutions:
* Stong iodine solution
* Potassium iodide
* Sodium iodide I(131) and I(132)

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18
Q

Antithyroid Hormones
Mechanism of Action

A

Thiomides
* Prevents formation of thyroid hormone within the thyroid cells

Sodium Iodide I(131) and I(132)
* Enters thyroid cells and destroys them by giving off radiation

Strong iodine solution and potassium iodide
* High doses saturate the thyroid cells preventing thyroid hormone formation

19
Q

Antithyroid Hormones
Indications

A

Thiomides:
* Hyperthyroidism

Sodium Iodide I(131) and I(132):
* Low Dose: Diagnosis/evaluation of thyroid function
* High Dose: Hyperthyroidism, radiation emergencies

Strong iodine solution & Potassium Iodide:
* Hyperthyroidism
* Radiation emergencies
* Suppression of thyroid gland before surgery
* Acute thyrotoxicosis

20
Q

Antithyroid Hormones
Contraindications

A

Absolute:
* Allergy

Caution:
* PTU: Liver Impairment

21
Q

Antithyroid Hormones
Adverse Effects

A
  • ALL: Hypothyroidism
  • Methimazole: Bone marrow suppression
  • PTU: Severe liver toxicity
  • Iodine Solutions: Iodism
22
Q

Antithyroid Hormones
Drug Interactions

A
  • Oral anticoagulants
  • Theophylline
  • Beta-Blockers
  • Digoxin
23
Q

Antithyroid Hormones
Assessment

A

History:
* Check for allergy, liver impairment

Physical:
* Skin
* CNS
* Vitals
* ECG

Labs:
* Thyroid function, CBC, liver function, pregnancy test

24
**Antithyroid Hormones** Nursing Diagnoses
* Altered cardiac output * Malnutrition risk: More than body requirements * Injury Risk/infection and bleeding risk * Knowledge deficit
25
**Antithyroid Hormones** Implementation/Patient Teaching
* Administer Methimazole and PTU three times a day around the block * Give iodine solution through a straw: tablets can be crushed * Arrange for periodic blood tests * Assess patients receiving iodine solution for any sign of iodism (sore mouth)
26
What is Hypoparathyroidism?
* The absence of parathormone (Parathyroid hormone) * Most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery
27
What is Hyperparathyroidism?
* The excessive production of parathormone * Can occur as a result of a parathyroid tumor or certain genetic disorders
28
What two hormones regulate calcium in the body?
* Calcitonin (from the thyroid): released in response to HIGH serum calcium levels * Parathyroid Hormone (from the parathyroid): Released in response to LOW serum calcium levels
29
**AntiHYPOcalcemic Agents** Mechanism of Action
**Raises Calcium levels in the blood** * Stimulates osteoclasts to release calcium from the bone * Increases intestinal absorption of calcium * Increases calcium resorption from the kidneys * Stimulates cells in the kidney to produce calcitriol (Vitamin D3) * **Teriparatide:** stimulates new bone formation
30
**AntiHYPOcalcemic Agents** Indications
**Low calcium in the blood** * Management of hypocalcemia in patients undergoing chronic renal dialysis * Treatment of hypoparathyroidism * **Teriparatide:** treatment of osteoporosis
31
**AntiHYPOcalcemic Agents** Drug Names
**Teriparatide** **Parathyroid Hormone** **Calcitriol (Vitamin D)**
32
**AntiHYPOcalcemic Agents** Contraindications
**Absolute:** * Allergy * Vitamin D toxicity **Relative:** * Hypercalcemia **Caution:** * History of renal stones
33
**AntiHYPOcalcemic Agents** Adverse Effects
* GI effects: N/V, constipation * CNS effects: somnolence, irritability
34
**AntiHYPOcalcemic Agents** Drug Interactions
* Magnesium containing antacids * Digoxin
35
**AntiHYPOcalcemic Agents** Assessment
**History:** * Check for allergy, vit. D toxicity, hypercalcemia, kidney stones **Physical:** * Skin * CNS * GI **Labs:** * Serum calcium levels * Serum magnesium levels * Alkaline phosphate levels * Liver function tests * Xrays of the bones as appropriate
36
**AntiHYPOcalcemic Agents** Diagnoses/Conclusions
* Impaired Comfort/Acute Pain * Malnutrition Risk: Less than body requirements * Knowledge Deficit
37
**AntiHYPOcalcemic Agents** Implementation/Patient Teaching
* Monitor serum calcium levels * Provide comfort and safety measures * Arrange for nutritional consult
38
**AntiHYPERcalcemic Agents** Mechanism of Action
**Biphosponates:** * Act on the serum levels of calcium and NOT directly on the parathyroid gland or PTH * Inhibits bone resorption **Calcitonins:** * Hormones secreted by the thyroid gland to balance the effects of PTH * Inhibits bone resorption
39
**AntiHYPERcalcemic Agents** Indications
**Biphosphonates:** * Osteoporosis * Paget's Disease * Hypercalcemia in cancer **Calcitonins:** * Osteoporosis * Paget's Disease * Emergency treatment of hypercalcemia
40
**AntiHYPERcalcemic Agents** Drug names
**Biphosphonates:** * Etidronate * Ibandronate * Pamidronate * Risedronate * Alendronate **Calcitonins:** * Calcitonin salmon
41
**AntiHYPERcalcemic Agents** Contraindications
**Absolute:** * **Biphosphonates:** allergy, hypocalcemia * **Calcitonins:** allergy to fish **Relative:** * **Biphosphonates:** Renal dysfunction, GI disease, prolonged use * **Calcitonins:** Pregnancy, renal dysfunction, pernicious anemia
42
**AntiHYPERcalcemic Agents** Adverse Effects
**Biphosphonates:** * GI: abdominal pain, nausea, diarrhea/constipation * Esophageal erosion * Bone pain with Paget's disease **Calcitonins:** * Flushing of face and hands * Skin rash * Nausea and vomiting * Urinary frequency * Local inflammation at injection site
43
**AntiHYPERcalcemic Agents** Drug Interactions
**Biphosphonates:** * Other meds, aspirin **Calcitonins:** * None
44
**AntiHYPERcalcemic Agents** Assessment
**History:** * Check for allergy, hypocalcemia, allergy to fish, renal dysfunction, GI disease, pregnancy, pernicious anemia **Physical:** * GI * Skin * Urinary System **Labs:** * Calcium, phosphorous, Vitamin D, magnesium levels * Renal function tests
45
**AntiHYPERcalcemic Agents** Nursing Diagnoses/Conclusions
* Impaired Comfort/Acute Pain * Malnutrition: less than body requirements * Knowledge Deficit
46
**AntiHYPERcalcemic Agents** Implementation
**Biphosphonates:** * Administer on an EMPTY stomach with a FULL glass of water * 30-60 minutes before other food or medication * Stay upright for 30 minutes after administration * Ensure adequate hydration * Arrange for concomitant Vitamin D, calcium supplements, and HRT **Calcitonins:** * Rotate injection sites and monitor for inflammation *** * Monitor calcium levels regularly * Arrange for periodic blood tests of renal function

Pharmacology Exam #3 (14 decks)

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