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Questions and Answers
What is the general range of synthetic levothyroxine for the treatment of hypothyroidism?
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?
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?
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?
What can occur when thyroid replacement is initiated due to the enhanced cardiovascular effects of catecholamines?
What are some clinical manifestations that patients on thyroid hormone replacement may complain of despite normal TSH levels?
What are some clinical manifestations that patients on thyroid hormone replacement may complain of despite normal TSH levels?
What occurs when thyroid hormone is given in relation to oxygen demand and delivery?
What occurs when thyroid hormone is given in relation to oxygen demand and delivery?
What does the occurrence of angina and acute coronary syndrome signal in relation to the oxygen needs of the myocardium?
What does the occurrence of angina and acute coronary syndrome signal in relation to the oxygen needs of the myocardium?
What occurs when metabolism is subnormal and the tissues require relatively little oxygen?
What occurs when metabolism is subnormal and the tissues require relatively little oxygen?
What is the drug of choice for the treatment of hypothyroidism?
What is the drug of choice for the treatment of hypothyroidism?
What is the signal that the oxygen needs of the myocardium exceed its blood supply?
What is the signal that the oxygen needs of the myocardium exceed its blood supply?
What is a contraindication to levothyroxine therapy?
What is a contraindication to levothyroxine therapy?
Why should dosage of levothyroxine be individualized?
Why should dosage of levothyroxine be individualized?
When should patients take levothyroxine?
When should patients take levothyroxine?
What should patients do if they experience adverse effects of levothyroxine?
What should patients do if they experience adverse effects of levothyroxine?
What are some adverse effects of levothyroxine therapy?
What are some adverse effects of levothyroxine therapy?
How often is thyroid replacement therapy for hypothyroidism required?
How often is thyroid replacement therapy for hypothyroidism required?
What should patients do before taking over-the-counter drugs while on levothyroxine therapy?
What should patients do before taking over-the-counter drugs while on levothyroxine therapy?
What should the nurse assess for as therapeutic effects of levothyroxine therapy?
What should the nurse assess for as therapeutic effects of levothyroxine therapy?
What condition warrants caution when administering levothyroxine?
What condition warrants caution when administering levothyroxine?
How should the dosage of levothyroxine be adjusted initially?
How should the dosage of levothyroxine be adjusted initially?
What percentage does absorption of levothyroxine vary after oral administration?
What percentage does absorption of levothyroxine vary after oral administration?
What is the FDA's BLACK BOX WARNING regarding the use of thyroid hormones?
What is the FDA's BLACK BOX WARNING regarding the use of thyroid hormones?
What is the recommended action regarding levothyroxine use in older adults?
What is the recommended action regarding levothyroxine use in older adults?
What is a potential adverse effect of levothyroxine in patients with hepatic impairment?
What is a potential adverse effect of levothyroxine in patients with hepatic impairment?
What is the main adverse effect of levothyroxine?
What is the main adverse effect of levothyroxine?
What should be monitored in older adults receiving levothyroxine?
What should be monitored in older adults receiving levothyroxine?
How does levothyroxine affect the metabolic rate in the body's tissues?
How does levothyroxine affect the metabolic rate in the body's tissues?
What is the recommended management of patients in thyroid storm or thyrotoxic crisis?
What is the recommended management of patients in thyroid storm or thyrotoxic crisis?
What is the action of levothyroxine in the body's tissues?
What is the action of levothyroxine in the body's tissues?
What is the recommended method for rewarming in patients with myxedema coma?
What is the recommended method for rewarming in patients with myxedema coma?
What percentage of levothyroxine is absorbed after oral administration?
What percentage of levothyroxine is absorbed after oral administration?
What is the standard of care for long-term treatment of hypothyroidism?
What is the standard of care for long-term treatment of hypothyroidism?
What has the FDA issued a BLACK BOX WARNING cautioning against using thyroid hormones for?
What has the FDA issued a BLACK BOX WARNING cautioning against using thyroid hormones for?
What is a key adverse effect of levothyroxine in older adults, especially those with cardiovascular disease?
What is a key adverse effect of levothyroxine in older adults, especially those with cardiovascular disease?
What condition requires increased or more frequent dosing of levothyroxine due to the hypermetabolic state?
What condition requires increased or more frequent dosing of levothyroxine due to the hypermetabolic state?
What are some adverse effects of levothyroxine?
What are some adverse effects of levothyroxine?
What is a contraindication to levothyroxine therapy?
What is a contraindication to levothyroxine therapy?
What should be done if angina or arrhythmias occur during thyroid hormone administration?
What should be done if angina or arrhythmias occur during thyroid hormone administration?
What effect does levothyroxine have on the body's tissues and metabolism?
What effect does levothyroxine have on the body's tissues and metabolism?
What is necessary to increase the absorption of levothyroxine after oral administration?
What is necessary to increase the absorption of levothyroxine after oral administration?
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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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.