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State the cause of Hyperthyroidism
Anything that increases levels of circulating thyroid hormone (TH) - its all about energy
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List risk factors for Hyperthyroidism
- Women age 30 to 40
- Family History
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What is Primary Thyrotoxicosis?
- Not caused by elsewhere
- Too much of a good thing
- Graves Dx
- Toxic multinodular goiter
- Follicular thyroid cancer (rare)
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List clinical manifestations for Hyperthyroidism
- Reflects Increased Basal Metabolic Rate
- CV- tachycardia, palpitations, angina, chest pain
- Neuro- hyperactive reflexes, sleeplessness, nervousness
- GI- Inc appetite with wt loss, inc gastric motility, diarrhea
- Heat intolerance
- Eye syndrome- exophthalamos (tissue buildup behind orbit)
- Dec or absent menses
- Goiter
- Inc thyroid hormone levels
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What is the pathophysiology of Graves Dx?
- Thyroid antibodies (autoimmune)
- Rate of onset: slow insedious
- Multisystem syndrome
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What does Graves Dx result in?
- Inc thyroid hormone (TH) levels
- Inc iodide uptake
- Inc rate of thyroid gland metabolism leads to goiter
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What characteristics must be present to have Graves Dx?
- Hyperthyroidism- test serum level
- Goiter
- Exophthalmos
- Dermopathy
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What is a Thyrotoxic Crisis (Thyroid Storm)?
- Stressors (infection or lung/ heart disorders)
- Rare
- Dead in 48 hours
- Huge outflow of thyroid hormone
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List manifestations of Thyrotoxic Crisis
- Think catecholamines- epinephrine (fight or flight)
- Tachycardia
- Hyperthermia
- N/V
- Diarrhea
- Agitation or delirium
- Heart failure
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What is the prototype drug for Antithyroid agents?
Propylthiouracil (PTU)
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State MOA of propylthiouracil (PTU)
Blocks hormone synthesis by inhibiting conversion of T4 to T3 in peripheral circulation
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What is the therapeutic use of propylthiouracil (PTU)?
Restore euthyroid (nml levels- not too high or too low) and metabolic levels
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State the MOA of Radioactive Iodine (131I)- tx for hyperthyroidism
Localized radiation effect, slowing thyroid production
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State mode of delivery for Radioactive iodine (131I)
Capsule or solution
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List Nsg implications of Radioactive iodine (131I)
- Localized radiation therapy- safe to be around, gone in 2-3 days
- Lugol solution is a strong iodine solution with K+ that protects thyroid to some extent, it slows it down w/o knocking it down
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What is the cause of hypothyroidism?
- Anthing that decreases levels of circulating thyroid hormone (TH)
- Ex. Hashimoto's thyroiditis or overtreatment of hyperthyroidism
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List risk factors for Hypothyroidism
- Female
- More common in aging people
- Pregnancy
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Describe S&S of Hypothyroidism
- Opposite of hyperthyroidism (or no energy)
- Bradycardia, dyspnea, low energy, constipation, dry hair and skin, cold, inc menses, depressed, no energy
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List major S&S of Congenital Hypothyroidism (Cretinism)
- Neuro- floppy, dull appearing facial features, hypotonia, hoarse sounding cry
- Integumentary- dry, brittle hair, and low hairline
- Musculoskeletal- thick, protruding tongue, large fontanelles, broad and short
- GI- poor feeding, choking episodes, constipation
- Myxedema
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What is Hashimoto Thyroiditis?
- Aka Hashimoto dx or lymphocytic thyroiditis
- Autoimmune disorder
- all about size not fxn!
- Inflammation/ Destruction
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List clinical manifestations of Hashimoto Thyroiditis
- Enlarged thyroid gland
- Sx typical of hypothyroidism (hypoactive goiter)
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What is Myxedema (Hypothyroid Crisis)?
- Severe or prolonged thyroid deficiency
- A crisis level lack of metabolism that can kill
- pts in infurmed condition- nsg home, chronic illness
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What is the clinical presentation for Myxedema?
- Altered mental state
- "myxedema coma" from too little energy
- Cold intolerance
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List clinical presentations of severe Myxedema
- Cardiovascular collapse
- Hypoventilation
- Hypoglycemia
- Lactic acidosis
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State the natural and synthetic drugs for Thyroid agents
- Natural- Thyroid (Armour thyroid)
- Synthetic- Levothyroxine (Synthroid) synthetic T4
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What is the MOA for thyroid agents?
Exogenous replacement of thyroid hormone to achieve euthyroid levels and normalize metabolism
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What are the indications and contraindications of Levothyroxine Na (Sythyroid)?
