Chapters 18, 19, & 21: Drugs for Osteoporosis and Hormonal Problems

Page 1: Introduction

• Overview of the chapters covering drugs for osteoporosis and hormonal issues in women's and men's health.

Page 2: Copyright Information

• Women's Health & Osteoporosis

• Copyright 2022 by Elsevier Inc. All rights reserved.

Page 3: Female Reproductive Functions

• Female sex steroid hormones:

  • Estrogens

  • Progesterone

• Pituitary gonadotropin hormones:

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH)

Page 4: Estrogenic Drugs

• List of Estrogenic Drugs:

  • Conjugated estrogens (Premarin)

  • Esterified estrogens (Estratab)

  • Estradiol transdermal (Estraderm, Climara, Vivelle)

  • Estradiol cypionate (Depo-Estradiol, DepoGen)

  • Estradiol valerate (Delestrogen)

  • Ethinyl estradiol (Estinyl)

  • Estradiol vaginal dosage forms (Vagifem, Estrace Vaginal Cream)

  • Estrone (Estrone Aqueous)

  • Estropipate (Ogen, Ortho-Est)

Page 5: Estrogens: Indications

• Treatment or prevention of disorders caused by estrogen deficiency including:

  • Atrophic vaginitis

  • Hypogonadism

  • Oral contraception (given with a progestin)

  • Uterine bleeding

  • Vasomotor spasms of menopause ("hot flashes")

  • Osteoporosis (treatment and prophylaxis)

  • Palliative treatment for breast or prostate cancer

  • Ovarian failure or castration

Page 6: Estrogens: Contraindications

• Contraindications Include:

  • Drug allergy

  • Any estrogen-dependent cancer

  • Undiagnosed abnormal vaginal bleeding

  • Pregnancy

  • Active thromboembolic disorder or history

Page 7: Estrogens: Adverse Effects

• Adverse Effects Include:

  • Thromboembolic events (most serious)

  • Nausea (most common)

  • Hypertension

  • Thrombophlebitis

  • Edema

  • Vomiting

  • Diarrhea

  • Constipation

  • Abdominal pain

  • Photosensitivity

  • Chloasma

  • Amenorrhea

  • Breakthrough uterine bleeding

  • Tender breasts

  • Fluid retention

  • Headaches

Page 8: Estrogens: Interactions

• Drug Interactions Include:

  • Decrease activity of oral anticoagulants

  • Decrease effect of rifampin

  • Interaction with St. John’s wort

  • Interaction with tricyclic antidepressants

  • Increased effects of smoking

Page 9: Estrogens

• Usage:

  • Indicated for treatment of many clinical conditions resulting from estrogen deficiency.

  • The smallest dosage required to relieve symptoms or prevent the condition is utilized.

Page 10: Progestins: Mechanisms of Action

• Mechanism of Action:

  • Induction of secretory changes in the endometrium

  • Increases basal body temperature

  • Thickening of the vaginal mucosa

  • Relaxation of uterine smooth muscle

  • Stimulation of mammary alveolar tissue growth

  • Feedback inhibition of the release of pituitary gonadotropins

Page 11: Progestins

• Commonly Used Progestins:

  • Hydroxyprogesterone (Hylutin)

  • Levonorgestrel (Plan B)

  • Medroxyprogesterone (Provera, Depo-Provera)

  • Megestrol (Megace)

  • Norethindrone acetate (Aygestin)

  • Norgestrel (Ovrette, Ovral)

  • Progesterone (Prometrium)

  • Etonogestrel implant (Implanon)

Page 12: Progestins: Indications

• Indications for Progestins Include:

  • Treatment of functional uterine bleeding caused by:

  • Hormonal imbalance

  • Fibroids

  • Uterine cancer

  • Treatment of primary and secondary amenorrhea

  • Adjunctive and palliative treatment for some cancers and endometriosis

Page 13: Progestins: Indications (Cont.)

