NUR 426 Lecture Notes - Lecture 10: Thyroid, Esophageal Atresia, Parathyroid Gland

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Published on 14 Nov 2017
Department
Course
Professor
Endocrine Medications
Prototypes
Thyroid agents: Levothyroxine
Anti-thyroid agents: methimazole
Posterior pituitary: Vasopressin
Gluccorticoids: Prednisone
Mineralocorticoids: Florinef
Parathyroid agents: calcitriol, parathyroid hormone
Osteoporosis agents: alendronate
Categories
Pituitary hormones
- Posterior pituitary: ADH, Oxytocin
- Anterior Pituitary: TSH, PRL, FSH & LH (gonadotropins), ACTH, GH
o TSH stimulates thyroid to produce thyroid hormone
o PRL acts on mammary glands to stimulate milk production
o FDH & LH stimulate development of sperm and oocytes
o ACTH Stimulate adrenal cortex to release cortisol, corticosteroids
o GH stimulate hepatic synthesis of IGF-1, which acts on body tissues, cartilage,
bone, muscle, adipose, connective tissue stimulate growth
Thyroid hormones and anti-thyroid hormones
Growth hormone and growth hormone inhibitors
Adrenal hormones
- Glucocorticoids
- Mineralocorticoids
Thyroid Hormones: Thyroid replacement and Antithyroid
Thyroid Disease
Hypothyroidism
- CNS: decreased reflexes, lethargy, slow speech, emotional dullness
- CV: decreased HR, BP, anemia, decreased sensitivity to catecholamines
- Integumentary: pale, coarse, dry, thick skin; puffy eyes, eyelids, coarse, thin hair, hair loss,
thick, hard nails
- Metabolic: decreased body temp; cold interolerance, decreased appetite; increased
cholesterol, fat and weight gain
- GU: Menorrhagia, habitual abortion, sterility, decreased sexual function
- General: Myxedema mucopolysaccharides in heart, tongue, vocal cords; periorbital
edema, cardiomyopathy; hoarseness, thick speech
Hyperthyroidism
- CNS: increased reflexes, anxiety, nervousness, insomnia, tremors, restlessness
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- CV: increased HR, palpitations, systolic hypertension, increased pulse pressure, increased
sensitivity to catecholamines
- Integumentary: flushed, warm, thin, moist skin; sweating, fine, soft hair, soft, thin nails
- Metabolic: increased body temp; heat intolerance, increased appetite; weigth loss; muscle
wasting, weakness
- GU: oligomenorrhea, amenorrhea
- General: periorbital edema; lid lag; exophthalmos; pretibial edema
- Diffuse goiter (enlargement)
Thyroid
- Hypothalamus -> release thyrotropin-releasing hormone (TRH)
- Anterior Pituitary -> releases thyroid stimulating hormone (TSH)
- Thyroid -> releases T4 and T3
- Thyroid gland uses iodine to produce thyroid hormones
Causes of Hypothyroidism
- Absence of the thyroid gland
- Lack of sufficient iodine in the diet to produce the needed level of thyroid hormone
- Lack of sufficient functioning thyroid tissue due to tumor or autoimmune disorders
- Lack of TRH related to a tumor or disorder of the hypothalamus
- Most common issue with thyroid function
- Thyroid Agent Medication: Prototype: Levothyroxine (synthroid)
o Synthetic form of T4
o Desiated throid dried aial throid glads – T3&T4 unpredictable hormone
ratios dose and effects vary widely
o Medications safety
IV: should not be used for the treatment of weight loss or obesity. Larger
doses may produce serious or even life threatening manifestations of
toxicity
Oral: should not be used either alone or with other therapeutic agents for
the treatment of obesity, weight loss, larger does may produce serious or
even life threatening manifestations of toxicitiy
o does not cross placenta
o pregnancy category A
o does enter breast milk in small amounts
o interactions
drugs that interfere with absorption (must be taken 2 hrs apart)
Cholestyramine, antacids, iron, calcium
anticoagulants (warfarin) increased effect
digitalis glycosides decreased effect
theophylline decreased clearance
also interacts with anti-seizure meds, antidepressants (increased
metabolism of thyroid meds)
o adverse effects
usually temporary: loss of hair, sweating
common:
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cardiac: arrhythmia, hypertension, palpitations
CNS: anxiety, sleeplessness, HA
GI: difficulty swallowing, esophageal atresia, weigth loss, diarrhea
Serious
Angina, HF, MI, tachycardia
Hyperthyroidism
Decreased bone density, hip fracture
o Assess
Allergies: thyroid medicines
PMH: addiso’s disease hpoadreal, MI, Throiosis
Assess baseline: skin, mental status, VS, lungs, EKG, thyroid function
Assess: drugs that interact with thyroid medicine
Assess: foods that decrease effectiveness (soy)
o Diagnoses
Decrease cardiac output
Nutrition < body reuirement
Ineffective tissue perfusion
Knowledge deficit: drug therapy
o Goals
Drug therapy will have best therapeutic effect
Patient will have limited adverse effects
Patient will have an understanding of the drug therapy, adverse effects to
anticipate and self camera measures
o Implementation
Administer daily dose at breakfast each day (empty stomach)
Administer with full glass of H2O
Monitor response, especically cardiac effects
Arrange for periodic blood test of thyroid
Teach needs life long replacement
o Evaluate
Monitor for therapeutic response: return of metabolism, prevention of
goiter
Monitor for adverse effects; tachycardia, hypertension, anxiety, skin rash
Teach-back: name of drug, dosage, adverse effects to watch for, self-care
T4 goes up (returns to normal)
TSH foes down (returns to normal_
Therapeutic response may take 1-3 weeks to begin to see response
Thyroid Hormone
- Increases cardiac output and oxygen consumption
- Increase carbohydrate use and protein synthesis
- Increases lipolysis
- Heat regulation
- Menstrual cycles
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