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Drugs for Osteoporosis and Hormonal Problems

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

Page 1: Introduction

  • Focus: Overview of drugs related to osteoporosis and hormonal issues, specifically targeting Female Health.

Page 2: 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 Overview

  • Types of Estrogens:

    • 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

  • Conditions treated or prevented by Estrogens:

    • Atrophic vaginitis

    • Hypogonadism

    • Oral contraception (with a progestin)

    • Uterine bleeding

    • Vasomotor spasms of menopause (“hot flashes”)

    • Osteoporosis (treatment and prophylaxis)

    • Breast or prostate cancer (palliative treatment)

    • 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:

    • 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:

    • Decrease the activity of oral anticoagulants

    • Decrease the effect of rifampin

    • Interaction with St. John's wort

    • Tricyclic antidepressants

    • Smoking

Page 9: Estrogens: Administration Guidelines

  • General administration principle:

    • Use the smallest dosage of estrogen that relieves symptoms or prevents the condition.

Page 10: Progestins: Mechanisms of Action

  • Mechanisms include:

    • Induction of secretory changes in the endometrium

    • Increase in basal body temperature

    • Thickening of vaginal mucosa

    • Relaxation of uterine smooth muscle

    • Stimulation of mammary alveolar tissue growth

    • Feedback inhibition on pituitary gonadotropins release

Page 11: Progestins Overview

  • 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

  • Conditions treated with Progestins:

    • Functional uterine bleeding caused by hormonal imbalance, fibroids, uterine cancer

    • Primary and secondary amenorrhea

    • Adjunctive and palliative treatment for some cancers and endometriosis

Page 13: Progestins: Additional Indications

  • Other uses include:

    • Alone or with estrogens for birth control

    • Prevention of threatened miscarriage

    • Alleviation of premenstrual syndrome symptoms

Page 14: Progestins: Contraindications

  • Contraindications:

    • Similar to estrogens

Page 15: Progestins: Adverse Effects

  • Adverse Effects include:

    • Liver dysfunction causing cholestatic jaundice

    • Thrombophlebitis, thromboembolic disorders (e.g., pulmonary embolism)

    • Nausea, vomiting, amenorrhea, spotting

    • Edema, weight gain or loss, headaches

Page 16: Medroxyprogesterone (Provera, Depo-Provera)

  • Mechanism of action:

    • Inhibits secretion of pituitary gonadotropins, preventing follicular maturation and ovulation

    • Stimulates growth of mammary tissue and acts against endometrial cancer

    • Indicated for uterine bleeding, secondary amenorrhea, endometrial cancer, renal cancer, and as a contraceptive

Page 17: Contraceptive Drugs Overview

  • Definition:

    • Medications used to prevent pregnancy

  • Types:

    • Oral contraceptive medications (most contain estrogen-progestin combinations)

Page 18: Other Contraceptive Forms

  • Available contraceptive forms include:

    • Long-acting injectable form of medroxyprogesterone

    • Transdermal contraceptive patch

    • Intravaginal contraceptive ring

    • Implantable rods

Page 19: Contraceptive Drugs: Mechanism of Action

  • Prevention Mechanism:

    • Inhibition of gonadotropins release and increase in uterine mucus viscosity

    • Results in:

    • Decreased sperm movement and fertilization

    • Possible inhibition of implantation of fertilized egg (zygote)

Page 20: Contraceptive Drugs: Other Effects

  • Additional benefits include:

    • Improvement in menstrual cycle regularity

    • Decrease in blood loss during menstruation

    • Reduction in functional ovarian cysts and ectopic pregnancies

Page 21: Contraceptive Drugs: Interactions

  • Drugs that decrease the effectiveness of oral contraceptive drugs:

    • Antibiotics (especially penicillins and cephalosporins)

    • Barbiturates

    • Isoniazid

    • Rifampin

  • Drugs that may have reduced effectiveness with oral contraceptives:

    • Beta blockers, warfarin, tricyclic antidepressants, vitamins, hypnotics, anticonvulsants, theophylline, and antidiabetic drugs

Page 22: Uterine Stimulants Overview

  • Definition:

    • Medications used to alter uterine contractions

  • Uses include:

    • Promote labor

    • Prevent onset or progression of labor

    • Postpartum use to reduce risk of postpartum hemorrhage

Page 23: Types of Uterine Stimulants

  • Common Uterine Stimulants:

    • Oxytocin (hormonal drug)

    • Prostaglandins

    • Ergot derivatives

    • Progesterone antagonist mifepristone (RU-486)

Page 24: Oxytocin (Pitocin)

  • Synthetic form:

    • Induces labor at full-term gestation

    • Enhances labor when contractions are weak

  • Other Uses:

    • Prevent/control postpartum uterine bleeding

    • Complete incomplete miscarriage

    • Promote milk ejection during lactation

Page 25: Ergot Alkaloids

  • Parameters:

    • Increase the force and frequency of uterine contractions

    • Used post-delivery to prevent uterine atony and hemorrhage

  • Example: Methylergonovine (Methergine)

Page 26: Managing Preterm Labor

  • Objective:

    • Stop labor that begins early (after 20 weeks of gestation)

  • Definition of Premature Labor:

    • Uterine contractions between the 20th and 37th weeks of gestation

  • Non-pharmacologic measures include:

    • Bed rest, sedation, hydration

Page 27: Uterine Relaxants: Tocolytics

  • Examples:

    • Indomethacin: Nonsteroidal antiinflammatory agent inhibiting prostaglandin activity

    • Nifedipine: Calcium channel blocker inhibiting myometrial activity

Page 28: Corticosteroids During Preterm Labor

  • Usage:

    • Given when indomethacin and nifedipine fail and delivery is imminent

    • Commonly betamethasone or dexamethasone; promotes fetal lung maturity in cases between 24 to 34 weeks of gestation

Page 29: Osteoporosis Overview

  • Description:

    • Condition of low bone mass leading to increased fracture risk

  • Demographics:

    • Primarily affects women; 40% of women over 50 develop osteoporotic fractures, 20% of those affected are men.

Page 30: Osteoporosis Risk Factors

  • Risk Factors Include:

    • European or Asian descent

    • Slender body build

    • Early estrogen deficiency

    • Smoking

    • Alcohol consumption

    • Low-calcium diet

    • Sedentary lifestyle

    • Family history of osteoporosis

Page 31: Drug Therapy for Prevention of Osteoporosis

  • Recommendations:

    • Calcium supplements and vitamin D are recommended especially for women over 60 years for bone health.

Page 32: Drug Therapy for Osteoporosis Overview

  • Drug Categories:

    • Bisphosphonates:

    • Alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), zoledronic acid (Reclast)

    • Selective Estrogen Receptor Modifiers (SERMs):

    • Raloxifene (Evista), Tamoxifen (Nolvadex)

    • Hormonal Treatments:

    • Calcitonin (Calcimar), Teriparatide (Forteo - stimulates bone formation), Denosumab (Prolia - prevents bone resorption)

Page 33: Bisphosphonates Mechanism of Action

  • Mechanism:

    • Inhibit osteoclast-mediated bone resorption, indirectly enhancing bone mineral density.

    • Strong evidence indicates bisphosphonates can reverse lost bone mass and reduce fracture risk.

Page 34: Calcitonin and Teriparatide

  • Calcitonin (Calcimar):

    • Directly inhibits osteoclastic bone resorption.

  • Teriparatide (Forteo):

    • Only drug stimulating bone formation; derivative of parathyroid hormone (PTH); action similar to natural PTH.

Page 35: Denosumab (Prolia)

  • Mechanism and Administration:

    • Monoclonal antibody blocking osteoclast activation, preventing bone resorption.

    • Administered subcutaneously once every 6 months with daily calcium and vitamin D.

Page 36: Indications for Osteoporosis Drugs

  • Medications for:

    • Bisphosphonates: prevention and treatment of osteoporosis

    • Raloxifene: prevention of postmenopausal osteoporosis

    • Teriparatide: high-risk fracture patients

    • Calcitonin: treatment of osteoporosis

Page 37: Contraindications for Osteoporosis Drugs

  • Bisphosphonates:

    • Drug allergy, hypocalcemia, esophageal dysfunction, inability to stay upright for 30 minutes post-dose.

  • SERMs:

    • Allergy, pregnancy, venous thromboembolic disorders (DVT, PE, retinal vein thrombosis).

Page 38: Further Contraindications

  • Calcitonin:

    • Allergy to salmon.