- Indications: Hypothyroidism
- Contra: CHD (do not overwork the heart) and allergy
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List SE and Interactions for Levothyroxine Na (Synthyroid)
- SE: associated with overdose
- Oral anticoagulants
- Digitalis
- Cholestyramine (antilipemic agent)- binds to thyroid hormone in GI track- dec absortion of thyroid
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List pt teaching for Synthyroid
- Take in AM, on empty stomach, at least 30 minutes before eating (to give you energy)
- S&S of hypo and hyperthyroidism
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List monitoring for levothyroxine (Synthyroid)
- Relief of symptoms of hypothyroidism
- Absence of symptoms of hyperthyroidism
- Labs of Serum TSH and T4 levels
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What are the major post pituitary problems?
- Syndrome of inappropriate Antidiuretic hormone secretion (SIADH)
- Diabetes Insipidus (DI)
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What are the problems of Anterior Pituitary gland?
- Hypopituitarism
- Hyperpituitarism
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Define SIADH
- High levels of antidiuretic hormone (ADH) in absence of nml physiologic stimuli for its release
- (high levels w/o reason to be there)
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List common causes for SIADH
- Ectopically produces ADH - adenocarcinomas
- Transient SIADH- post-pituitary surgery
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List Sx of Hyponatremia
- Thirst
- Dyspnea (movement of fluid)
- Fatigue
- Dulled sensorium, confusion, lethargy
- Muscle twitching, convulsions
- Impaired taste, anorexia, vomitting, cramps
- Severe (100-115): irreversible damage, coma, death
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What is the prototype drug for Demeclocycline?
Demeclocycline (Declomycin)
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What is the classification and drug use of Demeclocycline?
- Tetracycline broad-spectrum antibiotic
- Antibiotic therapy
- Treatment of persistent SIADH
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What is the MOA of Demeclocycline (Declomycin)?
Interferes with renal response to ADH
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Define Diabetes Insipidus
- Inability to concentrate urine due to insufficiency of ADH
- Body water floods out- causing dilute urine
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What does DI do to neurogenic (central)?
- Causes head trauma, brain death
- sudden onset
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What does DI do to nephrogenic (renal)?
- Causes CRF, lithium, water based urine
- Slow onset
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List clinical manifestations for DI
- Polyuria and polydipsia
- Dec urine specific gravity and osmolality (like water)
- Serum osmolality concentrated in body
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What is the prototype drug for Neurogenic DI?
- Desmopressin (DDAVP)
- aka Vasopressin
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What is the MOA of Desmopressin (DDAVP)?
Synthetic ADH, replacement therapy
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What is the delivery mode for Desmopressin?
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What are the common SE of Desmopressin?
None, except for nasal
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What are the nsg implications for Desmopressin?
Monitor and baseline data- serum and urine osmolality, and fluid balance/ weight (I&O)
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What is the client teaching for Desmopressin?
- Careful adjustment of water intake w/ tx to avoid water intoxication and dilutional hyponatremia (do not overload)
- Missed dose? Take now, do not double
- Tolerance possible
- Nasal may be irritating
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What drug is given for nephrogenic DI?
Hydrochlorothiazide (HCTZ)
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What is HCTZ therapy used for?
- Paradoxical effect in DI (dec polyuria, inc osmolality)- reverses Sx
- MOA unknown
- Taken with K+ sparing diuretic
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What is Addison's Dx?
- Primary adrenocortical insufficiency
- Dx of adrenal cortex
- Results in loss or lack of cortisol hormones
- Idiopathic, autoimmune, or other
- Can result in permanent gland damage
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What does Addison's Dx cause a decrease in?
- Cortisol
- Aldosterone
- Androgens
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Discuss early clinical manifestations of Addison's Dx
- Results from sodium and water problems
- Slow degenerative destruction w/ rapid onset
- Anorexia, wt loss
- Weakness, malaise, apathy
- Electrolyte imbalances
- Skin hyperpigmentation (very tan appearance)
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What causes Addisonian (Adrenal) Crisis?
- Sudden insufficiency of serum corticosteroids from...
- sudden loss of adrenal gland
- sudden increase in stres in chronic condition
- sudden cessation of corticosteroid drug therapy
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What are the Sx of Addisonian (Adrenal) Crisis?
- Sudden penetrating pain in the lower back, abdomen, or legs
- Severe vomitting and diarrhea
- Dehydration
- Low BP
- Loss of conciousness- coma (severe sodium/ water balance)
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What is the drug therapy for Addison's Dx?
- Replace those deficient hormones
- Cortisol- hydrocortizone (Cortef) 1-2 x/day
- Aldosterone- mineralocorticoid (fludrocortisone- Florinef) and inc salt intake
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What are Nsg Implications for Addison's Dx?
- Closely follow Rx dosing schedule
- Never abruptly stop therapy
- Replacement therapy is lifelong (chronic dx)
- Dosage will need to be inc during stress- 3x3 (3 times dose for 3 days)
- Always maintain emergency supply
- Wear Medic Alert bracelet
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How do you treat Addisonian Crisis and why?
- IV- hydrocortisone, saline, and dextrose (replace what is lost)
- B/c PO- dec hydrocortisone and aldosterone until achieved over days
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