• Additional Indications:

  • Administered alone or with estrogens to prevent conception

  • Prevention of threatened miscarriage

  • Alleviation of premenstrual syndrome symptoms

Page 14: Progestins: Contraindications

• Contraindications for Progestins:

  • Similar to estrogens

  • Includes liver dysfunction, thrombophlebitis, and thromboembolic disorders

Page 15: Progestins: Adverse Effects

• Adverse Effects Include:

  • Liver dysfunction symptoms (cholestatic jaundice)

  • Thrombophlebitis and thromboembolic disorders (like pulmonary embolism (PE))

  • Nausea, vomiting

  • Amenorrhea, spotting

  • Edema, weight gain or loss

  • Others

Page 16: Medroxyprogesterone (Provera, Depo-Provera)

• Mechanisms of Action/Uses:

  • Inhibits secretion of pituitary gonadotropins preventing follicular maturation and ovulation

  • Stimulates mammary tissue growth and has antineoplastic action against endometrial cancer

  • Used to treat uterine bleeding, secondary amenorrhea, endometrial cancer, renal cancer, and contraception

Page 17: Contraceptive Drugs

• Definition:

  • Medications used to prevent pregnancy, with most containing estrogen-progestin combinations.

Page 18: Contraceptive Forms

• Other Forms of Contraceptives:

  • Long-acting injectable forms of medroxyprogesterone

  • Transdermal contraceptive patch

  • Intravaginal contraceptive ring

  • Implantable rods

Page 19: Contraceptive Drugs: Mechanism of Action

• Mechanism:

  • Prevent ovulation by inhibiting the release of gonadotropins and increasing uterine mucus viscosity, which leads to:

  • Decreased sperm movement and fertilization of the ovum

  • Possible inhibition of implantation of a fertilized egg (zygote)

Page 20: Contraceptive Drugs: Other Drug Effects

• Other Effects:

  • Improve menstrual cycle regularity

  • Decrease blood loss during menstruation

  • Decrease incidence of functional ovarian cysts and ectopic pregnancies

Page 21: Contraceptive Drugs: Interactions

• Interactions:

  • Drugs that decrease effectiveness of oral contraceptive drugs include antibiotics (especially penicillins and cephalosporins), barbiturates, isoniazid, and rifampin.

  • Drugs that may have reduced effectiveness when given with oral contraceptives include beta blockers, warfarin, tricyclic antidepressants, and several others.

Page 22: Uterine Stimulants

• Definition:

  • Drugs that alter uterine contractions, used to:

  • Promote labor

  • Prevent the start or progression of labor

  • Reduce risk of postpartum hemorrhage

Page 23: Uterine Stimulants (Cont.)

• Other Names:

  • Also referred to as oxytocics, include:

  • Oxytocin (hormonal drug)

  • Prostaglandins

  • Ergot derivatives

  • Mifepristone (RU-486), a progesterone antagonist

Page 24: Oxytocin (Pitocin)

• Synthetic Form Usage:

  • Induces labor at or near full-term gestation

  • Enhances labor when contractions are weak and ineffective

  • Prevents or controls postpartum uterine bleeding

  • Completes an incomplete abortion (after miscarriage)

  • Promotes milk ejection during lactation

Page 25: Ergot Alkaloids

• Mechanisms:

  • Increase the force and frequency of uterine contractions

  • Used after delivery to prevent postpartum uterine atony and hemorrhage

  • Example: Methylergonovine (Methergine)

Page 26: Uterine Relaxants: Tocolytics

• Usage Information:

  • Used to stop labor that begins before term; generally used after the 20th week of gestation

  • Nonpharmacologic measures: include bed rest, sedation, hydration

Page 27: Uterine Relaxants

• Examples:

  • Indomethacin:

  • Nonsteroidal antiinflammatory agent that inhibits prostaglandin activity

  • Nifedipine:

  • Calcium channel blocker that inhibits myometrial activity by blocking calcium influx

Page 28: Uterine Relaxants (Cont.)

• Administration of Corticosteroids:

  • When indomethacin and nifedipine are ineffective, corticosteroids such as betamethasone or dexamethasone are administered to promote lung maturity in the fetus between 24 and 34 weeks of gestation.

