NUR 426 Lecture Notes - Lecture 10: Thyroid, Esophageal Atresia, Parathyroid Gland
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Published on 14 Nov 2017
School
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 Desiated throid dried aial throid glads – 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 hpoadreal, MI, Throiosis
▪ 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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