Pharm CH 14 (2)

Which drug suppresses thyroid activity? a. Methimazole (Tapazole) b. Metolazone (Mykrox) c. Levothyroxine (Synthroid) d. Liothyronine (Cytomel)

A Levothyroxine and liothyronine are thyroid hormone agonists and increase metabolism. Metolazone is a diuretic, not a thyroid suppression agent.

Which assessment is most important to perform before giving a patient who is prescribed levothyroxine (Synthroid) the first dose of the drug? a. Measuring heart rate and rhythm b. Determining level of consciousness c. Asking about an allergy to "sulfa" drugs d. Checking intake and output for the last 24 hours

A The side effects and adverse effects of thyroid hormone replacement drugs increase metabolic rate and cardiac activity. Checking heart rate and rhythm before giving the drug provides a baseline to determine whether or not the drug is working correctly or is causing an overdose effect.

How do thyroid replacement drugs affect diabetes? a. Thyroid replacement drugs reduce the effectiveness of all antidiabetic drugs. b. When thyroid replacement drugs return metabolism to normal, diabetes is gone. c. Thyroid replacement drugs can allow a patient to switch from insulin to an oral antidiabetic drug. d. Thyroid replacement drugs require that a patient taking an oral antidiabetic drug be placed on insulin.

A Thyroid hormone replacement drugs change the effectiveness of insulin and other drugs for diabetes, and often these drugs need to be increased to prevent high blood glucose levels (hyperglycemia). Patients with diabetes and hypothyroidism should be taught to check blood glucose levels more frequently.

A patient with hyperthyroidism is in the hospital waiting for surgery to remove the thyroid gland. This patient has all of the following conditions. For which condition should you notify the prescriber immediately? a. High level of anxiety about having surgery on the neck b. Temperature increase of 2 F c. Pulse pressure decrease of 10 mm Hg d. Increased bowel sounds and flatulence

B A complication of severe hyperthyroidism is thyroid crisis (also known as thyroid storm). Symptoms include fever, dangerously high blood pressure, and a rapid, irregular heartbeat. The symptoms can develop quickly, and if not treated, this problem can lead to seizures, heart failure, and death. An elevation in temperature may be an indication of impending thyroid crisis and requires immediate attention.

Which drug belongs to the mineralocorticoid class? a. Aminoglutethimide (Cytadren) b. Fludrocortisone (Florinef) c. Cortisol (Prednisone) d. Mitotane (Lysodren)

B Fludrocortisone is a drug used for mineralocorticoid replacement and raises blood glucose levels as well as increasing blood sodium levels and decreasing blood potassium levels. Cortisol is a glucocorticoid. Aminoglutethimide and mitotane are adrenal gland suppressants.

A patient with hypothyroidism as a result of Hashimoto's thyroiditis asks how long thyroid replacement drugs will need to be taken. What is your best response? a. "You will need to take the thyroid replacement drug until the goiter is completely gone." b. "You will need thyroid replacement drugs for the rest of your life because thyroid function will not return." c. "The thyroiditis will be cured with antibiotics and then you will no longer need the thyroid replacement drugs." d. "When your thyroid function studies indicate a normal blood level of thyroid hormones you will be able to discontinue the drugs."

B Hashimoto's thyroiditis results in a permanent loss of thyroid function. Without continuous thyroid replacement drugs, the patient's metabolism would eventually stop and death would occur.

A patient who has been taking levothyroxine (Synthroid) for 2 months has all of the following conditions. Which condition indicates that the drug therapy is effective? a. Increased thirst b. Daily bowel movement for 1 week c. White blood cell count of 6000/mm3 d. Weight unchanged for the last 3 weeks

B Hypothyroidism decreases GI motility significantly. One of the parameters that can be used to determine if changes in the dose of a thyroid replacement drug should be adjusted is the frequency of bowel movements. A bowel movement everyday is a strong indication that the dose of thyroid replacement hormone is adequate.

Which precaution is most important to teach a patient who is newly prescribed a thyroid hormone replacement drug? a. "Avoid taking fiber supplements while on this drug." b. "Be sure to take this drug at the same time everyday." c. "Weigh yourself daily and keep a record of these weights." d. "Do not increase the dose without your prescriber's knowledge."

