Endocrine Drugs: Thyroid, Parathyroid, and Adrenal PDF

Endocrine Drugs: Thyroid, Parathyroid, and Adrenal NUR 210/BSL 101 Unit 9  Action Increases metabolic rate, oxygen consumption and body growth (Increases T3 and T4) Thyroid hormone Uses...

Endocrine Drugs: Thyroid, Parathyroid, and Adrenal NUR 210/BSL 101 Unit 9  Action Increases metabolic rate, oxygen consumption and body growth (Increases T3 and T4) Thyroid hormone Uses replacement Levothyroxine is drug of choice levothyroxine Hypothyroidism ◦ Myxedema – severe hypothyroidism in adults ◦ Cretinism – severe hypothyroidism in children Signs and symptoms ◦ Lethargy, memory impairment, slow thinking, cold intolerance, dry skin, constipation, weight gain  Side effects/adverse reactions GI distress Tremors/nervousness/insomnia Hypothyroidism: Weight loss levothyroxine Tachycardia Hypertension Palpitations Osteoporosis Thyroid storm  ▪Interactions Increased effects of anticoagulants, TCAs, vasopressors, decongestants Decreased effects of antidiabetic drugs, digoxin Hypothyroidism: Food – take on empty stomach ½-1 hour levothyroxine before food Contraindications Severe renal disease Caution ◦ cardiovascular disease ◦ Hypertension ◦ Diabetes (increases blood glucose)  Increase in circulating T4 and T3 levels Graves disease, or thyrotoxicosis ◦ Signs and symptoms ▪ tachycardia, palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos Hyperthyroidism (bulging eyes), and weight loss Treatment Antithyroid drugs, which inhibit either synthesis or release of thyroid hormone ◦ Surgical removal of a portion of the thyroid gland (subtotal thyroidectomy) ◦ Radioactive iodine therapy  Action Reduce the excessive secretion of thyroid hormones (T3 and T4) Hyperthyroidism - Uses propylthiouracil hyperthyroidism ◦ Can take a week to work ◦ May need beta blocker (propranolol- drug of choice for hyperthyroidism to control bp & hr)  Interactions ◦ Increase effect of anticoagulants ◦ Decrease effect of antidiabetics Hyperthyroidism - ◦ Digoxin and lithium increase propylthiouracil action of thyroid drugs. Side effects/adverse reactions ◦ Sore throat ◦ Rash ◦ fever  Assessment Thyroid drug Baseline vital signs nursing process T3, T4, and TSH levels 1 Medical and medication history (history of diabetes) Allergies  Nursing interventions Monitor vital signs, weight. Administer thyroid replacement drug before breakfast on empty Thyroid Conditions stomach Take antithyroid drug with meals Check labels before using OTC’s. Advise reporting of symptoms of hyperthyroidism/hypothyroidism Encourage medical alert tag.  Nursing interventions Do not abruptly stop thyroid drugs. Advise reporting of symptoms of hypothyroidism/hyperthyroidism Thyroid Conditions Take drug same time every day Teach client to take vital signs Teach diabetic client that thyroid drugs can decrease effectiveness of antidiabetic drugs  Parathyroid disorders (parathyroid hormone deficiency) low calcium associated with CRF Decrease bone resorption Treatment Calcitriol Class – Vitamin D analog Hypoparathyroidism Action Promotes calcium absorption from GI tract Decreases bone resorption (secretion of calcium from bone to blood) Enhances Ca reabsorption by kidneys Net effect: increase serum calcium level  Side Effects ◦ Fatigue, weakness, somnolence, N/V, diarrhea, cramps, dizzy/drowsy, anorexia Hypoparathyroidism Adverse Reactions - calcitriol Hypercalcemia, arrythmias, HTN Contraindications/Interactions Cardiac disease, renal calculi, malabsorption syndrome Digoxin, verapamil Can increase calcium with thiazide diuretics and calcium supplements  Assessment Serum calcium level – 9-10.5 mg/dl Signs and symptoms of hypocalcemia – twitching of mouth, tingling and numbness of fingers, carpopedal Hypoparathyroidism spasms, muscle spasms - calcitriol Interventions Monitor serum calcium level and for s/s of hypocalcemia Teach client to report s/s of hypocalcemia https://youtu.be/kvmwsTU0InQ Chvostek and trousseau signs  Adrenal glands Adrenal medulla ◦ Produces epinephrine and norepinephrine Adrenal cortex Adrenal glands ◦ Produces glucocorticoids (cortisol) ◦ Mineralocorticoids (aldosterone) Glucocorticoid hyposecretion ◦ Addison disease Glucocorticoid hypersecretion ◦ Cushing syndrome  Adrenal glands Produces glucocorticoids (cortisol) ◦ Promote sodium and water retention, potassium excretion ◦ Adrenal hyposecretion (Addison’s Adrenal glands disease) ◦ Levels controlled by negative feedback Mineralocorticoids (aldosterone) ◦ Promotes sodium and water retention, potassium excretion ◦ Controlled by renin-angiotensin system  Prednisone Action ◦ Affect inflammatory response ◦ Affect carbohydrate, protein, and fat Adrenal drugs - metabolism Glucocorticosteroids ◦ Affect