  • Teriparatide:

    • Drug allergy.

  • Denosumab:

    • Hypocalcemia, renal impairment, infection.

Page 39: Adverse Effects of Osteoporosis Drugs

  • SERMs:

    • Hot flashes, leg cramps, increased risk of venous thromboembolism, teratogenic effects, leukopenia.

  • Bisphosphonates:

    • Headache, gastrointestinal upset, joint pain, risk of esophageal burns, osteonecrosis of the jaw, possibly severe bone/joint/muscle pain.

Page 40: Continuation of Drug Effects

  • Calcitonin:

    • Flushing, nausea, diarrhea, reduced appetite.

  • Teriparatide:

    • Chest pain, dizziness, hypercalcemia, nausea, arthralgia.

  • Denosumab:

    • Risk of infections.

Page 41: Alendronate (Fosamax)

  • Application:

    • First nonestrogen nonhormonal option for preventing bone loss.

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

Page 42: Raloxifene (Evista)

  • Type:

    • SERM

  • Primary Use:

    • Prevention of postmenopausal osteoporosis;

  • Adverse Effect:

    • Hot flashes.

Page 43: Nursing Implications for Patient Assessment

  • Assess:

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

    • History of medication, smoking, contraindications such as potential pregnancy.

Page 44: Nursing Implications for Uterine Stimulants

  • Before administration of uterine stimulants:

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

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

Page 45: Nursing Implications for Bisphosphonates

  • Ensure patients do not have esophageal abnormalities.

  • Patients should remain upright or sitting for at least 30 minutes after taking medication.

Page 46: Bisphosphonates Administration Guidelines

  • Instructions Include:

    • Take upon rising, with a full glass of water, 30 minutes before eating.

    • Emphasize the importance of sitting upright for at least 30 minutes post-dose.

Page 47: SERMs Patient Instructions

  • Instructions:

    • Discontinue use 72 hours before and during prolonged immobility (e.g., surgery or long trips).

Page 48: Men's Health

  • Copyright: 2022 by Elsevier Inc. All rights reserved.

Page 49: Androgens Overview

  • Definition:

    • Group of male sex hormones (primarily testosterone).

  • Role of Testosterone:

    • Normal development and maintenance of male sex characteristics.

    • Development of bone and muscle tissue.

    • Inhibition of protein catabolism.

    • Retention of electrolytes.

    • Stimulates production of blood cells.

Page 50: Anabolic Steroids

  • Characteristics:

    • Anabolic activity for tissue synthesis and formation.

    • Schedule III classification due to misuse potential (particularly by athletes).

  • Examples:

    • Oxymetholone (Anadrol-50), Oxandrolone (Oxandrin), Nandrolone (Deca-Durabolin).

Page 51: Approved Indications for Anabolic Steroids

  • Indications Include:

    • Adjunctive therapy after extensive surgery,

    • Trauma,

    • Chronic diseases,

    • Anemia,

    • Hereditary angioedema,

    • Metastatic breast cancer.

Page 52: Anabolic Steroid Misuse

  • Points of Concern:

    • Misuse by bodybuilders and weightlifters due to muscle-building properties.

    • Serious consequences: sterility, cardiovascular disease, and liver cancer.

    • Schedule III controlled substances by the U.S. DEA.

    • Potential for psychological or physical dependence.

Page 53: Androgen Inhibitors

  • Mechanism:

    • Block effects of endogenous androgens.

  • Examples Include:

    • 5-alpha reductase inhibitors for benign prostatic hyperplasia (BPH).

    • Medications:

    • Finasteride,

    • Dutasteride.

Page 54: Clinical Effects of Alpha1-Adrenergic Blockers

  • Indications:

    • Immediate shrinkage of the prostate; however, may take up to 6 months for full effects.

  • Clinical Use:

    • Symptomatic relief of obstruction from BPH.

Page 55: Finasteride (Propecia)

  • Notes:

    • Used to prevent hair thinning caused by DHT.

    • Gender Specificity:

    • Not indicated for women or pregnant women due to teratogenic effects.

    • Recommend wearing gloves when handling.

Page 56: Alpha1-Adrenergic Blockers for BPH Treatment

  • Medications Include:

    • Doxazosin (Cardura),

    • Tamsulosin (Flomax),

    • Terazosin (Hytrin),

    • Alfuzosin (Uroxatral),

    • Silodosin (Rapaflo).

