Pharm - Chapter 31 - Thyroid and Antithyroid Drugs

Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine? 1 "I will take this medication first thing in the morning." 2 "I can expect to see relief of my symptoms within 1 week." 3 "I will double my dose if I gain more than 1 pound per day." 4 "It is best to take the medication with food to prevent gastrointestinal upset."

1 "I will take this medication first thing in the morning." Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. Depending on the symptoms, some symptoms may take weeks to improve. The patient should not increase the dose. The medication is absorbed best on an empty stomach.

A patient with primary hypothyroidism receives levothyroxine and regular insulin. Which finding does the nurse monitor in the patient to help prevent complications of the pharmacotherapy? 1 Blood glucose 2 Heat intolerance 3 Fatigue and edema 4 Anxiety and warmth

1 Blood glucose The nurse would assess a patient who receives levothyroxine and insulin for clinical indicators of hyperglycemia because the combination therapy decreases the effectiveness of insulin. Because the insulin is less effective when administered with levothyroxine, the patient's blood sugar is likely to increase with levothyroxine therapy, or more insulin will be required to maintain a steady serum glucose level. Heat intolerance is a clinical indicator of hyperthyroidism. Fatigue and edema are signs of hypothyroidism. Anxiety and warmth are clinical indicators of hypoglycemia.

Which are the symptoms of hypothyroidism? Select all that apply. 1 Depression 2 Cold intolerance 3 Increased appetite 4 Altered menstrual cycle 5 Dry, brittle hair and nails

1 Depression 2 Cold intolerance 5 Dry, brittle hair and nails Hypothyroidism is decreased levels of thyroid hormones, which results in symptoms such as depression; cold intolerance; and dry, brittle hair and nails. Increased appetite and altered menstrual cycle are symptoms of hyperthyroidism, which is increased levels of thyroid hormones.

The nurse is assessing a patient undergoing levothyroxine therapy. Which symptom makes the nurse suspect excessive thyroid replacement? 1 Irritability 2 Drowsiness 3 Bradycardia 4 Intolerance to cold

1 Irritability Irritability is a symptom of hyperthyroidism. Drowsiness, bradycardia, and intolerance to cold are signs of hypothyroidism.

The nurse counsels a patient about preventing insomnia caused by liotrix. Which information would the nurse provide? 1 Take the drug before breakfast. 2 Take the drug along with meals. 3 Take the drug 1 hour after meals. 4 Take a nap during the day, after lunch.

1 Take the drug before breakfast. The nurse would suggest taking the drug early in the morning before breakfast to avoid insomnia. The drug activity is better achieved on an empty stomach; therefore the nurse would not ask the patient to take it with a meal. Rather, the nurse instructs the patient to take the medication before meals. Administering the drug 1 hour after meals will decrease the absorption of drug and cannot prevent insomnia. Taking a nap during the day will not alter the insomniac effect of the drug.

Which are the adverse effects of antithyroid medication? Select all that apply. 1 Vertigo 2 Cramps 3 Tremor 4 Leukopenia 5 Loss of taste

1 Vertigo 4 Leukopenia 5 Loss of taste Antithyroid medication causes vertigo. These medications also decrease the leukocyte count and cause a loss of the sense of taste. Cramps and tremors are adverse effects of thyroid medications.

The nurse is educating a patient who is taking thyroid hormone replacement therapy. Which response given by the patient indicates effective learning? 1 "I should take the thyroid tablet every night after dinner." 2 "I should take the tablet every morning with an empty stomach." 3 "I should take the tablet twice daily, before breakfast and after breakfast." 4 "I can stop the medication whenever I want without consulting my primary health care provider."

2 "I should take the tablet every morning with an empty stomach. Food decreases the absorption of the thyroid drug. The patient should take the thyroid drug every morning on an empty stomach to achieve maximum absorption of the drug. The therapeutic effect of the drug decreases if the patient takes the tablet after meals. Administering the drug twice daily leads to drug overdose and adverse effects. The drug therapy should not be withdrawn without informing the primary health care provider because this would worsen the hypothyroidism.

A patient with hypothyroidism reports severe sleeping disturbances. Which statement given by the patient is helpful in identifying the reason for the insomnia? 1 "I always take the same brand of tablet." 2 "I take the tablet every evening at the same time." 3 "I take the tablet every morning at the same time." 4 "I take the tablet every morning on an empty stomach."

