Medication List Nur 106 - Pituitary, Thryoid, Parathroid, Adrenal Disorders

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Propylthiouracil

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Indications
• Palliative treatment of hyperthyroidism
• Adjunct in the control of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy
Action
Inhibits the synthesis of thyroid hormones

Therapeutic Effect(s):
Decreased signs and symptoms of hyperthyroidism

Contraindication/Precautions:
• ↓ bone marrow reserve
• OB: May be used safely; however, fetus may develop thyroid problems
• Lactation: Safety not established
• Pedi: Children <6 yr (safety not established)
Adverse Reactions/Side Effects
CNS: drowsiness, headache, vertigo.

GI: HEPATOTOXICITY, nausea, vomiting, diarrhea, loss of taste.

Derm: rash, skin discoloration, urticaria.

Endo: hypothyroidism.

Hemat: AGRANULOCYTOSIS, leukopenia, thrombocytopenia.

MS: arthralgia.

Misc: fever, lymphadenopathy, parotitis.
Assessment
• Monitor response of symptoms of hyperthyroidism or thyrotoxicosis (tachycardia, palpitations, nervousness, insomnia, fever, diaphoresis, heat intolerance, tremors, weight loss, diarrhea)
• Assess patient for development of hypothyroidism (intolerance to cold, constipation, dry skin, headache, listlessness, tiredness, or weakness). Dose adjustment may be required
• Assess patient for skin rash or swelling of cervical lymph nodes. Treatment may be discontinued if this occurs
Lab Test Considerations
• Thyroid function studies should be monitored prior to therapy, monthly during initial therapy, and every 2–3 mo throughout therapy
» WBC and differential counts should be monitored periodically throughout course of therapy. Agranulocytosis may develop rapidly and usually occurs during first 2 mo. This necessitates discontinuation of therapy
» May cause increased AST, ALT, LDH, alkaline phosphatase, serum bilirubin, and prothrombin time

Patient/Family Teaching
• Instruct patient to take medication exactly as directed, around the clock. If a dose is missed, take as soon as remembered; take both doses together if almost time for next dose; check with health care professional if more than 1 dose is missed. Consult health care professional prior to discontinuing medication
• Instruct patient to monitor weight 2–3 times weekly. Report significant changes
• May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known
• Advise patient to consult health care professional regarding dietary sources of iodine (iodized salt, shellfish)
• Advise patient to report sore throat, fever, chills, headache, malaise, weakness, yellowing of eyes or skin, unusual bleeding or bruising, symptoms of hyperthyroidism or hypothyroidism, or rash to health care professional promptly

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Methimazole

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ACTION: Methimazole is used for treating hyperthyroidism. It also is used for decreasing symptoms of hyperthyroidism in preparation for surgical removal of the thyroid gland or before inactivating the thyroid gland with radioactive iodine. Long-term use of methimazole may lead to a remission of the hyperthyroidism.

DRUG INTERACTIONS: Warfarin (Coumadin) works by reducing the activity of vitamin K and therefore the formation of vitamin K dependent clotting factors. Methimazole may increase the activity of warfarin by further reducing the activity of vitamin K in the body.

SIDE EFFECTS: Methimazole is generally well-tolerated with side effects occurring in 3 out of every 100 patients. The most common side effects are related to the skin and include rash, itching, hives, abnormal hair loss, and skin pigmentation. Other common side effects are swelling, nausea, vomiting, heartburn, loss of taste, joint or muscle aches, numbness and headache.

Less common but more serious side effects include a decrease in white blood cells (agranulocytosis) and blood platelets (thrombocytopenia). Symptoms and signs of agranulocytosis include infections of the throat, the gastrointestinal tract, and skin with an overall feeling of illness and fever. Since platelets are important for the clotting of blood, thrombocytopenia may lead to problems with excessive bleeding. Hepatitis and death of liver cells (hepatic necrosis) have rarely been associated with methimazole.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

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Levothyroxine

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Levothyroxine is a synthetic (man-made) version of the principle thyroid hormone, thyroxine (T4) that is made and released by the thyroid gland.

PRESCRIBED FOR: Levothyroxine is approved to treat hypothyroidism and to suppress thyroid hormone release in the management of cancerous thyroid nodules and growth of goiters.

DRUG INTERACTIONS: Initiation or discontinuation of therapy with levothyroxine in diabetic patients may create a need for an increase or decrease in the required dose of insulin and/or antidiabetic drug, [for example, glyburide (Micronase)].

Levothyroxine may increase the effect of blood thinners such as warfarin (Coumadin). Therefore, monitoring of blood clotting is necessary, and a decrease in the dose of warfarin may be necessary.


Converting a state of hypothyroidism (underactivity) to a normal state (euthyroid state) with levothyroxine may decrease the actions of certain beta-blocking drugs, [for example, metoprolol (Lopressor) or propranolol (Inderal)]. It may be necessary, therefore, to change the dose of beta-blocker. For the same reason, the dose of digoxin (Lanoxin), a drug used to manage heart failure or an irregular heart rhythm (for example, atrial fibrillation), also may need to be changed.


SIDE EFFECTS: Levothyroxine therapy is usually well-tolerated. If symptoms occur, often they are due to toxic levels of thyroid hormone and the symptoms are those of hyperthyroidism. Symptoms may include all or some of the following: chest pain, increased heart rate or pulse rate, excessive sweating, heat intolerance, nervousness, headache, insomnia, diarrhea, vomiting, weight loss, or fever. Women may experience irregular menstrual cycles.

HOW TO USE: Take this medication by mouth usually once a day on an empty stomach, 1/2 to 1 hour before breakfast, or as directed by your doctor. To prevent difficulty swallowing the tablet, take it with a full glass of water unless otherwise directed by your doctor

Remember to use it at the same time each day. Your doctor may need to adjust your dosage based on your medical condition, your response to therapy, and your laboratory test results.Do not stop taking this medication without consulting with your doctor. Replacement therapy is usually taken for life.It may take up to 4-6 weeks before the full benefits of this medication take effect. Inform your doctor if your condition persists or worsens.

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Calcitonin

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DRUG CLASS: Calcitonin-salmon is a man-made version of the hormone, calcitonin, that is found in salmon. Calcitonin is used for treating postmenopausal (after menopause) osteoporosis (bone loss), Paget's disease of bone, and hypercalcemia (high blood calcium levels).

SIDE EFFECTS: Side effects from calcitonin are uncommon and usually are mild. Injectable calcitonin can cause nausea with or without vomiting in 10% of patients. Nausea can occur with initial treatment and tends to disappear with continued use. Injectable calcitonin also can cause local redness of the skin at the site of injection. Flushing and skin rash are also seen. The nasal spray can cause runny nose (rhinorrhea), nose-bleeding, bone pain and headaches. The nausea that can occur with injectable calcitonin is unlikely to occur with the nasal spray. In rare instances, the nasal spray can cause an upset stomach.

SIDE EFFECTS: Runny nose, nose bleeds, nasal irritation, dry nose with crusting, headache, dizziness, nausea, flushing of the face, or back pain may occur.

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Desmopressin acetate

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Antidiuretic replacement therapy in the management of central diabetes insipidus; management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region.


Contraindications
Moderate to severe renal function impairment (CrCl below 50 mL/min); hyponatremia or a history of hyponatremia; hypersensitivity to any component of the product.

Precautions
Monitor BP and pulse during infusion. Monitor I&O closely and accurately when drug is administered to very young and elderly patients. Monitor patient at regular intervals during the course of tablet therapy to ensure adequate antidiuretic response.