Page 57: PDE Inhibitors for Erectile Dysfunction (ED)

  • Definition:

    • Used to treat erectile dysfunction.

  • Sildenafil (Viagra):

    • First oral ED drug; relaxes smooth muscle in corpora cavernosa for blood inflow.

Page 58: Other PDE Inhibitors

  • Additional Drugs:

    • Vardenafil (Levitra), Tadalafil (Cialis), Avanafil (Stendra).

  • Note:

    • Sildenafil and tadalafil also treat pulmonary hypertension.

Page 59: Contraindications for Men's Health Drugs

  • Drugs & Risks:

    • Androgen-responsive tumors contraindications due to risk of significant cardiovascular events (especially with nitrates),

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

Page 60: Adverse Effects of Men's Health Drugs

  • Side Effects Include:

    • Fluid retention, thromboembolic disorders, heart attack risks.

    • Anabolic Steroids Specific Side Effects:

    • Peliosis of the liver, hepatic neoplasms, cholestatic hepatitis, jaundice, abnormal liver function.

Page 61: Priapism and its Implications

  • Definition:

    • Abnormally prolonged penile erection; a medical emergency due to excessive therapeutic drug response.

Page 62: Adverse Effects Continuation

  • PDE Inhibitors Effects:

    • Can cause unexplained visual loss.

  • Finasteride Effects:

    • Loss of libido, erection issues, ejaculatory dysfunction, hypersensitivity, gynecomastia, severe myopathy, reduced PSA concentrations.

Page 63: Drug Interactions and Risks

  • Androgens and Anticoagulants:

    • Can significantly alter anticoagulant activity.

  • Sildenafil and Other PDE inhibitors:

    • Severe hypotension risk when combined with nitrates.

Page 64: Alpha Blockers Interactions

  • Risks of Additive Hypotension:

    • When combined with other blood pressure-lowering drugs.

  • Effects with Certain Medications:

    • Increased effects when taken with azole antifungal drugs, erythromycin, clarithromycin, beta blockers, and verapamil.

Page 65: Nursing Implications for Administration

  • Sublingual, Buccal, and Oral Forms:

    • Follow precise instructions for administration.

    • Transdermal Testoderm patches:

    • Applied to scrotal skin.

    • Transdermal Androderm patches:

    • Applied to other skin areas, never scrotal skin.

Page 66: Nursing Implications Guidance

  • Patient Instructions:

    • Pregnant women should avoid crushed/broken hormone drugs.

    • Instruct on proper administration techniques and monitor for therapeutic responses and adverse effects.

Page 67: Endocrine Drugs Overview

  • Copyright: 2022 by Elsevier Inc. All rights reserved.

Page 68: Endocrine System Overview

  • Goal:

    • Maintain physiological stability; influences all cells and organs in the body.

  • Hormones:

    • Act as the “chemical language” of the endocrine system; natural substances secreted into the bloodstream to their action sites.

Page 69: Neuroendocrine System: Pituitary Hormones

  • Components:

    • Hypothalamus: Part of the CNS.

    • Pituitary Gland:

    • Anterior Pituitary (adenohypophysis)

    • Posterior Pituitary (neurohypophysis)

  • Functions: Govern all bodily functions using hormones and a negative feedback loop.

Page 70: Negative Feedback Loop

  • Regulation:

    • Endocrine activity is controlled through a surveillance signaling system.

    • Hormone secretion is often regulated by a negative feedback loop.

Page 71: Hydrocortisone (Cortef)

  • Description:

    • Drug form of cortisol; anti-inflammatory effects.

  • Functions:

    • Reduces inflammatory leukocyte functions, promotes renal sodium retention, causing potential edema and hypertension.

Page 72: Cosyntropin (Cortrosyn)

  • Functions:

    • Stimulates cortisol release from adrenal cortex; anti-inflammatory property.

    • Used for diagnosing adrenal insufficiency and wasting syndromes, promotes sodium retention.

Page 73: Somatropin and Somatrem Overview

  • Functions:

    • Recombinantly made growth hormone; stimulates skeletal growth in GH-deficient patients (e.g., hypopituitary dwarfism).

  • Octreotide (Sandostatin):

    • Reduces severe diarrhea associated with carcinoid tumors.