Page 29: Osteoporosis

• Definition:

  • Characterized by low bone mass and increased risk of fractures. Primarily affects women, with 40% of women over 50 years of age expected to develop an osteoporotic fracture. 20% of those affected are men.

Page 30: Osteoporosis: Risk Factors

• Factors contributing to osteoporosis risk include:

  • European or Asian descent

  • Slender body build

  • Early estrogen deficiency

  • Smoking

  • Alcohol consumption

  • Low-calcium diet

  • Sedentary lifestyle

  • Family history

Page 31: Drug Therapy for Prevention of Osteoporosis

• Recommendations:

  • Calcium and vitamin D supplements may be recommended for women at high risk for osteoporosis, especially those older than age 60 years, for bone health.

Page 32: Drug Therapy for Osteoporosis

• List of Drug Therapies Include:

  • Bisphosphonates:

  • Alendronate (Fosamax)

  • Ibandronate (Boniva)

  • Risedronate (Actonel)

  • Zoledronic acid (Reclast)

  • Selective Estrogen Receptor Modulators (SERMs):

  • Raloxifene (Evista)

  • Tamoxifen (Nolvadex)

  • Hormones:

  • Calcitonin (Calcimar)

  • Teriparatide (Forteo) - stimulates bone formation

  • Denosumab (Prolia) - prevents bone resorption

Page 33: Drug Therapy for Osteoporosis (Cont.)

• Bisphosphonates:

  • Inhibit osteoclast-mediated bone resorption, enhancing bone mineral density. Clinical evidence indicates bisphosphonates can reverse lost bone mass and reduce fracture risk.

  • SERMs:

  • Stimulate estrogen receptors on bone and increase bone density.

Page 34: Drug Therapy for Osteoporosis (Cont.)

• Calcitonin (Calcimar):

  • Directly inhibits osteoclastic bone resorption.

• Teriparatide (Forteo):

  • The only drug that stimulates bone formation, a derivative of parathyroid hormone (PTH) with action similar to natural PTH.

Page 35: Drug Therapy for Osteoporosis (Cont.)

• Denosumab (Prolia):

  • Monoclonal antibody that blocks osteoclast activation preventing bone resorption. Administered as a subcutaneous injection once every 6 months along with daily calcium and vitamin D.

Page 36: Drug Therapy for Osteoporosis: Indications

• Indications Include:

  • Raloxifene: prevention of postmenopausal osteoporosis

  • Bisphosphonates: prevention and treatment of osteoporosis

  • Teriparatide: treatment for highest risk subset of osteoporosis patients (e.g., those with prior fractures)

  • Calcitonin: treatment of osteoporosis

Page 37: Drug Therapy for Osteoporosis: Contraindications

• Bisphosphonates:

  • Contraindications include drug allergy, hypocalcemia, esophageal dysfunction, or inability to sit or stand upright for at least 30 minutes after taking the medication.

• SERMs:

  • Contraindicated in women with allergies to these drugs, those who are or may become pregnant, or with venous thromboembolic disorders such as deep vein thrombosis (DVT), PE, or retinal vein thrombosis.

Page 38: Drug Therapy for Osteoporosis: Contraindications (Cont.)

• Calcitonin:

  • Contraindications include drug allergy or allergy to salmon.

• Teriparatide:

  • Contraindications include drug allergy.

• Denosumab:

  • Contraindications include hypocalcemia, renal impairment or failure, and infection.

Page 39: Drug Therapy for Osteoporosis: Adverse Effects

• Adverse Effects for SERMs:

  • Include hot flashes, leg cramps, venous thromboembolism risk, teratogenic effects, and leukopenia.

• Adverse Effects for Bisphosphonates:

  • Headaches, gastrointestinal upset, joint pain, risk of esophageal burns if lodged in esophagus, risk of osteonecrosis of the jaw, severe (incapacitating) bone, joint, or muscle pain.

Page 40: Drug Therapy for Osteoporosis: Adverse Effects (Cont.)

• Calcitonin:

  • Adverse effects include flushing of the face, nausea, diarrhea, and reduced appetite.

