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Generic Name: levothyroxine Brand name: Synthroid Classification: thyroid preparations Why is patient/client receiving this? Thyroid supplementation for pt’s hypothyroidism Dosage/Route: Typical dose is 125 mcg/day PO 50-100 mcg/day IV single dose Dosage/Route prescribed to client: 125 mch PO daily before breakfast Rate of administration with IV meds:[ 100mcg/mL] @100mcg/min IV diluents compatible with IV medication: reconstitute 200 or 500 mcg with 2mL or 5mL of .9%NaCl;Major Side effects: -CNS: HA, insomnia -CV: angina pectoris, arrhythmias, tachycardia -GI: abd cramping, diarrhea, vomiting -DERM: sweating -heat intolerance, weight loss Data used to indicate medication is effective: TH lab values Medication administration concerns: Administered before breakfast; assess apical bp and pulse before administration, assess for tachyrythmias Pt admitted c/o of chest pain which is major side effect of medication ; takes about 4 half lives (1 mo) to achieve therapeutic. Different concentrations in diff colorsPatient/client teaching points: Remind patient of importance of yearly thyroid studies Alert nurse for any adverse side effects T3/liothyronine (Cytomel)Thyroid preperatons Why is pt receiving this? A structurally identical analog to T3. One of the Thyroid hormones, T3 is the active form of T4 which acts on the thyroid (has shorter halflife, more rapid onset of action) Dose Mild hypo: 25 mcg once daily, can increase at 1-2 wk intervals. Usual maintanence dose: 25-50 mcg/day. Myxedema: 2.5 mcg one day initially, increase 5-10 q 1-2 wk; maintanence dose 25-50 mcg/day. Simple goiter: usual maintanence dose 50-100 mcg/day. T3 suppression test. 75-100 mcg/day for 7 days. Also given IV for myxedema coma. SE Usually only seen when excessive doses cause hyperthyroidism. Insomnia, HA, arrhythmias, tachycardia, angina pectoris, hyperhidrosis, hyperthyroidism, menstrual irregularities, weight loss, heat intolerance, accelerated bone maturation (peds) Med admin bile acid sequestrants decrease absorption, alters effectiveness of warfarin, may increases requirement for insulin/oral hypoglycemic agnets, estrogen therapy may affect, additive CV effects Assess BP and pulse before administration. Admin as single dose before breakfast. Can be crushed and suspended in water Pt education Take missed dose ASAP, if 2-3 missed doses contact HCP. Notify for significant weight loss. Importance of follow up exams. Armour thyroid Animal preparationObsolete w/ synthroid and cytomel No evidence to show any difference in effectiveness propylthiouracil (PTU) Antithyroid agents Why is pt receiving this? Mgmt of Grave’s disease or hyperthyroidism or toxic multinodular goiter intolerant of methimazole and for whom irradiation/surgery inappropriate. Inhibits synthesis of thyroid hormones. Also inhibits conversion of T4 to T3. Dose PO 100 mg q 8 hr; may be increased up to 400 mg/day. Usual maintanece dose = 100-150 mg/daySE agranulocytosis, can develops as cretinism and other fetal developmental issues. HEPATOTOXICITY, hypothyroidismMed admin Monitor CBC freuqnetly and stop therapy for suppressed WBC count. Additive bone marrow depression, antithyroid effects. May cause liver enzymes and prothombrin time to increase. Administer at same teach q daily in relation to foods. Pt education Take medication exactly as directed. If dose is missed, take as soon as remembered. Take both doses together if almost next dose. Monitor weight 2-3 times daily. Emphasize importance of routine exams. methimazole (Tapazole) antithyroid agents Why is pt receiving this? Palliative treatment of hyperthyroidism. Used as adjunct to control thyroid in prep for thyroidectomy or radioactive iodine therapy. Inhibits synthesis of new hormones but DOES NOT block conversion of T4 to T3. Dose thyrotoxic crisis: 15-20 mg q 4 hr during first 24. Hyperthyroidism: 15-60 mg/day as single dose or divided doses for 6-8 wk; maintnaece is 5-30 mg/kg as single dose or 2 divided doses SE drowsiness, diarrhea, hepatotoxicity, n/v, rash, AGRANULOCYTOSIS, hypothyroidism Med admin additive bone marrow depression; antithyroid effect may be decreased by KI or amiodarone. Increased risk of agranuloctyosis with phenothiaziens. May alter response to warfarin/digoxin. Monitor WBC frequently. Administer at same time in relation to meals each day. Back and forth as to if this or PTU is preferential for kids. Pt education Take medication