D Although all instructions are appropriate when a patient begins treatment with thyroid replacement drugs, the most important instruction is D. The starting drug dosage is very low, with no attempt to bring the blood thyroid hormone level back to normal quickly. These drugs can change metabolism quickly and lead to adverse effects such as heart attack or seizure. Dosages start low and are raised very slowly (about every 3 weeks). The patient should never increase the dose unless instructed to do so by the prescriber.

Which statement about adrenal cortex hormones is true? a. When underproduced, these hormones can lead to high blood pressure and stroke. b. When overproduced, these hormones can cause cancer. c. These hormones differ between men and women. d. These hormones are essential for life.

D Hormones from the adrenal cortex, especially the glucocorticoids, are essential for life. They regulate the stress response; carbohydrate, protein, and fat metabolism; immune function; sodium and water balance; and excitability of heart muscle cells. If these hormones are not present in sufficient amounts or are not provided as drugs, death will occur.

How do thyroid replacement drugs work to treat hypothyroidism? a. Forcing the thyroid gland to secrete more thyroid hormones b. Inhibiting the enzymes that break down thyroid hormones c. Preventing damage to thyroid endocrine cells d. Providing thyroid hormones

D Hypothyroidism is low thyroid functioning, which is demonstrated by very low production of thyroid hormones. Thyroid replacement drugs are thyroid hormone agonists. Taking these drugs provides an exogenous source of thyroid hormones.

A patient who is prescribed liothyronine (Cytomel) also takes warfarin (Coumadin). Which laboratory blood test result indicates a possible drug interaction? a. Hematocrit 42% b. Hemoglobin 14.2 g/dL c. Blood urea nitrogen (BUN) 12 mg/dL d. International normalized ratio (INR) 4.5

D Liothyronine increases the effectiveness of warfarin. Warfarin's effectiveness is measured by the INR. This value should be between 1.5 and 3.0 in a patient taking warfarin. With an INR level of 4.5 the patient is at extreme risk for excessive bleeding.

The nurse is instructing a patient about dietary iodine. The nurse tells the patient what items are the most common sources of dietary iodine? (select all that apply) a. Saltwater fish b. Enhanced salt c. Red meat d. Whole grain e. Paprika

A,B The most common dietary sources of iodine are saltwater fish and table salt to which iodide is added. Thyroid cells may fail to produce enough thyroid hormones because they have been damaged and no longer function, or because the person's diet does not include enough iodine or tyrosine to make thyroid hormones. Red meat is a good source of protein and iron, but not iodine. Whole grain is a good source of bran and vitamins, but not iodine. Although it is similar in color to antiseptic iodine, paprika is not a good source of dietary iodine.

The nurse admits a patient to the unit who has a goiter. The nurse knows that a goiter can be a symptom of what conditions? (select all that apply) a. Hyperthyroidism b. Hypothyroidism c. Normal thyroid activity d. Absence of a thyroid gland e. Graves' disease

A,B,E The presence of a goiter indicates that the patient has a thyroid problem but does not indicate whether the thyroid is underactive or overactive. With some types of hyperthyroidism, such as Grave's disease, the patient also has a goiter. In an effort to increase thyroid hormone production, the thyroid gland cells can divide, making the whole thyroid gland larger, forming a goiter, which is a distinct swelling in the neck. A goiter is not a symptom of a normal thyroid or a missing thyroid.

Which actions, side effects, conditions, or problems are associated with thyroid-suppressing drugs? (select all that apply) a. Can cause birth defects. b. Work by destroying cells within the thyroid gland. c. Begin to lower thyroid hormone levels within the first 24 hours after taking the drug. d. Patients have an increased risk for infection while taking one of these drugs. e. A yellow tinge to the soles of the feet is an indication to stop taking these drugs. f. Any older adult taking one of these drugs along with warfarin should have his or her international normalized ratio (INR) checked weekly.

A,D, F Thyroid-suppressing drugs are pregnancy category D drugs and can cause birth defects and suppress bone marrow production of white blood cells, which increases the patient's risk for infection. Thyroid-suppressing drugs can change the activity of warfarin (increase it or decrease it), so patients taking these drugs along with warfarin should have their INR checked at least weekly.

The nurse is discharging a patient who has been given a prescription for a drug to suppress adrenal hormone production. What is the most important point the nurse needs to teach the patient? a. To take the drug in the morning on an empty stomach. b. To learn the signs and symptoms of adrenal insufficiency. c. To have blood pressure taken every other day to check for high readings. d. To make sure to have magnesium level tested as ordered.

