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Pharmacology > Wk 8. Thyroid Disorders > Flashcards

Wk 8. Thyroid Disorders Flashcards

1
Q

What two hormones does the thyroid produce?

A

Triiodothyronine T3

Thyroxine T4

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2
Q
  1. Which thyroid hormone is converted in the periphery?
A

T4 is converted to T3

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3
Q
  1. Which thyroid hormone is more potent?
A

T3

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4
Q
  1. Describe the steps of thyroid hormone regulation. (TRH, TSH, T3, T4, negative feedback loop)
A

TRH from hypothalamus TSH from anterior pituitary T3 & T4 from thyroid inhibit TSH from anterior pituitary

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5
Q
  1. Describe the relationship of TSH levels to T3 and T4 levels.
A

Low T3 or T4 increases TSH, high T3 or T4 lowers TSH

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6
Q
  1. Describe common clinical signs and symptoms of hypothyroidism?
A

Goiter; puffy, expressionless face; cold/dry skin; brittle hair; hair loss from scalp & outer half of eyebrows; fatigue; irritability; depression; lack of concentration; cold intolerance; constipation; heavy menses; increased cholesterol

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7
Q
  1. Persons over 50 years of age may need what change in the initial dose of levothyroxine?
A

Lowered

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8
Q
  1. Discuss the effects on the fetus of maternal hypothyroidism in pregnancy. A person treated for hypothyroidism may need to increase the dose of levothyroxine by how much?
A

Decreased IQ and neuropsychological function of the child. Increase levothyroxine dose by up to 50%.

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9
Q
  1. Discuss the effects of congenital hypothyroidism in infants.
A

Mental retardation, large tongue, pot belly, dwarfish stature, derangement of growth - nerves, muscles, bone, teeth

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10
Q
  1. How long until levothyroxine reaches a plateau?
A

One month

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11
Q
  1. Levothyroxine should be given with or without food?
A

Without food

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12
Q
  1. Discuss the expected change in TSH when a patient is responding to levothyroxine.
A

TSH decreases to normal levels

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13
Q
  1. Describe the signs and symptoms of thyrotoxicosis.
A

Tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating, abdominal cramping, weight loss, increased appetite, menstrual irregularities

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14
Q
  1. Which drugs can cause decreased absorption of levothyroxine? How many hours after the administration of levothyroxine may these drugs be given?
A

H2-recptor blockers, proton pump inhibitors, bile-acid sequestrants such as colestyramine (Questran) and colestipol (Colestid); sucralfate (Carafate); calcium, iron, magnesium, aluminum.
4 hours.

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15
Q
  1. Why would a nurse administer levothyroxine with caution to a patient on warfarin?
A

Levothyroxine increases the degradation of Vitamin K-dependent clotting factors and may increase the chance of bleeding. May need to decrease dose of warfarin.

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16
Q
  1. What is the interaction between catecholamines and levothyroxine?
A

Levothyroxine increases the body’s response to epinephrine, norepinephrine, and dopamine.

17
Q
  1. Why might liothyronine (Cytomel) be given instead of levothyroxine (Levothyroid)?
A

Rapid onset of action in myxedema coma.

18
Q
  1. Discuss the nursing care of a patient with hypothyroidism.
A

Life-long replacement; take on an empty stomach; monitor for hypothyroidism & hyperthyroidism; hold levothyroxine if pulse >100/min & call primary care provider; monitor TSH, T3 & T4; minimize adverse drug interactions; monitor warfarin levels.

19
Q
  1. What are the symptoms of thyrotoxic crisis (thyroid storm)? What usually triggers it?
A

Restlessness, agitation, tremor, severe tachycardia, hypotension, heart failure, hyperthermia, profound weakness, unconsciousness, coma.
Severe illness or major surgery.

20
Q
  1. What mimics TSH in patients with Grave’s Disease?
A

Thyroid-stimulating immunoglobulins (TSI)

21
Q
  1. What are some signs and symptoms of Grave’s Disease?
A

Rapid, strong heartbeat; rapid thoughts & speech; trouble concentrating; tremor; insomnia; weakened muscles; increased body temperature; warm, moist skin; increased appetite with weight loss; diarrhea; exophthalmos.

22
Q
  1. What TSH level is expected with hyperthyroidism?
A

Decreased TSH

23
Q
  1. Give two ways propylthiouracil (PTU) works in hyperthyroidism?
A

Inhibits thyroid hormone synthesis by inhibiting peroxidase. Suppresses conversion of T4 to T3 in the periphery.

24
Q
  1. Name a blood disorder caused by thionamides?
A

Agranulocytosis – may see sore throat or fever.

25
Q
  1. What may happen to thyroid hormone production after the use of a thionamide?
A

Hypothyroidism

26
Q
  1. How does Tapazole (methimazole) work differently from PTU?
A

Inhibits thyroid hormone synthesis, but does not block T4 or T3 in the periphery.

27
Q
  1. LOW-dose iodine-131 causes which delayed adverse effect?
A

Hypothyroidism

28
Q
  1. What precautions should be taken with persons undergoing HIGH-dose iodine-131?
A

Stay 3-6 feet from patient; only 30 min of contact per day; double flush urine and secretions down toilet; have patient increase fluids and void frequently.

29
Q
  1. How does an iodine solution work?
A

Inhibits synthesis and release of thyroid hormones.

30
Q
  1. At what heart rate would the nurse hold the levothyroxine and call the prescriber?
A

Hold if >100/min

Pharmacology (25 decks)

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