exactly as directed. If dose is missed, take as soon as remembered. Take both doses together if almost next dose. Monitor weight 2-3 times daily. Emphasize importance of routine exams. Notify adverse s/sx 135I RF abalation of thyroid in hyperthyroidism; kills off hyperthyroid cells; Emits γ and β rays to block hormone synthesis . Med admin concerns: people become hypothyroid (must treat for), must sleep alone for few days can’t share utensils/driking glasses (radioactivity). Half life is 8 days. Iodine (Lugol’s solution) Why is pt receiving this? Adjunct with other antithyroid drugs in preparation for thyroidectomy. Treatment of thyrotoxic crisis. Rapidly inhibits release and synthesis of thyroid hormones. Decreases vascularity of thyroid gland. Decreases thyroidal uptake of radioactive iodine following radiation emergencies or administration of radioactive isotypes of iodine. Dose Hyperthyroidism: strong sln 1 mL in water tid. SSKI 6-10 drops (300-500 mg) tid. Surgical Prep: Strong 3-5 drops tid for 10 days prior to surgery; SSKI 1-5 drops 3 times daily for 10 days SE confusion, weakness, GI BLEEDING, d/nv, hypothyroidism, hyperkalemia, hypersensitivity Med admin concerns Use w/ lithium may increase hypothyroidism, addative antithyroid effects, hyperkalemia may result in combined use w/ potassium sparing diuretics, ACE inhibitors, ARBs or potassium supplements. Assess for s/sx of iodism (metallic taste, stomatitis, skin lesions, cold symptoms, gi upset), monitor for s/sx of hyperthyroidism and hypersensitivity. Mix soln if full glass of juice, water, broth, or milk. Administer after meals. Pt education Take as directed, take mixed doses ASAP but don’t double up on doses. KIKept in radioactive emergencies Thyroid takes up KI to prevent absorption or radioactive I from dirty bomb prednisone corticosteroid Why is pt receiving this? used systemically/locally in wide variety of inflammatory, allergic, hemotologic, neoplastic , and autoimmune disorders. Used w/ other immune suppressants in prevention of organ rejection in transplantation surgery, asthma. Suppress inflammation and normal immune response. Dose PO most uses: 5-60 mg/day as single divided dose. Given w/ MS, P. jirovecii in AIDS. SE altered glucose metabolism, CNS alteration mood/behaviors, hypertension, peptic ulceration, anorexia, n/v, acne, decreased wound healing, adrenal suppression, hyperglycemia, fluid retention, hypokalemia, thromboembolism, wt gain, muscle wasting, osteoporosis, cushingoid appearance Med admin ALWAYS taper to allow recovery time from adrenal suppression and withdrawl. Promotes gluconeogenesis and reduces peripheral glucose utilization (resulting in hyperglycemia), unfavorable impact on prn metabolism/fat metabolism, neutrophilia but suppresses other WBCs. Incr risk of hypokalemia with loop or thiazide diruteics or amphotericin B. Incr requirement for oral/insulin. Hormonal contraceptives may decrease metabolism. Administer w/ meals. Pt education Review SE, explore issues r/t altered body image, notify for adverse s/sx, DO NOT D/C MEDS IMMEDIATELY Periods of stress may require increased dosesdexamethasone (Dexasone) Long acting corticosteroids Why is pt receiving this? Among other uses for corticosteroids, diagnostic agent in adrenal disorders. Dose PO 1 mg at 11 PM or 0.5 mg q 6hr for 48 hr. Procedure To diagnose Cushing’s, obtain baseline cortisol levels; administer @ 11 pm and obtain cortisol levels @ 8 AM next day. Normal response is a decreased cortisol level. POSITIVE result is no suppression of Adrenal Corticotropic Horme (ACTH): Cushing’s is overproduction of adrenal corticosteroid, so would not respond to stimuli of exogenous hormone. spironolactone (Aldactone) Potassium sparing diuretic Why is pt receiving this? Tx of primary hyperaldosteronism. Antagonizes aldosterone receptors Dose 100-400 mg/day in 1-2 divided doses PO SEdizziness, clumsiness, HA, erectile dysfunction, SJS, TENS, breast tenderness/gynecomastia, hyperkalemia, hyponatremia. Med admin may increases hypotension w/ ETOH, antihypertensives, or nitrates. Incr risk of hyperkalemia with ACE, ARBs, NSAIDS, potassium supplements. Incr toxicity w/ lithium. May increase effectiveness of digoxin. Monitor Is and Os, monitor for hypo/hyperkalemia. Assess for rash. Administer in AM to avoid disruption in sleep, w/ food or milk to increase bioavailability decrease gastric irritationPt education Importance of continuing med, avoid salt