B It is most important for a patient taking any drug to suppress adrenal hormone production to know about the signs and symptoms of adrenal insufficiency. These include hypoglycemia, salt craving, muscle weakness, hypotension (not hypertension), and fatigue. These drugs alter blood levels of sodium and potassium and not magnesium. So remind patients to keep all appointments for laboratory blood work. Drugs to suppress adrenal hormone production can also cause nausea, vomiting, and other gastrointestinal upsets, so patients need to take these drugs with food and not on an empty stomach. In addition, women of childbearing age who are sexually active need to use two reliable forms of birth control while taking mifepristone.

Why should pregnant patients who have hypothyroidism continue to take thyroid replacement drugs throughout pregnancy? a. These drugs have a low likelihood of increasing the risks for birth defects. b. Without continuing thyroid replacement drugs, the pregnancy may not continue. c. Pregnancy is a high metabolism condition and less drug is needed but should still be taken. d. The fetus produces thyroid hormones that help supplement the pregnant woman's hormone level, but minimal replacement is needed during pregnancy.

B The thyroid gland secretes hormones that are necessary for life. Not taking the drug can lead to problems with the pregnancy and with the fetus. The pregnant woman often needs a higher dose of the drug.

The nurse is discharging a patient with a prescription for a thyroid hormone (TH). What body functions are controlled by this type of drug? (select all that apply) a. Digestion b. Bone formation c. Memory and learning d. Respiration e. Heart muscle function

B,C,D,E Thyroid hormones regulate whole body metabolism and increase the rate of metabolism in any cell that they enter by speeding up the energy use and work output of each cell. Important functions controlled by thyroid hormones include: maintaining heart and skeletal muscle function; assisting in brain development before birth and during early childhood; maintaining brain function throughout the life span including the ability to think, remember, and learn; ensuring continued production of other hormones; and maintaining effective respiratory function and cell uptake of oxygen. TH has no effect on digestion.

Which actions, side effects, conditions, or problems are associated with perimenopausal hormone replacement drugs? (select all that apply) a. The primary purpose of this therapy is to reduce the risk for pregnancy. b. The use of conjugated estrogens lowers the blood levels of follicle-stimulating hormone. c. Patients should be cautioned not to smoke cigarettes while taking these drugs. d. Patients taking these drugs must avoid all alcoholic beverages. e. Women who take these drugs have a greater risk for lung and colon cancers. f. This therapy should be used with caution or not used at all in patients with hypertension. g. Women who have had a hysterectomy should only take estrogen along with progesterone. h. Women who take estrogen-based hormone replacement therapy have a lower risk for osteoporosis and heart disease.

B,C,F The exogenous estrogen inhibits the feedback system of the pituitary gland, decreasing production and release of FSH. In turn, this reduces many of the unpleasant side effects of menopause. The hormones in HRT promote blood clot formation. This risk is greatly increased with smoking. HRT drugs cause fluid retention, which can worsen hypertension.

The nurse is discharging a patient with a prescription for a thyroid replacement drug. The nurse should tell the patient to notify his or her prescriber if what signs or symptoms should occur? (select all that apply) a. Pulse rate that is 20 beats higher than normal and that lasts for 1 day b. Pulse rate that is 20 beats higher than normal and that lasts for 1 week c. Irregular pulse rate d. Vomiting e. Improved, regular bowel movements

B,C.D Teach patients to check their own pulse each morning before taking the drug and again each evening before going to bed. If the pulse rate becomes 20 beats higher than the normal rate for 1 week or if it becomes consistently irregular, they should notify their prescriber. Tell them to go to the emergency department immediately if they start to have chest pain. If the patient becomes ill and cannot take the drugs orally, he or she will need to contact their prescriber to get a parenteral dose of the drug. Having an increased pulse rate for 1 day only is not a reason to call the prescriber. Improved, regular bowel movements are an expected side effect of thyroid replacement drugs.

