Medication for Thyroid Disorder
levothyroxine precautions
- cardiovascular disorders (hypertension, angina pectoris, ischemic heart disease) - renal impairment - diabetes mellitus - older adults
levothyroxine interactions
- cholestyramine, antacids, iron and calcium supplements, and sucralfate reduce absorption, so client should not take levothyroxine within 4 hr of these drugs - food reduces absorption - many anti seizure and antidepressant drugs, including carbamazepine, phenytoin, phenobarbital, and sertraline, decrease levels - anticoagulant effects of warfarin increase - cardiac response to catecholamines increase
proprylthiouracil interactions
- concurrent use with antienoplastics or radiation therapy can lead to additional bone marrow depression - increased antithyroid effects noted when taken with lithium or potassium iodide - risk of agranulocytosis increases with concurrent use of phenothiazines
Proprylthiouracil contraindications
hypersensitivity
levothyroxine therapeutic use
hypothyroidism
levothyroxine client instructions
watch for and report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and chest pain
levothyroxine administration
- give orally to treat hypothyroidism and IV to treat myxedema coma - give daily on an empty stomach (at least 30-60 min before breakfast with full glass of water) - measure baselines vital signs, weight, and height, and monitor periodically thereafter. - monitor for cardiac excitability (angina, chest pain, palpitations, dysrhythmias) - monitor T4 and TSH levels - be aware that the various formulations of thyroxine are not interchangeable; instruct clients to notify the provider if a pharmacy dispenses a different levothyroxine product - expect lifelong replacement therapy
propylthiouracil therapeutic use
- hyperthyroidism (Graves' disease) - thyrotoxic crisis - suppression of thyroid hormone production in preparation for thyroidectomy
propylthiouracil adverse drug reactions
- hypothyroidism m - agranulocytosis - hepatotoxicity - aplastic anemia - rash - arthralgia, headache - vertigo, drowsiness, headache
proprylthiouracil precautions
- immunosuppression - bone marrow depression - infection - liver dysfunciton - pregnancy
levothyroxine contraindications
- thyrotoxicosis - recent myocardial infarction
a.
a nurse in a clinic is reviewing the laboratory values of a client who has primary hypothyroidism. the nurse should anticipate an elevation of which of the following laboratory values? a. thyroid stimulating hormone (TSH) b. Free T4 c. serum T4 d. serum T3
d.
a nurse is assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. which of the following manifestations should the nurse expect? a. drowsiness b. bradycardia c. dry skin d. heat intolerance
c.
a nurse is assessing a client who is receiving litholyroxine for treatment of hypothyroidism. the nurse should recognize which of the following findings is a therapeutic response to this medication? a. decrease in appetite b. increase in weight c. increase in energy d. decrease in body temperature
a.
a nurse is assessing a client who is taking levothyroxine. the nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose? a. insomnia b. constipation c. drowsiness d. hypoactive deep-tendon reflexes
Proprylthiouracil administration
- give orally at regular intervals, such as every 8 hr - measure baselines vital signs and weight and monitor periodically thereafter - monitor T3 and T4 levels
levothyroxine interventions
- monitor thyroid function - monitor for indications of hyperthyroidism (anxiety, tachycardia, palpitations, tremors, altered appetite, heat intolerance, fever, diaphoresis, weight loss)
propythiouracil interventions
- monitor thyroid function - monitor for indications of hypothyroidism (fatigue, weakness, weight gain, cold intolerance, dry skin, and listlessness) - recommend a reduced dosage for clients who develop these effects - monitor CBC at baselines and periodically thereafter (leukocytes, neutrophils) - monitor for indications of agranulocytosis; for these symptoms, stop therapy. - monitor integumentary status - monitor for joint and muscle pain and headache
levothyroxine adverse drug reactions
- thyrotoxicosis, hyperthyroidism (from excessive doses) - headache, irritability, insomnia - abdominal cramping, diarrhea - tachycardia, arrhythmia - heat intolerance, diaphoresis - menstrual irregularities
proprylthiouracil client instructions
- watch for and report signs of hyperthyroidism and hypothyroidism - report fever or sore throat - report rash - report joint or muscle pain or headache - report any OTC meds, herbal remedies, and supplements to the provider
c.
a nurse is caring for a client who has developed agranulocytosis as a result of taking propylthiouracil to treat hyperthyroidism. the nurse should understand that this client is at increased risk for which of the following conditions? a. excessive bleeding b. ecchymosis c. infection d. hyperglycemia
b.
a nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. on which of the following medications should the nurse prepare to instruct the client? a. radioactive iodine b. levothyroxine c. sumatriptan d. levofloxacin
c.
a nurse is providing teaching to a client who has a new prescription for levothyroxine for hypothyroidism. the nurse should instruct the client to avoid which of the following herbal supplements? a. saw palmetto b. cranberry c. soy d. garlic
d.
a nurse is reviewing the medical record of a client who has been on levothyroxine for several months. which of the following findings indicates a therapeutic response to the medication a. decrease in level of thyroxine (T4) b. increase in weight c. increase in hr of sleep per night d. decrease in level of thyroid stimulating hormone (TSH)
b.
a nurse is teaching about levothyroxine which a client who has primary hypothyroidism. which of the following statements should the nurse use when teaching the client? a. take this medication until your symptoms are gone and then discontinue b. tremors, nervousness, and insomnia may indicate your dose is too high c. symptoms improve immediately after starting the medication d. the medication decreases the overproduction of the thyroid hormone thyroxine.
propylthiouracil
what is the antithyroid drugs?
synthroid
what is the brand name of levothyroxine?
levothyroxine
what is the thyroid replacement medicaiton?