Page 74: Posterior Pituitary Gland Hormones

  • Vasopressin & Desmopressin:

    • Mimic antidiuretic hormone; increases water resorption, concentrates urine (reduces water excretion by up to 90%).

    • Utilized in treating diabetes insipidus.

Page 75: Vasopressin Additional Uses

  • Effects include:

    • Potent vasoconstriction during hypotensive emergencies such as septic shock.

    • Used in Advanced Cardiac Life Support for pulseless cardiac arrest and to manage bleeding from esophageal varices.

Page 76: Desmopressin Mechanism

  • Mechanism:

    • Increases levels of factor VIII, von Willebrand factor, and tissue plasminogen activator.

    • Utilized in the management of nocturnal enuresis.

Page 77: Nursing Implications of Octreotide

  • Monitor for:

    • Gallbladder function, blood glucose levels.

    • Report abdominal pain to patients; caution in renal impairment patients; therapeutic responses should be checked.

Page 78: Administration Guidelines

  • Instructions:

    • Provide specific instructions for nasal spray forms of vasopressin.

    • Rotate injection sites, avoid abrupt discontinuation, and check with a healthcare provider before taking OTC products.

Page 79: Monitoring Therapeutic Responses

  • Criteria:

    • Somatropin should show growth increases in children.

    • Desmopressin and vasopressin should reduce severe thirst, decrease urinary output.

    • Octreotide aims to reduce carcinoid crisis symptoms.

Page 80: Thyroid Disorders Overview

  • Interaction of TRH (thyrotropin-releasing hormone), TSH (thyroid-stimulating hormone), and thyroid hormones (T4 and T3).

  • Components:

    • Feedback mechanisms between hypothalamus, pituitary gland, and thyroid gland.

Page 81: Thyroid Gland Functions

  • Hormones Secreted:

    • Thyroxine (T4), Triiodothyronine (T3), Calcitonin.

  • Role: Essential regulation of metabolism.

  • Location: Near parathyroid glands that manage calcium levels in extracellular fluid.

Page 82: Hypothyroidism Overview

  • Definition:

    • Deficiency in thyroid hormones due to:

    • Primary: thyroid gland abnormalities.

    • Secondary: pituitary gland dysfunction.

    • Tertiary: hypothalamus dysfunction.

Page 83: Hypothyroidism Classification

  • Types Include:

    • Congenital Hypothyroidism (Cretinism): Hyposecretion during youth.

    • Myxedema: Hyposecretion in adulthood leading to low metabolic rate and physical changes.

Page 84: Goiter in Hypothyroidism

  • Definition:

    • Enlargement of the thyroid gland due to overstimulation from elevated TSH from insufficient thyroid hormone.

Page 85: Hashimoto’s Disease

  • Description:

    • Chronic autoimmune disorder affecting the thyroid, causing low hormone levels.

    • Genetics: Account for about 80% of likelihood of development; other names include: Hashimoto thyroiditis, chronic autoimmune thyroiditis, lymphocytic thyroiditis.

Page 86: Common Symptoms of Hypothyroidism

  • Symptoms Include:

    • Thickened skin

    • Hair loss

    • Constipation

    • Lethargy

    • Anorexia

Page 87: Hyperthyroidism Overview

  • Causes:

    • Graves’ disease, multinodular disease, Plummer’s disease, thyroid storm.

  • Impact: Results in excessive thyroid hormone and increased metabolic activity.

Page 88: Symptoms of Hyperthyroidism

  • Physical Symptoms:

    • Diarrhea, flushing, increased appetite, weakness, sleep disorders, altered menstrual flow.

  • Other Symptoms:

    • Fatigue, palpitations, nervousness, heat intolerance, irritability.

Page 89: Treatment of Hyperthyroidism

  • Methods Include:

    • Radioactive iodine (I131) destroys thyroid gland.

    • Surgery to remove part/all of the gland, requiring lifelong hormone replacement.

Page 90: Antithyroid Drug Options

  • Types:

    • Thioamide derivatives (Methimazole (Tapazole), Propylthiouracil).

    • Also involves radioactive iodine and potassium iodine.