• Teriparatide:

  • Adverse effects include chest pain, dizziness, hypercalcemia, nausea, and arthralgia.

• Denosumab:

  • Adverse effects include infections.

Page 41: Alendronate (Fosamax)

• Drug Profile:

  • Oral bisphosphonate; first nonestrogen nonhormonal option for preventing bone loss.

  • Inhibits or reverses osteoclast-mediated bone resorption.

  • Indications include prevention and treatment of osteoporosis in men and postmenopausal women, treatment of glucocorticoid-induced osteoporosis in men, and treatment for Paget disease in women.

Page 42: Raloxifene (Evista)

• SERM Profile:

  • Primary use for prevention of postmenopausal osteoporosis.

  • Adverse effect includes hot flashes.

Page 43: Nursing Implications

• Initial Assessment:

  • Assess baseline vital signs, weight, blood glucose levels, and renal and liver function.

  • Assess smoking history.

  • Assess history and medication history including contraindications, especially regarding potential pregnancy.

Page 44: Nursing Implications (Cont.)

• Before Uterine Stimulants Administered:

  • Assess mother’s vital signs and fetal heart rate.

  • Note that uterine relaxants are used for premature labor between 20 and 37 weeks of gestation.

Page 45: Nursing Implications (Cont.)

• Administration of Bisphosphonates:

  • Ensure patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose.

Page 46: Nursing Implications (Cont.)

• Instructions for Bisphosphonates:

  • Instruct patients to take the medication upon rising in the morning, with a full glass of water, and 30 minutes before eating.

  • Emphasize that patients should remain upright for at least 30 minutes after taking the medication.

Page 47: Nursing Implications (Cont.)

• Instructions for SERMs:

  • Instruct patients to discontinue medication 72 hours prior to and during any prolonged immobility (e.g., surgery or long travel).

Page 48: Men's Health

• Overview and copyright information for subsequent sections of the notes on Men's Health focusing on androgen usage, treatments, and implications in health issues.

Page 49: Androgens

• Definition and Functions:

  • Androgens are primarily male sex hormones, with testosterone being the most prominent.

  • Functions include normal development and maintenance of primary and secondary male sex characteristics, development of bone and muscle tissue, inhibition of protein catabolism, retention of electrolytes, and stimulation of blood cell production.

Page 50: Anabolic Steroids

• Classification:

  • Anabolic steroids exhibit anabolic activity, promoting tissue synthesis and increasing tissue formation.

  • Schedule III substances due to their potential for misuse by athletes, including drugs like: Oxymetholone (Anadrol-50), Oxandrolone (Oxandrin), and Nandrolone (Deca-Durabolin).

Page 51: Anabolic Steroids: Approved Indications

• Indications for Use:

  • Adjunctive therapy to promote weight gain post extensive surgery, trauma, chronic diseases, anemia, hereditary angioedema, and metastatic breast cancer.

Page 52: Anabolic Steroids: Misuse Potential

• Concerns:

  • Great potential for misuse, especially among bodybuilders and weightlifters due to muscle-building properties.

  • Serious consequences can include sterility, cardiovascular diseases, and liver cancer.

  • Recognized as Schedule III controlled substances by the U.S. Drug Enforcement Administration, leading to potential psychological or physical dependence.

Page 53: Androgen Inhibitors

• Mechanism:

  • Block the effects of endogenous androgens.

  • Example: 5-Alpha reductase inhibitors such as Finasteride and Dutasteride used in the treatment of benign prostatic hyperplasia (BPH).

Page 54: Clinical Effects of Androgen Inhibitors

• Clinical Effects:

  • 5-Alpha reductase inhibitors have immediate clinical effects of prostate shrinkage, while effects may take up to 6 months with continuous therapy.

Page 55: Finasteride (Propecia)

• Usage and Considerations:

  • Indicated for male pattern baldness but not for treatment of female baldness due to teratogenic risks.

  • Women of any age, particularly pregnant women, should not use finasteride, and gloves should be worn when handling the drug.

