Levothyroxine Therapy Nursing Implications Quiz
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Questions and Answers

What is the general range of synthetic levothyroxine for the treatment of hypothyroidism?

  • 100 to 200 mcg per day
  • 50 to 100 mcg per day
  • 75 to 150 mcg per day (correct)
  • 25 to 75 mcg per day

    • How is treatment generally started with synthetic levothyroxine?

  • At the lower dose and titrated slowly (correct)
  • At the average dose for the patient's age
  • At the maximum dose immediately
  • At the higher dose and titrated quickly

    • What dose of synthetic levothyroxine is often sufficient for older adult patients to achieve normal TSH levels?

  • 25 mcg per day
  • 75 mcg per day
  • 100 mcg per day
  • 50 mcg per day (correct)

    • What can occur when thyroid replacement is initiated due to the enhanced cardiovascular effects of catecholamines?

    <p>Angina or arrhythmias</p> Signup and view all the answers

    What are some clinical manifestations that patients on thyroid hormone replacement may complain of despite normal TSH levels?

    <p>Continued clinical manifestations</p> Signup and view all the answers

    What occurs when thyroid hormone is given in relation to oxygen demand and delivery?

    <p>Oxygen demand increases, but delivery cannot be increased unless atherosclerosis improves</p> Signup and view all the answers

    What does the occurrence of angina and acute coronary syndrome signal in relation to the oxygen needs of the myocardium?

    <p>The oxygen needs of the myocardium exceed its blood supply</p> Signup and view all the answers

    What occurs when metabolism is subnormal and the tissues require relatively little oxygen?

    <p>A reduction in blood supply is tolerated without overt symptoms of coronary artery disease</p> Signup and view all the answers

    What is the drug of choice for the treatment of hypothyroidism?

    <p>Synthetic levothyroxine</p> Signup and view all the answers

    What is the signal that the oxygen needs of the myocardium exceed its blood supply?

    <p>The occurrence of angina and acute coronary syndrome</p> Signup and view all the answers

    What is a contraindication to levothyroxine therapy?

    <p>Hypersensitivity</p> Signup and view all the answers

    Why should dosage of levothyroxine be individualized?

    <p>To account for age and severity of hypothyroidism</p> Signup and view all the answers

    When should patients take levothyroxine?

    <p>In the morning on an empty stomach</p> Signup and view all the answers

    What should patients do if they experience adverse effects of levothyroxine?

    <p>Report adverse effects to the prescriber</p> Signup and view all the answers

    What are some adverse effects of levothyroxine therapy?

    <p>Tachycardia and chest pain</p> Signup and view all the answers

    How often is thyroid replacement therapy for hypothyroidism required?

    <p>It's lifelong</p> Signup and view all the answers

    What should patients do before taking over-the-counter drugs while on levothyroxine therapy?

    <p>Consult a healthcare provider</p> Signup and view all the answers

    What should the nurse assess for as therapeutic effects of levothyroxine therapy?

    <p>Increased energy and improved sleep</p> Signup and view all the answers

    What condition warrants caution when administering levothyroxine?

    <p>Addison's disease</p> Signup and view all the answers

    How should the dosage of levothyroxine be adjusted initially?

    <p>With gradual increases at 2-week intervals</p> Signup and view all the answers

    What percentage does absorption of levothyroxine vary after oral administration?

    <p>48% to 79%</p> Signup and view all the answers

    What is the FDA's BLACK BOX WARNING regarding the use of thyroid hormones?

    <p>Thyroid hormones should not be used for the treatment of obesity or weight loss</p> Signup and view all the answers

    What is the recommended action regarding levothyroxine use in older adults?

    <p>Use smaller initial dosages and smaller drug increments at longer intervals</p> Signup and view all the answers

    What is a potential adverse effect of levothyroxine in patients with hepatic impairment?

    <p>Delayed drug metabolism</p> Signup and view all the answers

    What is the main adverse effect of levothyroxine?

    <p>Signs and symptoms of hyperthyroidism</p> Signup and view all the answers

    What should be monitored in older adults receiving levothyroxine?

    <p>Blood pressure and pulse</p> Signup and view all the answers

    How does levothyroxine affect the metabolic rate in the body's tissues?

    <p>Increases the metabolic rate</p> Signup and view all the answers

    What is the recommended management of patients in thyroid storm or thyrotoxic crisis?

    <p>Increased or more frequent dosing of medications</p> Signup and view all the answers

    What is the action of levothyroxine in the body's tissues?

    <p>Increases oxygen consumption, respiratory rate, and heart rate</p> Signup and view all the answers

    What is the recommended method for rewarming in patients with myxedema coma?

    <p>Passive rewarming with a blanket</p> Signup and view all the answers

    What percentage of levothyroxine is absorbed after oral administration?

    <p>48% to 79%</p> Signup and view all the answers

    What is the standard of care for long-term treatment of hypothyroidism?

    <p>Levothyroxine</p> Signup and view all the answers

    What has the FDA issued a BLACK BOX WARNING cautioning against using thyroid hormones for?

