Week 10 Adrenal Thyroid Pharm 315 Questions With
Complete Soutions
Adrenal Cortex Drug Therapy: Correct Answer
Before administering calcitriol, the nurse will assess for signs of
hypocalcemia:
-Twitching of mouth
-Tinging and numbness of fingers carpopedal spasm
-Larynx spasm
Review laboratory test results:
*PTH level
*Serum calcium level
*Vitamin D level
Drug interactions:
-Potentiates hypercalcemia when used with thiazide diuretic or
calcium supplements
-Potentiates cardiac dysrhythmia when used with digoxin or
verapamil
-Lipid lowering drugs decrease calcitriol absorption and
effectiveness
*Lab values
Elevation in AST/ALT, blood urea nitrogen, creatinine Correct
Answer Contraindications
Absolute contraindications:
-Allergy to drug
-Hyperphosphatemia
-Hypercalcemia
-Vitamin D toxicity
Use with caution:
*Persons at risk for seizures
,*Persons with cardiovascular disease
*Pregnancy (unless benefit outweighs fetal risk), breastfeeding
Case Study
Mrs. Weston, a 22-year-old female patient, is being seen by her
primary health care provider. She has reported feeling tired all
the time, gaining weight, and having trouble concentrating. Her
vital signs upon arrival were HR 85, BP 110/68, RR 18, and T
98°F. She has no chronic health conditions, but she states that
her mother has hypothyroidism.
Her primary health care provider ordered a free T4 and TSH,
which revealed low free T4 and a high TSH level. Correct
Answer
Case Study
Ms. Sanders is a 68-year-old female patient who has been
diagnosed with Addison's disease. The patient has a medical
history positive for type 2 diabetes mellitus and hypertension.
She takes an oral antidiabetic medication and an angiotensin-
converting enzyme (ACE) inhibitor. The health care provider
has prescribed oral hydrocortisone 20 mg daily upon waking and
fludrocortisone 0.10 mg once daily. The nurse provides
education to the patient on these medications and their side
effects. Correct Answer
Case Study
Tommy, a 4-year-old boy, presents to the clinic with short
stature. His height is 85 cm and weight is 14 kg. Upon review of
his history and growth chart, Tommy was average height and
weight at birth; however, there is a marked leveling off and
progressive decline in growth rate around 6 months of age.
,Physical assessment of Tommy reveals an immature face and
overweight body build; the child's proportions remain normal.
Intelligence is normal. Laboratory evaluation demonstrates
growth hormone deficiency. The patient is started on
replacement GH (dose: 40 mcg/kg/day, subcutaneous). After 1
year of GH therapy, his growth rate has significantly increased.
Correct Answer
Contraindications with Levothyroxine
Absolute Contraindications:
-Drug allergy
-Recent myocardial infarction (MI)
-Adrenal insufficiency
-Hyperthyroidism (thyrotoxicosis)
Use caution with:
Older adults
During pregnancy, breastfeeding
Note:
Thyroid hormone sensitizes the heart to catecholamines
(epinephrine, dopamine, dobutamine) and may produce
dysrhythmias. Correct Answer *Adrenergic drugs such as
epinephrine: increases sympathetic response (heart rate, blood
pressure, possible coronary insufficiency); cardiac medications
may need to be adjusted.
*Oral anticoagulant drugs such as warfarin: increases
anticoagulant effects due to displacement from protein-binding
site. Warfarin dosage may need to be adjusted.
, *Antidiabetic drugs such as insulin or metformin: increases in
blood glucose levels; insulin and noninsulin dosage may need to
be increased.
Dosage, Safe Administration, Side Effects, and Adverse Effects
of Antithyroid Drugs
Side effects:
Frequent:
-Urticaria, rash, pruritus
-Nausea
-Increase skin pigmentation
-Headache, paresthesia
Occasional: drowsiness
(Adverse effects)
*Hepatitis: observe for jaundice
*Bone marrow depression: agranulocytosis. May develop
infection with symptoms of sore throat, fever, malaise.
*Thrombocytopenia (may occur up to 4 months after start of
therapy Correct Answer Patient/family teaching includes the
following points:
-Stress rationale for therapy; remind that response to therapy
may take several months, and that drug therapy is not a cure but
used to manage symptoms.
-Advise to take as prescribed. Stopping antithyroid drug could
bring on thyroid crisis.
-Instruct to take the medication with a meal and limit intake of
iodine rich foods like seafood, seaweed, and iodized salt, which
will decrease drug effectiveness.
-Tell the health care provider about use of over the counter
drugs that may interfere with absorption or compromise
effectiveness.
