PHARM EXAM 3 MASTER

What is the goal of thyroid replacement?

Euthyroid

What is the dose goal for thyroid replacement?

Lowest possible dose

What is the source of levothyroxine?

Synthetic

What is the half-life of levothyroxine?

7 days

What is the source of desiccated thyroid?

Bovine

Which hormone does levothyroxine contain?

T4

Which hormones does desiccated thyroid contain?

T3 and T4

What is the source of liothyronine?

Synthetic

Which hormone does liothyronine contain?

T3

How is liothyronine administered?

IV

What is liothyronine used to treat?

Myxedema coma

What is the mechanism of action of thyroid replacement hormones?

Stimulate metabolism in nearly all body tissues

Why can levothyroxine not have a loading dose?

Cardiovascular implications

What percent protein bound are thyroid replacement hormones?

99

What can lack of binding sites in the elderly contribute to with thyroid replacement?

Toxicity

What are s/sx of a dose of thyroid replacement that is too high?

Hyperthyroidism: insomnia, unexplained weight loss

What nursing assessment should be done before administering every dose of thyroid replacement?

Apical pulse for 60 seconds

Which vitals and labs should be monitored for a patient on thyroid replacement?

Weight, TSH, T4

When should patients take levothyroxine?

In the morning on an empty stomach

What are the three classes of treatment for hyperthyroidism?

Antithyroid drugs, iodine preparations, and surgery

Which hyperthyroidism treatment is used short term to prevent thyroid storm?

Antithyroid drugs

How do antithyroid drugs decrease thyroid levels?

By decreasing vascularity and blood flow which decreases hormone synthesis and release

Which drug is used to inhibit the synthesis of new thyroid hormone?

Methimazole

Which antithyroid drug is more likely to cause birth defects?

Methimazole

Which antithyroid drug inhibits the synthesis of new thyroid hormones and prevents the conversion of T4 into T3 in peripheral tissue?

Propylthiouracil (PTU)

What is the black box warning on PTU for?

Liver damage

When is PTU used?

When other treatments fail and/or during the first trimester of pregnancy

What is the adverse effect associated with both antithyroid drugs?

Potentially fatal granulocytopenia

Which hyperthyroidism treatments is contraindicated during pregnancy?

Radioactive iodine

Which hyperthyroidism treatment can cause hypothyroidism during pregnancy?

Lugol’s solution

What are important patient education points for antithyroid drugs?

Take with a meal or snack, report fever or other s/sx of infection

What sort of iodine levels interfere with thyroid hormone synthesis?

High

What are the two types of iodine preparations?

Non-radioactive iodine (potassium iodide/Lugol’s solution) or Radioactive iodine (RAI-131)

What are side effects of non-radioactive iodine?

Metallic taste, GI upset, teeth staining

What are side effects of RAI-131?

Radioactivity for 11 days, sore throat

What are radioactivity precautions?

All bodily fluids are radioactive, private room, disposable everything, avoid contact with children, pregnant people, and kids

What must nurses caring for radioactive patients wear?

A tracer

What should patients be taught when taking RAI-131?

Double flush after using the restroom

What are low doses of RAI-131 used for?

Diagnostic RAI uptake test

What are large doses of RAI-131 used for?

Thyroid ablation

What is the most common iodine treatment in the US?

RAI-131

What stimulates the adrenal cortex?

ACTH from the anterior pituitary

What is the treatment for Addison’s disease?

Replacement of cortical hormones

What are the actions of glucocorticoids?

Suppression of histamine release, suppression of immune response

What are the indications for glucocorticoids?

Severe inflammation, autoimmune disorders, transplant rejection prevention, cerebral edema, adjuvant therapy for some cancers, replacement for adrenal insufficiency/Addison’s

What are examples of short active glucocorticoids?

Cortisone, hydrocortisone

What are examples of intermediate acting glucocorticoids?

Prednisone, methylprednisolone

What are examples of long acting glucocorticoids?

Betamethasone, dexamethasone

Which disease process do the adverse effects of glucocorticoids mimic?

Cushing’s

What are the “cushingoid” side effects associated with the GI system?

Ulcers, gastric bleeding

What are the “cushingoid” side effects associated with the immune system?

Immunosuppression

What are the “cushingoid” side effects associated with the metabolic system?

Steroid-induced hyperglycemia, glycosuria

What are the “cushingoid” side effects associated with fat distribution?

Weight gain, moon face, buffalo hump

What are the “cushingoid” side effects associated with bones?

Osteoporosis, femoral head necrosis

What are the “cushingoid” side effects associated with the skin and hair?

Striae, thinning, bruising, hirsutism

What are the “cushingoid” side effects associated with the eyes?

Cataracts

What are the “cushingoid” side effects associated with the cardiovascular system?

HTN, cardiovascular collapse with sudden withdrawl

How is Cushing’s treated?

Tumor removal or dose adjustment

When are glucocorticoids given?

In the morning with food

Which labs are monitored for patients on glucocorticoids?

CBC, BMP

How are glucocorticoid doses adjusted during periods of stress?

Increased and then tapered

What should patients be taught to report while taking glucocorticoids?

Black tarry stools and s/sx of infection

What is the main mineralocorticoid?

Aldosterone

Which disease impacts the production of aldosterone?

Addison’s

Which medication is used to treat Addison’s disease?

Fludrocortisone

What is fludrocortisone?

Synthetic aldosterone

How does fludrocortisone help maintain fluid balance?

By causing sodium reabsorption and conservation in the kidney tubule and eliminating potassium

What are the s/sx associated with a fludrocortisone dose that is too low?

Low BP, dehydration

What are the s/sx associated with a fludrocortisone dose that is too high?

Weight gain, edema, SOB

Which labs should be monitored for a patient on fludrocortisone?

Sodium & potassium

What should patients be taught to do while taking fludrocortisone?

Eat a potassium-rich diet and avoid high-sodium foods

Which medication is used to treat GH deficiency?

Somatotropin

To whom and how is somatotropin given?

By injection to children who aren’t growing enough

Which medication is used to treat GH excess?

Octreotide

What is octreotide?

Synthetic somatostatin

To whom and how is octreotide given?

SubQ to patients with acromegaly or severe watery diarrhea

Which adverse effect can exogenous GH precipitate because of it’s impact on glucose metabolism?

Diabetes mellitus

What is DDAVP also called?

Desmopressin

What is DDAVP?

Synthetic ADH

What is the most common route of DDAVP?

Intranasal

How is vasopressin given?

Parenterally

What is vasopressin used for?

Raise BP in patients in CV collapse

What are indications for DDAVP?

DI, bedwetting, Von Willebrand disease

What are adverse affects of DDAVP?

FLuid retention, hyponatremia

What should nurses do with intranasal DDAVP?

Alternate nares, monitor specific gravity of urine

What should patients be taught with intranasal DDAVP?

Report congestion, don’t give it lying down or with head back, monitor voiding, report specific gravity outside of normal limits

How many voids per day is the goal for patients on DDAVP?

4-8

How is SIADH treated?

Fluid restriction, adjust DDAVP if needed, treat underlying cause, demeclocycline, hypertonic saline

Which classes of drugs are used to treat metabolic bone disorders?

Calcium & vitamin D supplements, bisphosphonates, calcitonins, SERMs