Page 91: Thyroid Replacement Drugs

  • Examples Include:

    • Levothyroxine (Synthroid, Levoxyl): Synthetic T4

    • Liothyronine (Cytomel): Synthetic T3

    • Liotrix (Thyrolar): Combination of T3 and T4.

Page 92: Mechanism of Thyroid Replacement Drugs

  • Action:

    • Replace what the thyroid gland cannot produce; achieving normal thyroid levels (euthyroid).

Page 93: Indications for Thyroid Replacement Drugs

  • Conditions:

    • Replace hormones not produced by the thyroid, diagnosis of suspected hyperthyroidism, prevention/treatment of goiters, hormonal therapy post-thyroid surgery.

Page 94: Additional Indications for Replacement Drugs

  • Specific Situations Include:

    • Post-surgical removal or destruction of thyroid due to cancer/hyperthyroidism and hypothyroidism occurring during pregnancy.

Page 95: Adverse Effects of Thyroid Replacement Drugs

  • Primary Risk:

    • Cardiac dysrhythmia, along with tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea,

    • Menstrual irregularities, weight loss, sweating, heat intolerance, fever.

Page 96: Levothyroxine (Synthroid)

  • Characteristics:

    • Most commonly prescribed synthetic thyroid hormone;

    • Dosage: Usually taken at 0600 on an empty stomach, dosed in micrograms (mcg).

Page 97: Antithyroid Drugs: Overview

  • Purpose:

    • Treat hyperthyroidism and prevent surges of thyroid hormones after surgeries or during radioactive treatments.

Page 98: Mechanism of Antithyroid Drugs

  • Function:

    • Methimazole and propylthiouracil inhibit iodine incorporation into tyrosine to hinder thyroid hormone formation; propylthiouracil also blocks T4 conversion to T3.

Page 99: Indications for Antithyroid Drugs

  • Conditions Treated Include:

    • Hyperthyroidism treatment and prevention of thyroid hormone surges post-surgery or radioactive therapy.

Page 100: Adverse Effects of Antithyroid Drugs

  • Major Risks:

    • Liver and bone marrow toxicity are notably serious.

Page 101: Propylthiouracil (PTU)

  • Note:

    • Thioamide antithyroid; may require 2 weeks of therapy for symptoms to improve.

Page 102: Nursing Implications for Antithyroid Drugs

  • Assess for:

    • Allergies, contraindications, potential interactions. Baseline vital signs and weight should be taken; cautious use is advised in cardiac disease, hypertension, and during pregnancy.

Page 103: Nursing Implications During Pregnancy

  • Continuity in Treatment:

    • Hypothyroidism treatment should continue to avoid retarded fetal growth; adjust dosage every 4 weeks to maintain TSH within low normal range.

Page 104: Antithyroid Medications Guidance

  • Administration Tips:

    • Better tolerated when given with food; maintain consistent administration schedule. Avoid abrupt cessation; limit iodine-rich foods.

Page 105: Thyroid Crisis (Thyroid Storm) Overview

  • Definition:

    • Exacerbation of hyperthyroidism, potentially life-threatening; assess for precipitating causes such as stress and infection.

Page 106: Patient Education and Monitoring

  • Guidance for Patients:

    • Report unusual symptoms and heart palpitations.

    • Avoid OTC medications without consultation. Understand therapeutic effects may take weeks.

Page 107: Nursing Implications Further Guidance

  • Monitoring Effects:

    • Thyroid medications should reduce hypothyroidism symptoms; antithyroid drugs should indicate no hyperthyroidism evidence. Monitor for adverse reactions including dysrhythmias (thyroid drugs) and leukopenia (antithyroid drugs).

Page 108: Hyperthyroidism vs. Hypothyroidism Symptoms

  • Hyperthyroid Symptoms:

    • Weight loss, Increased appetite, Heat intolerance, Increased sensitivity to heat, Tachycardia, Palpitations, Arrhythmias.

  • Hypothyroid Symptoms:

    • Weight gain, Decreased appetite, Cold intolerance, Increased sensitivity to cold, Bradycardia, Diarrhea, Anxiety, Nervousness, Irritability, Insomnia, Tremors, Increased hair and nail growth, Increased sweating, Constipation, Fatigue, Depression, Impaired memory, thin hair, dry skin.

Page 109: Homework

  • Instructions: Read Chapter Study Guide - Chapters 18, 19, & 21 to prepare for assessments.