Complete Soutions
Adrenal Cortex Drug Therapy: Correct Answer
Before administering calcitriol, the nurse will assess for signs of
hypocalcemia:
-Twitching of mouth
-Tinging and numbness of fingers carpopedal spasm
-Larynx spasm
Review laboratory test results:
*PTH level
*Serum calcium level
*Vitamin D level
Drug interactions:
-Potentiates hypercalcemia when used with thiazide diuretic or
calcium supplements
-Potentiates cardiac dysrhythmia when used with digoxin or
verapamil
-Lipid lowering drugs decrease calcitriol absorption and
effectiveness
*Lab values
Elevation in AST/ALT, blood urea nitrogen, creatinine Correct
Answer Contraindications
Absolute contraindications:
-Allergy to drug
-Hyperphosphatemia
-Hypercalcemia
-Vitamin D toxicity
Use with caution:
*Persons at risk for seizures
,*Persons with cardiovascular disease
*Pregnancy (unless benefit outweighs fetal risk), breastfeeding
Case Study
Mrs. Weston, a 22-year-old female patient, is being seen by her
primary health care provider. She has reported feeling tired all
the time, gaining weight, and having trouble concentrating. Her
vital signs upon arrival were HR 85, BP 110/68, RR 18, and T
98°F. She has no chronic health conditions, but she states that
her mother has hypothyroidism.
Her primary health care provider ordered a free T4 and TSH,
which revealed low free T4 and a high TSH level. Correct
Answer
Case Study
Ms. Sanders is a 68-year-old female patient who has been
diagnosed with Addison's disease. The patient has a medical
history positive for type 2 diabetes mellitus and hypertension.
She takes an oral antidiabetic medication and an angiotensin-
converting enzyme (ACE) inhibitor. The health care provider
has prescribed oral hydrocortisone 20 mg daily upon waking and
fludrocortisone 0.10 mg once daily. The nurse provides
education to the patient on these medications and their side
effects. Correct Answer
Case Study
Tommy, a 4-year-old boy, presents to the clinic with short
stature. His height is 85 cm and weight is 14 kg. Upon review of
his history and growth chart, Tommy was average height and
weight at birth; however, there is a marked leveling off and
progressive decline in growth rate around 6 months of age.
,Physical assessment of Tommy reveals an immature face and
overweight body build; the child's proportions remain normal.
Intelligence is normal. Laboratory evaluation demonstrates
growth hormone deficiency. The patient is started on
replacement GH (dose: 40 mcg/kg/day, subcutaneous). After 1
year of GH therapy, his growth rate has significantly increased.
Correct Answer
Contraindications with Levothyroxine
Absolute Contraindications:
-Drug allergy
-Recent myocardial infarction (MI)
-Adrenal insufficiency
-Hyperthyroidism (thyrotoxicosis)
Use caution with:
Older adults
During pregnancy, breastfeeding
Note:
Thyroid hormone sensitizes the heart to catecholamines
(epinephrine, dopamine, dobutamine) and may produce
dysrhythmias. Correct Answer *Adrenergic drugs such as
epinephrine: increases sympathetic response (heart rate, blood
pressure, possible coronary insufficiency); cardiac medications
may need to be adjusted.
*Oral anticoagulant drugs such as warfarin: increases
anticoagulant effects due to displacement from protein-binding
site. Warfarin dosage may need to be adjusted.
, *Antidiabetic drugs such as insulin or metformin: increases in
blood glucose levels; insulin and noninsulin dosage may need to
be increased.
Dosage, Safe Administration, Side Effects, and Adverse Effects
of Antithyroid Drugs
Side effects:
Frequent:
-Urticaria, rash, pruritus
-Nausea
-Increase skin pigmentation
-Headache, paresthesia
Occasional: drowsiness
(Adverse effects)
*Hepatitis: observe for jaundice
*Bone marrow depression: agranulocytosis. May develop
infection with symptoms of sore throat, fever, malaise.
*Thrombocytopenia (may occur up to 4 months after start of
therapy Correct Answer Patient/family teaching includes the
following points:
-Stress rationale for therapy; remind that response to therapy
may take several months, and that drug therapy is not a cure but
used to manage symptoms.
-Advise to take as prescribed. Stopping antithyroid drug could
bring on thyroid crisis.
-Instruct to take the medication with a meal and limit intake of
iodine rich foods like seafood, seaweed, and iodized salt, which
will decrease drug effectiveness.
-Tell the health care provider about use of over the counter
drugs that may interfere with absorption or compromise
effectiveness.