substitutes, dizziness (fall risk, driving), notify for advers e s/sx, importance of follow up fludrocortisone (Florinef) mineralcorticoid Why is pt receiving this? Sodium loss and hypotension assoc w/ adrenocortical insufficiency. Mgmt of sodium loss due to adrenogential syndrome. Causes sodium reabsorption, hydrogen and potassium excretion, and water retention. Dose Given IM for Addisonian crisis. PO: 100 mcg/day. SE persistent HA, HTN, dizziness, edema, joint pain, hypokalemia, weakness, parasthesias, HFMed admin weight gain, monitor IandO, Blood Pressure, Na restriction, monitor electrolytes, especially K+Pt education Instruct to take as directed, follow dietary modifications, inform us of adverse s/s weight gain dema, muscle weakness, or cramps, carry identification of disease process desmospressin acetate (DDAVP)Antidiuretic hormoneWhy is pt receiving this? PO, SubQ, IV, Intranasal. : treatment of central diabetes insipidus caused by vasopressin deficiency. IV also given for hemophilia and von Willebrand’s disease. PO used for nocturnal enuresis. Dose PO 0.05 mg twice daily, adjusted as needed. Intranasal: 5-40 mcg in 1-3 divided doses. Sub Q, IV: 2-4 mcg/day in 2 divided doses. Availability: spray (10 mcg/spray). Injection 4 mcg/mL. Concentration: undiluted [4mcg/mL] over 1 min. SE HTN, flushing, water retention (water intoxication: drowsy/listless/HA/convulsions/coma), vasoconstriction, rhinitis, nausea Med admin Tolerance can develop to nasal form, IV form 10x more potent than nasal, Nasal congestion will decrease effect, monitor fluid balance and watch for overload (espec. Pts w/ cardiac history) Pt education Avoid ETOH Instruct on correct intranasal. Prime pump prior to first use by pressing down 4 uses. Vasopressin antagonistIndications: hyponatremia in euvolemic/hypervolemic patients Conivaptan, Tolvaptan mecasermin (Increlex)Growth hormones Why is pt receiving this? Long term treatment of growth failure in children due to primary insulin like growth factor (ILG-1) deficiency or growth hormone gene deletion with antibodies to growth hormone. Dose SubQ: 0.04-0.08 mg/kg twice daily, may be increased up to 0.12 mg/kg twice dailySE SEIZURES, dizziness, HA, intracranial hypertension, vomiting, HYPOGCLYCEMIA, bruising, lipohypertrophy, ANAPHYLAXIS Med admin No drug-drug interactions. Monitor bone age annully and growth rate determinations (height, weight q 3-6 mo during therapy), assess tonsils for hypertrophy, assess for intracranial hypertension via fundoscopic eams, monitor for allergic rxns, administer w/in 20 min of meal or snack. DO not administer w/out food, if dose is omitted do not increase next dose. Pt education Instruct pts and or parents how to administer (sub q sites, rotation), advise pt and parent not to give to other ppl, discuss importance of well balanced diet, avoid driving/acitvities requiring alertness until response is known, notify for adverse s/sx octreotide (Sandostatin) GH receptor antagonist; hormones Why is pt receiving this? Tx of acromegaly. Synthetic analog of somatostatin which suppresses GH release. Dose Sub Q, IV: 50-100 mcg 3 times dialy, titrate to achieve GH levels <5ng/mL or IGF 1 levels <1.9 units/mL (males) or <2.2 units/mL (females) IM: sandostatin LAR 20 mg q 4 for 3 mo then adjusted on basis of GH levels. IVP undiluted over 3 min, IVPB: dilute in 50-200 mL NS or D5W for [1.5-250 mcg/mL] over 15-30 min SE GI, gallstones, GH receptor antagonist, dizziness, drowsiness, fatigue, HA, weakness, bradycardia, edema, Ileus, flushing, hyperglycemia/hypoglycemia, hypothyroidism Med admin May alter requirements for insulin or oral hypoglycemic agents, may decrease blood levels of cyclosporine; assess pt f&e status and skin tugor for dehydration. Monitor diabetic pts for signs of hypoglycemia. Assess for gallbladder disease (pain and muonitor ultrasound examinations of gallbladder and bile ducts prior to and periodically during prolonged therapy). Administer smallest volume needed to achieve required dose to prevent pain at injection site. Rotate injection sites. Administer between meals and at bedtime to avoid GI side effects. Mix IM solution by adding diluent included in kit. Pt education dizziness/drowsiness/vision disturbances (Fall risk, driving), change positions slowly to minimize orthostatics, teach proper injection technique and how to dispose of needles. Administer exactly as directed. ................
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