2 "I take the tablet every evening at the same time." Taking a thyroid tablet in the evening results in insomnia. When administered in the evening, the drug shows its effects at bedtime, resulting in sleep disturbances. If the patient regularly takes the same brand of tablet every day at the same time, it helps reduce the problems with the bioequivalence of drugs from different manufacturers. If the patient takes the tablet every morning at the same time, it increases the effectiveness of the medication, which is highly beneficial to the patient. If the patient takes the tablet every morning on an empty stomach, it maximizes the therapeutic effects of the drug and does not cause insomnia.

The nurse is caring for a patient who has myxedema. The nurse administers a hypothyroid drug and later learns that the drug was improperly mixed and that an increased dose of the drug was administered to the patient. For which symptom would the nurse initially assess? 1 Bloody stools 2 Increased sleep 3 Increased heart rate 4 Reduced urine output

3 Increased heart rate Myxedema is a condition where thyroid activity is diminished. Hypothyroid drugs such as levothyroxine are prescribed to treat it. When this drug is given in high doses, the patient's cardiac activity may be altered, so the nurse would check for increased heart rate. Diarrhea is also observed as a side effect in the event of an overdose. However, bloody stools are not observed. Patients who are administered an overdose of the drug develop insomnia as a side effect. Irregularities in urine output are a symptom of declined renal function. However, they may not be caused by an overdose of thyroid hormones.

The nurse is caring for a patient who has congenital hypothyroidism. Which medication would the nurse expect the primary health care provider to prescribe? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Propylthiouracil

3 Levothyroxine Levothyroxine is a thyroid drug used to treat congenital hypothyroidism. Liotrix is a thyroid drug used to treat hypothyroidism but not congenital hypothyroidism. Methimazole and propylthiouracil are the antithyroid drugs used to treat hyperthyroidism but not congenital hypothyroidism.

Which thyroid preparation, considered the purest form of thyroxine (T4), is the drug of choice for hypothyroidism? 1 Liotrix 2 Liothyronine 3 Levothyroxine 4 Propylthiouracil

3 Levothyroxine The drug of choice for thyroid hormone replacement therapy is the purest form of thyroxine, levothyroxine. Liotrix is a combination of liothyronine and levothyroxine and is not considered the purest form. Propylthiouracil is an antithyroid medication used in the treatment of hyperthyroidism.

The nurse teaches a nursing student about liotrix. Which statement made by the nurse is appropriate? 1 Liotrix contains T3 alone. 2 Liotrix contains T4 alone. 3 Liotrix contains T4 and T3 in a 4:1 ratio. 4 Liotrix contains T4 combined with calcium.

3 Liotrix contains T4 and T3 in a 4:1 ratio. Liotrix is used in treating hypothyroidism, and it contains T4 and T3 in a 4:1 ratio, which replaces the diminished hormone levels of the body. None of the thyroid drugs contain T3 alone. Levothyroxine is the only drug that contains only T4. Calcium is not combined with T4 in liotrix.

Which food should a patient avoid while taking antithyroid medications? 1 Milk 2 Eggs 3 Seafood 4 Chicken

3 Seafood Patients taking antithyroid medications must avoid eating foods high in iodine, such as tofu and other soy products, turnips, seafood, iodized salt, and some breads. Milk, eggs, and chicken do not contain excess amounts of iodine.

The nurse finds that, after 6 months of treatment for hyperthyroidism, a patient has little evidence of hyperthyroidism. Which condition does this imply regarding the patient's present condition? 1 The patient is receiving a higher dose of drug than prescribed. 2 The disease is progressing silently without any manifestations. 3 The patient has met the predicted outcomes of the treatment regimen. 4 The patient needs a slightly higher dose to resolve the condition completely.

3 The patient has met the predicted outcomes of the treatment regimen. Any intervention should be evaluated to deduce the outcomes. The treatment regimen is rigorously evaluated to reduce the possible adverse effects. After a thorough assessment, the nurse evaluates the prognosis of the patient's condition. Here, based on the findings, the nurse interprets that the patient has good prognosis with the predicted outcomes. The disease is not progressing silently because the patient is doing well in every aspect of life. The dosage cannot suddenly be reduced or discontinued. After thoroughly assessing and observing the patient's blood parameters, the primary health care provider will make the appropriate decision. The patient has been doing well with the current dosage for 6 months, so the patient does not need an increased dosage in the regimen.