Page 56: Alpha1-Adrenergic Blockers

• Usage:

  • Provide symptomatic relief of obstruction caused by BPH with examples including Doxazosin (Cardura), Tamsulosin (Flomax), Terazosin (Hytrin), Alfuzosin (Uroxatral), and Silodosin (Rapaflo).

Page 57: Drugs to Treat Erectile Dysfunction

• PDE Inhibitors:

  • Used in the treatment of erectile dysfunction (ED) include:

  • Sildenafil (Viagra), the first oral drug for ED, which relaxes smooth muscle in the penis, allowing inflow of blood.

Page 58: ED Drug Comparisons

• Other PDE Inhibitors:

  • Vardenafil (Levitra), Tadalafil (Cialis), Avanafil (Stendra) - similar to sildenafil but offer longer durations of action.

  • Sildenafil and Tadalafil are also indicated for pulmonary hypertension.

Page 59: Men’s Health Drugs: Contraindications

• Contraindications Overview:

  • Known androgen-responsive tumors

  • ED drugs contraindicated in men with major cardiovascular disorders, especially when using nitrates like nitroglycerin.

  • Finasteride is contraindicated in women (especially pregnant) and children.

Page 60: Men’s Health Drugs: Adverse Effects

• Adverse Effects Overview:

  • Androgens may cause fluid retention and thromboembolic disorders.

  • Anabolic steroids can lead to hepatic complications such as peliosis of the liver, hepatic neoplasms, cholestatic hepatitis, and jaundice.

Page 61: Priapism

• Definition and Medical Emergency:

  • Priapism is the abnormally prolonged penile erection, a potential adverse effect of both ED drugs and androgens, which requires urgent medical attention.

Page 62: ED Drugs Adverse Effects

• Visual and Sexual Dysfunction:

  • PDE inhibitors may cause unexplained visual loss; Finasteride may lead to loss of libido, erection, ejaculatory dysfunction, hypersensitivity reactions, gynecomastia, severe myopathy, and significant decrease in prostate-specific antigen (PSA) concentrations.

Page 63: Drug Interactions

• Diabetes Medication Concerns:

  • Androgens may affect the activity of oral anticoagulants, cyclosporine causing increased toxicity.

  • ED drugs may lead to severe hypotension when taken with nitrates.

Page 64: Additional Interactions

• Alpha Blocker Concerns:

  • Alpha blockers may have additive hypotension effect with other blood pressure-lowering drugs.

  • Effects of tamsulosin may be increased when taken with azole antifungals and cardiac drugs.

Page 65: Nursing Implications

• Administration Techniques:

  • Follow exact instructions for sublingual, buccal, and oral forms.

  • Transdermal Testoderm patches are applied to scrotal skin; Transdermal Androderm patches are for skin other than scrotal.

Page 66: Nursing Implications (Cont.)

• Pregnancy Safety:

  • Pregnant women should not touch crushed or broken hormone drugs.

  • Educate patients on proper administration techniques for each drug, monitor responses and adverse effects.

Page 67: Endocrine Drugs

• Introduction and copyright details for subsequent sections.

Page 68: Endocrine System Overview

• Main Goal:

  • Physiologic stability; every cell and organ influenced by the endocrine system.

  • Hormones:

  • Chemical language of the endocrine system, natural substances secreted into the bloodstream to act on target sites.

Page 69: Neuroendocrine System

• Components:

  • Hypothalamus: Part of the central nervous system

  • Pituitary Gland:

  • Anterior pituitary (adenohypophysis)

  • Posterior pituitary (neurohypophysis)

  • Governs bodily functions via hormones and negative feedback.

Page 70: Negative Feedback Loop

• Functionality:

  • Regulates endocrine system activity through a system of surveillance and signaling based on the body’s ongoing needs; hormone secretion commonly regulated by a negative feedback loop.

Page 71: Anterior Pituitary Drugs

• Hydrocortisone (Cortef):

  • Drug form of cortisol with anti-inflammatory effects, promotes renal retention of sodium leading to edema and hypertension.

Page 72: Anterior Pituitary Drugs (Cont.)