    <p>Obesity or weight loss</p> Signup and view all the answers

    What is a key adverse effect of levothyroxine in older adults, especially those with cardiovascular disease?

    <p>Increased workload of the heart</p> Signup and view all the answers

    What condition requires increased or more frequent dosing of levothyroxine due to the hypermetabolic state?

    <p>Thyroid storm</p> Signup and view all the answers

    What are some adverse effects of levothyroxine?

    <p>Tachycardia, cardiac dysrhythmias, weight loss</p> Signup and view all the answers

    What is a contraindication to levothyroxine therapy?

    <p>Euthyroid individuals</p> Signup and view all the answers

    What should be done if angina or arrhythmias occur during thyroid hormone administration?

    <p>Discontinuation and cautious resumption at lower dosage</p> Signup and view all the answers

    What effect does levothyroxine have on the body's tissues and metabolism?

    <p>Increases metabolic rate, oxygen consumption, and heart rate</p> Signup and view all the answers

    What is necessary to increase the absorption of levothyroxine after oral administration?

    <p>Taking the drug on an empty stomach</p> Signup and view all the answers

    Study Notes

    Levothyroxine Therapy: Nursing Implications and Patient Teaching

    • Excessive thyroid hormones can lead to cardiovascular problems, particularly in elderly patients and those with pre-existing heart disease
    • Contraindications to levothyroxine include hypersensitivity, thyrotoxicosis, and acute myocardial infarction related to hypothyroidism
    • Caution is warranted in Addison's disease, as thyroid hormones increase tissue demands for adrenocortical hormones
    • Dosage of levothyroxine should be individualized based on factors such as age, severity of hypothyroidism, and clinical response
    • Initial dosage is small, with gradual increases at 2-week intervals until symptoms are relieved and normal serum TSH levels are reestablished
    • Thyroid replacement therapy for hypothyroidism is lifelong, requiring frequent medical supervision and annual check-ups
    • Patients should take levothyroxine in the morning on an empty stomach, and not change brands of medication
    • The nurse assesses for therapeutic effects such as increased energy, improved sleep, and reversal of skin and hair coarseness
    • Adverse effects of levothyroxine include tachycardia, cardiac dysrhythmias, chest pain, edema, and signs of heart failure
    • Patient teaching includes the importance of lifelong levothyroxine therapy, periodic thyroid function tests, and consistent timing of medication
    • Patients should avoid switching drug brands, and consult a healthcare provider before taking over-the-counter drugs that stimulate the heart or cause nervousness
    • Patients should take levothyroxine every morning on an empty stomach, avoid certain drug interactions, and report adverse effects to the prescriber

    Levothyroxine: Key Points for Clinical Use

    • Discontinuation of thyroid hormone administration is necessary if angina or arrhythmias occur, and cautious resumption at lower dosage is advised with close monitoring by the primary provider and nurse.
    • Oral thyroid hormones interact with warfarin, adrenergic agents, insulin, oral hypoglycemic medications, and estrogen, requiring dosage adjustments and caution.
    • Absorption of levothyroxine varies after oral administration, with 48% to 79% absorption, which can be increased by taking the drug on an empty stomach.
    • Levothyroxine, a synthetic preparation of thyroxine, is the standard of care for long-term treatment of hypothyroidism and can be administered orally and parenterally.
    • Levothyroxine increases the metabolic rate in the body's tissues, oxygen consumption, respiratory rate, heart rate, and metabolism of fats, carbohydrates, and proteins.
    • Health care providers use levothyroxine for replacement therapy in hypothyroidism, treatment and prevention of euthyroid goiters, management of thyroid cancer, and prevention of goitrogenesis, hypothyroidism, and thyrotoxicosis during pregnancy.
    • The FDA has issued a BLACK BOX WARNING cautioning against using thyroid hormones for obesity or weight loss due to serious complications in euthyroid individuals.
    • Levothyroxine increases the workload of the heart and may cause serious adverse effects in older adults, especially those with cardiovascular disease, requiring cautious treatment and monitoring.
    • Hepatic metabolism of levothyroxine in patients with hypothyroidism is slow, necessitating assessment of drug reactions in patients with hepatic impairment.
    • Management of patients in thyroid storm or thyrotoxic crisis requires increased or more frequent dosing of levothyroxine due to the hypermetabolic state.
    • Adverse effects of levothyroxine include signs and symptoms of hyperthyroidism, tachycardia, cardiac dysrhythmias, angina pectoris, myocardial infarction, heart failure, nervousness, hyperactivity, insomnia, diarrhea, abdominal cramps, nausea, vomiting, weight loss, fever, and heat intolerance.
    • Most adverse reactions stem from excessive doses, and signs and symptoms produced are the same as those occurring with hyperthyroidism.

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    Description

    Test your knowledge of levothyroxine therapy nursing implications and patient teaching with this quiz. Assess your understanding of dosage individualization, contraindications, administration guidelines, monitoring for therapeutic effects, and patient education.

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