Thyroid and Antithyroid Drugs Flashcards

1
Q

Levothyroxine (t4, Synthroid)

Chemical Classification

A

Levoisomer of thyroxine

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2
Q

Levothyroxine (t4, Synthroid)

Mechanism of Action

A

Increases metabolic rate; controls protein synthesis; increases cardiac output, renal blood flow, O2 consumption, body temp, blood volume, growth, development at cellular level via action on thyroid hormone receptors

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3
Q

Levothyroxine (t4, Synthroid)

Uses

A

Hypothyroidism, myxedema coma, thyroid hormone replacement, thyrotoxicosis, congenital hypothyroidism, some types of thyroid cancer, pituitary TSH suppression

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4
Q

Levothyroxine (t4, Synthroid)

Contraindications

A

Adrenal insufficiency, recent MI, thyrotoxicosis, hypersensitivity to beef, alcohol intolerance (inj only)
Obesity treatment

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5
Q

Levothyroxine (t4, Synthroid)

Side Effects

A

CNS: Anxiety, Insomnia, Tremors, headache, THYROID STORM, excitability
CV: Tachycardia, Palpitations, Angina, Dysrhythmias, hypertension, CARDIAC ARREST
GI: nausea, diarrhea, increased or decreased appetite, cramps
MISC: Menstrual irregularities, weight loss, sweating, heat intolerance, fever, alopecia, decreased bone mineral density

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6
Q

Levothyroxine (t4, Synthroid)

Nursing Considerations

A

ASSESS:

  • BP, pulse periodically during treatment
  • Weight daily in same clothing, using same scale, at same time of day
  • Height, growth rate of child
  • T3,T4, FTIs, which are decreased; radioimmunoassay of TSH, which is increased; radio uptake, which is increased if patient receiving too low a dose of medication
  • PT may require decreased anticoagulant; check for bleeding, bruising
  • Increased nervousness, excitability, irritability, which may indicate too high a dose of medication, usually after 1-3 wk of treatment
  • Cardiac Status: angina, palpitation, chest pain, change in VS

PERFORM/PROVIDE
-Withdrawal of medication 4 wk before RAIU test

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7
Q

Propylthiouracil

Functional Classification

A

Thyroid hormone antagonist (antithyroid)

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8
Q

Propylthiouracil

Chemical Classification

A

Thioamide

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9
Q

Propylthiouracil

Mechanism of Action

A

Blocks synthesis peripherally of T3, T4 (triiodothyronine, thyroxine), inhibits organification of iodine

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10
Q

Propylthiouracil

Uses

A

Preparation for thyroidectomy, thyrotoxic crisis, hyperthyroidism, thyroid storm

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11
Q

Propylthiouracil

Contraindications

A

Pregnancy (D), breastfeeding, hypersensitivity, agranulocytosis, hepatitis, jaundice

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12
Q

Propylthiouracil

Side Effects

A

CNS: Drowsiness, Headache, Vertigo, Fever, paresthesias, neuritis
GI: Nausea, Diarrhea, Vomiting, JAUNDICE, HEPATITIS, loss of taste, LIVER FAILURE, DEATH
GU: NEPHRITIS
HEMA: AGRANULOCYTOSIS, LEUKOPENIA, THROMBOCYTOPENIA, HYPOTHROMBINEMIA, LYMPHADENOPATHY, bleeding, vasculitis, periarteritis
INTEG: Rash, Urticaria, Pruritus, Alopecia, Hyperpigmentation, lupuslike syndrome
MS: myalgia, arthralgia, nocturnal muscle cramps, osteoporosis

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13
Q

Propylthiouracil

Nursing Considerations

A

ASSESS:

  • HYPERTHYROIDISM: weight loss, nervousness, insomnia, fever, diaphoresis, tremors; HYPOTHYROIDISM: constipation, dry skin, weakness, headache
  • Pulse, BP, temp
  • I&O ratio; check for edema: puffy hands, feet, periorbits; indicates hypothyroidism
  • Weight daily; same clothing, scale, time of day
  • T3,T4, which are increased; serum TSH, which is decreased; free thyroxine index, which is increased if dosage is too low; discontinue product 3-4wk before RAIU
  • BLOOD DYSCRASIAS: CBC with differential; leukopenia, thrombocytopenia, agranulocytosis
  • OVERDOSE: peripheral edema, heat intolerance, diaphoresis, palpitations, dysrhythmias, severe tachycardia, increased temp, delirium, CNS irritability
  • HYPERSENSITIVITY: rash, enlarged cervical lymph nodes; product may have to be discontinued
  • HYPOPROTHROMBINEMIA: bleeding petechiae, ecchymosis
  • Clinical response: after 3wk should include increased weight, pulse; decreased T4
  • BONE MARROW SUPPRESSION: sore throat fever, fatigue
  • HEPATOTOXICITY: LFTs before, during treatment; jaundice, nausea, vomiting, abdominal pain, anorexia diarrhea, fatigue

PERFORM/PROVIDE:
-Fluids 3-4L/day unless contraindicated

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14
Q

Levothyroxine (t4, Synthroid)

Functional Classification

A

Thyroid Hormone

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