Which causes, symptoms, and management strategies are associated with hypothyroidism? (select all that apply) a. T3 (triiodothyronine) level of 90 ng/dL b. caused by an infection of the thyroid gland c. Hypertension d. Can be corrected with thyroid surgery e. Dietary deficiency of iodide can cause a goiter f. hypothyroidism in infants can lead to mental retardation g. Hypothyroidism is more common in girls and women than in boys and men h. Constipation

B,E,F,G,H The most common natural cause of hypothyroidism is an infection of the thyroid gland that results in destruction of some or all thyroid cells. Thyroid hormones are composed of the amino acid tyrosine and iodide. Iodide is made from dietary iodine. If a diet is too low in iodine, the person cannot make enough thyroid hormones. This triggers the cells of the thyroid gland to increase in size, forming a goiter. Thyroid hormones are important for brain development and maintenance. For unknown reasons thyroid problems occur five to ten times more often in females than in males. The slower rate of metabolism associated with hypothyroidism decreases peristalsis and digestion. These actions result in constipation.

The nurse is caring for a patient with a thyroid problem. The nurse knows that what factors can trigger a thyroid crisis or thyroid storm? (select all that apply) a. Missed dose of thyroid replacement hormone b. Pregnancy c. Infection d. Trauma e. Thyroidectomy

B.C,D When hyperthyroidism is severe, it is called thyroid crisis or thyroid storm. This condition is an extreme state of hyperthyroidism in which all symptoms are more severe and life threatening. The patient has a fever; dangerously high blood pressure; and a rapid, irregular heartbeat. Symptoms can develop quickly, and if not treated, this problem can lead to seizures, heart failure, and death. The death rate for thyroid crisis is about 30%, even when the patient is treated correctly.

A patient is prescribed levothyroxine sodium (Synthroid) 25 mcg orally once a day. The pharmacy sends liothyronine sodium (Cytomel) 25 mcg. What is your best action? a. Give the drug as sent from the pharmacy. b. Contact the nurse manager for advice. c. Call the pharmacy to send the correct drug. d. Explain to the patient that both drugs are thyroid hormone agonists.

C Never substitute one type or brand of thyroid hormone replacement drug with another. Drug strengths vary (e.g., liothyronine is four times as potent as levothyroxine), and patient responses vary.

Laboratory blood tests show that a patient has a T3 level of 190 ng/dL. How should you interpret this finding? a. Hypothyroidism b. Hyperthyroidism c. Normal thyroid function d. Thyroid function totally absent

C The normal level for T3 (triiodothyronine) ranges between 70 and 205 ng/dL

A patient is prescribed levothyroxine (Synthroid) and a fiber supplement. What key point would you be sure to teach the patient about these drugs? a. "Take the drugs together as there are no interactions between them." b. "Be sure to take the fiber supplement 2 hours before a meal and the levothyroxine 3 hours after a meal." c. "Take the fiber supplement in the morning with breakfast and the levothyroxine in the evening before you go to bed." d. "Do not take the drugs together because a fiber supplement will decrease the absorption of your levothyroxine."

D Taking a thyroid hormone agonist drug with food or with a fiber supplement reduces the absorption of the drug. Teach patients to take it 2 to 3 hours before a meal or taking a fiber supplement or at least 3 hours after a meal or taking the supplement.

Which side effects are most common when taking any drug to manage adrenal gland hyperfunction? a. Decreased urine output and increased sweating b. Blurred vision and dry mouth c. Headache and mouth sores d. Nausea/vomiting

D The most common side effects for any drug used to manage adrenal gland function are nausea/vomiting. They also cause many other gastrointestinal upsets. They are not associated with blurred vision, dry mouth, headache, mouth sores, or increased sweating. Urine output is usually increased, not decreased.

Which statement made by a patient who is taking a thyroid replacement drug indicates that a higher dose may be needed? a. "My goiter seems to be smaller." b. "I seem to feel the heat more than other people." c. "Food just doesn't taste good without a lot of salt." d. "I am always tired, even when I get 10 or 12 hours of sleep."

D When blood thyroid hormone levels are insufficient to maintain a normal metabolic rate, symptoms of hypothyroidism return. Patients usually feel tired or weak and often report an increase in time spent sleeping, sometimes up to 14 to 16 h/day.

Which patient condition indicates that drug therapy for hypothyroidism is effective? a. The patient is thirsty. b. The patient's weight has been the same for 3 weeks. c. The patient's total white blood cell count is 6000 cells/mm3. d. The patient has had a daily bowel movement for the past 8 days.

D With hypothyroidism all body functions are slow. Constipation is always present and may be severe. Having a daily bowel movement indicates a positive response to therapy for hypothyroidism.