• Cosyntropin (Cortrosyn):

  • Stimulates cortisol release from adrenal cortex and aids in diagnosing adrenocortical insufficiency.

  • Contributes to renal retention of sodium, leading to edema and hypertension.

Page 73: Anterior Pituitary Drugs (Cont.)

• Growth Hormone Therapies:

  • Somatropin and Somatrem: Recombinantly made growth hormones that stimulate skeletal growth in deficient patients.

  • Octreotide (Sandostatin):

  • Reduces severe diarrhea and hypotension during carcinoid crises.

Page 74: Posterior Pituitary Drugs

• Vasopressin and Desmopressin:

  • Mimic antidiuretic hormone, increasing water resorption in nephrons, reducing urine excretion by up to 90%, used in treating diabetes insipidus.

Page 75: Vasopressin Uses

• Functions:

  • Potent vasoconstrictor used in hypotensive emergencies and Advanced Cardiac Life Support (ACLS) scenarios, also to stop bleeding of esophageal varices.

Page 76: Desmopressin Uses

• Management Features:

  • Dose-dependent increases in plasma levels of factor VIII and von Willebrand factor aiding in management of nocturnal enuresis.

Page 77: Nursing Implications for Octreotide

• Monitoring and Usage:

  • May impair gallbladder function; instruct patient to report abdominal pain; also monitor blood glucose levels.

Page 78: General Nursing Implications

• Guidelines for Patient Care:

  • Provide instructions for nasal spray forms; rotate injection sites; do not discontinue drugs abruptly; be careful with OTC products; monitor child's growth with GHs.

Page 79: Monitoring Therapeutic Responses

• Expected Outcomes:

  • Monitoring for effectiveness of somatropin, desmopressin, and vasopressin through symptom relief; monitor for adverse effects.

Page 80: Thyroid Disorders Overview

• Key Components:

  • TRH - Thyroid Hormones - TSH - Calcitonin - T4 - T3 - Feedback loop with hypothalamus and pituitary gland.

Page 81: Thyroid Gland Function

• Hormones Secreted:

  • Thyroxine (T4), Triiodothyronine (T3), and Calcitonin are essential for metabolism regulation.

Page 82: Hypothyroidism

• Classification:

  • Primary: Abnormality in the thyroid gland itself.

  • Secondary: Dysfunctional pituitary gland not secreting TSH.

  • Tertiary: Dysfunctional hypothalamus not secreting TRH.

Page 83: Hypothyroidism Types

• Congenital Hypothyroidism (Cretinism):

  • Hyposecretion during youth leads to low metabolic rate and potential mental stunting.

• Myxedema:

  • Hyposecretion during adulthood leads to decreased metabolic rate and other symptoms.

Page 84: Hypothyroidism (Cont.)

• Goiter Formation:

  • Enlargement of the thyroid gland that results from overstimulation by elevated TSH due to lack of circulating thyroid hormones.

Page 85: Hashimoto’s Disease

• Overview:

  • Chronic autoimmune disease affecting the thyroid, resulting in lower-than-normal hormone levels and potentially linked to genetics.

Page 86: Common Symptoms of Hypothyroidism

• Symptoms include thickened skin, hair loss, constipation, lethargy, and anorexia.

Page 87: Hyperthyroidism

• Causes and Definitions:

  • Caused by several diseases including Graves’ disease, multinodular disease, Plummer’s disease, and thyroid storm.

Page 88: Effects of Hyperthyroidism

• Affects multiple body systems with increased metabolism leading to symptoms like diarrhea, flushing, increased appetite, and fatigue.

Page 89: Treatment of Hyperthyroidism

• Methods Include:

  • Radioactive iodine (I131) which destroys the thyroid gland or surgery to remove part/all of it, followed by lifelong hormone replacement.

Page 90: Antithyroid Drugs

• Examples of Antithyroid Drugs:

  • Methimazole (Tapazole), propylthiouracil, radioactive iodine, and potassium iodine for treating hyperthyroidism.