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine. Which statement would the nurse include in the teaching session? 1 "Always take the medication thrice a day, after meals." 2 "Take this medication with 250 mL of orange juice regularly." 3 "There are no dietary restrictions while taking this medication." 4 "Consult your provider before taking over-the-counter medications."

4 "Consult your provider before taking over-the-counter medications." Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to avoid taking over-the-counter medicines without first consulting with their primary health care providers. This helps prevent adverse effects caused by drug interactions. The nurse would instruct the patient to take the medication once a day on an empty stomach, half an hour before breakfast. This helps enhance the absorption of the drug. Taking the medication thrice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. This medication should be taken with water rather than orange juice because it helps enhance the disintegration and absorption of the drug. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore the nurse would not give false information that the patient need not follow dietary restrictions.

The health care provider prescribes a thyroid replacement drug to a patient with hypothyroidism. Which is the first intervention that helps determine the dosage of thyroid replacement drug for the patient? 1 Checking the physical parameters of the patient 2 Checking the patient's knowledge of thyroid therapy 3 Checking the medication history of patient and family 4 Checking the patient's serum thyroid-stimulating hormone levels

4 Checking the patient's serum thyroid-stimulating hormone levels Before prescribing the thyroid replacement drug to the patient with hypothyroidism, the nurse and primary health care provider have to check the patient's serum thyroid-stimulating hormone (TSH) level. This helps them know the underlying pathologic condition and helps them prescribe the right dosage and medication to the patient. Apart from the patient's TSH level, the patient's free thyroid hormone levels should also be checked. Doing a physical assessment would help calculate the optimal dosage for the patient to prevent adverse effects. The nurse does not expect the patient to have prior knowledge of thyroid therapy. After monitoring the TSH level, the nurse would check the patient's history; this helps rule out possible contraindications and allergies.

The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse? 1 Monitor the patient for cardiac dysrhythmias. 2 Assess peripheral pulses and Homan's sign daily. 3 Weigh the patient daily for excessive weight loss. 4 Monitor the patient for increased risk of bleeding.

4 Monitor the patient for increased risk of bleeding. Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at increased risk of dysrhythmias, deep vein thrombosis, or weight loss.

Which medication is used to treat hyperthyroidism during the first trimester of pregnancy? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Propylthiouracil

4 Propylthiouracil Propylthiouracil is an antithyroid medication used in the first trimester of pregnancy to treat hyperthyroidism. Methimazole is recommended after the first trimester of pregnancy because it causes fetal adverse effects like scalp abnormalities, goiter, and cretinism. Liotrix and levothyroxine are hypothyroid medications that are used to treat hypothyroidism.

A patient is taking an antithyroid medication. Which foods would the nurse teach the patient to avoid eating? 1 Ham and cheese omelet, rye toast with butter, orange juice 2 Hamburger on sesame roll, salad with French dressing, milk 3 Chicken salad sandwich with mayonnaise, vegetable soup, milk 4 Shrimp cocktail, boiled lobster, spinach salad without dressing, milk

4 Shrimp cocktail, boiled lobster, spinach salad without dressing, milk Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.

The nurse is assessing an older adult who has been taking liotrix for 6 months. The nurse finds that the patient has anxiety, tremors, and insomnia. Which would the nurse interpret from these findings? 1 The patient is hypersensitive to thyroid drugs. 2 The patient has common age-related symptoms. 3 The patient is not responding to the thyroid drugs. 4 The patient is experiencing adverse effects of the thyroid drugs.

4 The patient is experiencing adverse effects of the thyroid drugs. Anxiety, tremors, and insomnia are the adverse effects of liotrix. These adverse effects may be due to accumulation of the drug in the body or due to overdose of the medication. If the patient has an allergic reaction immediately after taking the drug or within 24 hours after drug administration, it indicates that the patient is hypersensitive to the medication. An elderly patient would not necessarily have anxiety, tremors, and insomnia. Therefore the nurse would avoid generalizing the symptoms and avoid considering them common age-related symptoms. If the patient were not responding to the medication, the patient would have decreased thyroid hormone levels.