muscle and blood cell activities - prednisone Use 1 ◦ Inflammation, ulcerative colitis, glomerulonephritis ◦ Autoimmune disorders ◦ drug reactions, anaphylaxis ◦ Asthma ◦ prevent organ rejection Controlled by acth in brain  Side effects Nausea, diarrhea, abdominal distension, increased appetite Sweating, headache, flushing Adrenal drugs - Mood changes, depression, cataracts, Glucocorticosteroids amenorrhea - prednisone Adverse Reactions – Think of Cushing’s disease 1 Petechiae, thin skin, ecchymosis, osteoporosis Tachycardia, hypertension Hyperglycemia, abnormal fat deposits, muscle wasting, edema Sodium and fluid retention, potassium loss Circulatory collapse, thrombophlebitis, embolism  Contraindications Allergy Psychosis Adrenal drugs - Fungal infection Glucocorticosteroids Peptic ulcer disease - prednisone Caution 1 Diabetes, Renal disease , CHF, MI, Hypertension Osteoporosis, Seizures, Cataracts, glaucoma Interactions Decreased effects of anticonvulsants, antidiabetics Digoxin, higher possibility of dig toxicity  Oral mineralocorticoid (Aldosterone) Use ◦ Adrenocortical insufficiency Adrenal drugs - ◦ Addison’s disease Mineralocorticoids - fludrocortisone Action ◦ Replaces aldosterone ▪ Increases water and sodium retention ▪ Excretes potassium Controlled by renin-angiotensin system Nursing Process: Assessment Glucocorticoids ▪ Baseline vital signs mineral ▪ Labs ▪ Sodium, potassium, blood glucose corticosteroids ▪ Weight ▪ Urine output ▪ Medical/medication history ▪ Glaucoma, cataracts, peptic ulcer, psych issues, DM  Nursing interventions VS Nursing Process: Weight Glucocorticoids Lung sounds mineral Monitor electrolytes, blood sugar corticosteroids Monitor for signs and symptoms of electrolyte imbalance ◦ Hypokalemia – N/v, muscular weakness, abdominal distension, irregular heart rate Increase potassium diet Monitor for side effects/adverse reactions Osteoporosis in the older adult  Teaching Do not stop abruptly – must be weaned off of medication Nursing Process: Teach to s/s of hypokalemia Glucocorticoids Weigh self mineral Report to other health care providers corticosteroids about use Stay away from people who are sick Teach to side effects ◦ Moon face, puffy eyelids, edema in feet, bruising, dizziness, bleeding, menstrual irregularity Take with food Increase potassium in diet  A client has adrenocortical insufficiency and was taking hydrocortisone 240 mg every 12 hours IV. Before discharge the drug was switched to prednisone. Which is appropriate Practice Question teaching for discharging a client with oral #1 prednisone? A. Stop the drug when feeling better. B. Prednisone is always given by injection. C. The dose needs to be tapered off over 1 to 2 weeks. D. Hyperkalemia is common.  Answer: C Practice Question Rationale: Glucocorticoids must be tapered #1 off gradually to avoid adrenal crisis. Never stop the drug abruptly. Prednisone is an oral preparation. Prednisone promotes potassium loss and hypokalemia.  A nurse has been teaching a client about levothyroxine. Which side effect should the Practice Question nurse teach the client to observe for? #2 A. Somnolence B. Bradycardia C. Constipation D. Nervousness Practice Question Answer: D #2 Rationale: Side effects of levothyroxine include nervousness, tremors, diarrhea, and insomnia.  The nurse will teach a client taking levothyroxine for hypothyroidism to notify the Practice Question health care provider if he or she experiences #3 A. dizziness. B. nausea. C. palpitations. D. abdominal cramps. Practice Question Answer: C Rationale: clients taking this drug should #3 report tachycardia or palpitations to the health care provider. The other options are considered to be not necessarily reportable.  During a diagnostic test for parathyroid function, a client asks the nurse what the parathyroid gland does. The nurse correctly informs the client that the Practice Question parathyroid gland is responsible for #4 A. regulating the body’s metabolism. B. maintaining blood glucose levels. C. controlling the release of glucocorticoids. D. regulating calcium levels. Practice Question Answer: D #4 Rationale: The parathyroid gland regulates calcium levels.  A client has hypoparathyroidism. The nurse anticipates administration of which Practice Question medication? #5 A. Mitotane B. Fludrocortisone C. Dexamethasone D. Calcitriol  Answer: D Rationale: Calcitriol is a vitamin D analogue that promotes calcium absorption Practice Question from the GI tract and secretion of calcium #5 from bone to the bloodstream. Dexamethasone (Decadron) is a glucocorticoid. Mitotane (Lysodren) inhibits glucocorticoid synthesis. Fludrocortisone (Florinef) is an oral mineralocorticoid that is used to treat Addison’s disease.