Page 91: Thyroid Replacement Drugs

• Examples:

  • Levothyroxine (Synthroid, Levoxyl) - synthetic T4,

  • Liothyronine (Cytomel) - synthetic T3,

  • Liotrix (Thyrolar) - combined T3 and T4.

Page 92: Thyroid Replacement Drugs: Mechanism

• Mechanism of Action:

  • Thyroid preparations replace what the thyroid gland cannot produce to achieve normal levels (euthyroid).

Page 93: Thyroid Replacement Drugs: Indications

• Indications Include:

  • Replace thyroid hormones for euthyroid condition, diagnosis of suspected hyperthyroidism, prevent/treat goiters or surgical removal aftermath.

Page 94: Thyroid Replacement Drugs: Indications (Cont.)

• Additional Indications:

  • Hormonal replacement for patients with surgically removed or destroyed thyroid glands; hypothyroidism during pregnancy.

Page 95: Thyroid Replacement Drugs: Adverse Effects

• Adverse Effects Include:

  • Most significant is cardiac dysrhythmia, along with tachycardia, palpitations, insomnia, and other physical symptoms.

Page 96: Levothyroxine (Synthroid)

• Profile:

  • Most commonly prescribed synthetic thyroid hormone, given daily on an empty stomach for optimal absorption.

Page 97: Antithyroid Drugs Overview

• Function:

  • Used to treat hyperthyroidism and prevent surges in thyroid hormones post-surgery or radioactive iodine treatment.

Page 98: Antithyroid Drugs: Mechanism

• Mechanism of Action:

  • Methimazole and propylthiouracil inhibit iodine incorporation into tyrosine, impeding the formation of T3 and T4; PTU also inhibits the conversion of T4 to T3.

Page 99: Antithyroid Drugs: Indications

• Indications:

  • Treat hyperthyroidism and prevent thyroid hormone surges post-treatment.

Page 100: Antithyroid Drugs: Adverse Effects

• Serious Adverse Effects:

  • Liver and bone marrow toxicity are the most serious risks associated with antithyroid medications.

Page 101: Propylthiouracil (PTU)

• Usage Notes:

  • A thioamide antithyroid; may take up to 2 weeks for symptoms to improve.

Page 102: Antithyroid Drugs: Nursing Implications

• Considerations:

  • Assess allergies, contraindications, initiate baseline vital signs, weight checks, and cautious use in cardiac disease or pregnancy contexts.

Page 103: Nursing Implications (Cont.)

• During Pregnancy:

  • Treat hypothyroidism continuously, adjusting dosages regularly to ensure maternal health and fetal growth.

Page 104: Nursing Implications (Cont.)

• Instructions for Patients:

  • Teach to take thyroid drugs in the morning to avoid insomnia; maintain brand consistency for medication.

Page 105: Thyroid Crisis (Thyroid Storm)

• Definition:

  • Life-threatening exacerbation of hyperthyroidism, often triggered by stress or infection; assess for potential causes.

Page 106: Nursing Implications (Cont.)

• Education for Patients:

  • Emphasize reporting unusual symptoms and not to take OTC medications without prior approval.

  • Understand therapeutic effects may take time to develop.

Page 107: Nursing Implications (Cont.)

• Awareness of Interactions:

  • Alert healthcare providers about thyroid medications; they may influence anticoagulant effectiveness.

Page 108: Nursing Implications (Cont.)

• Antithyroid Medications:

  • Better tolerated with food, taken consistently, and avoid iodine-rich foods.

Page 109: Monitoring Outcomes

• Expected Responses:

  • Monitor for therapeutic outcomes—decreased hypothyroid symptoms or evidence of hyperthyroidism with antithyroid medications; adverse effect monitoring crucial.

Page 110: Symptom Comparison

• Hyperthyroidism Symptoms:

  • Weight loss, increased appetite, heat intolerance, tachycardia.

• Hypothyroidism Symptoms:

  • Weight gain, decreased appetite, cold intolerance, bradycardia, fatigue, depression.

Page 111: Homework

• Study Guide:

  • Read Chapter and learn specified content as instructed.