Thyroid Medications
Name the labs that are monitored for Levothyroxine and Propylthiouracil
Monitor thyroid function, T3 and T4
Describe the mechanism of action of antacids
Neutralizes gastric acid in the stomach
Describe the mechanism of action for the bisphosphonate alendronate.
Inhibits activity of osteoclasts to reduce bone loss
What are the adverse reactions of expectorants such as guaifenesin?
GI effects nausea, diarrhea
Dizziness, drowsiness, headache
A patient hemorrhaging as a result of a heparin infusion will be provided this medication.
Protamine sulfate
Describe the indication for use of Levothyroxine
To treat hypothyroidism
This is the best time to administer Omeprazole to a patient.
Administer early in the morning, before breakfast, on an empty stomach
Provide two patient education points when taking the bisphosphonate, alendronate.
1. The patient must remain upright position x30 minutes after taking, and avoid eating (to reduce erosive esophagitis).
2. Educate the patient to report changes in swallowing.
3. Take with a full glass of water.
A patient reports they have a cough to the triage nurse. What education is important regarding beginning guaifenesin?
Educate patient for short-term use - not for prolonged cough or cough lasting more than a week
Describe 2 labs that are being monitored when patients have been prescribed heparin.
1. Monitor aPTT levels (no higher than twice baseline for therapeutic)
2. Monitor platelet counts
Explain your education plan for patient on Levothyroxine and include two contraindications for this drug.
1. Patient is on therapy for life
2. Contraindicated in hyperthyroid, recent MI
What is the mechanism of action of the fiber supplement Psyllium?
Absorbs water to form a glutinous mass, adding bulk, stimulates peristalsis
Describe an important dietary interaction present with bisphosphonates.
1. Do not give within 30 minutes of dairy or calcium supplements
2. Administer with a full glass of water
This describes the difference between short and long-term use of Beta2 Adrenergic Agonists such as albuterol.
1. Use short-acting for acute exacerbation of SOB
2. Use long-acting for chronic control - not useful in SOB
Describe the mechanism of action of the anticoagulant Warfarin.
Decreases production of vitamin K-dependent clotting factors
Describe the indicaton for use of Propylthiouracil
1. For the treatment of hyperthyroidism
Describe the plan for patient teaching before administering or discharging home with the serotonin antagonist ondansetron.
Educate the patient on driving and falls precautions if dizziness occurs. Best use is for prevention.
Describe some side effects of the bisphosphonate alendronate.
GI disturbances: nausea, vomiting, and abdominal pain.
Difficulty swallowing, erosive esophagitis.
Jaw osteonecrosis.
Describe at least 2 education points you would provide about Glucocorticoids like Beclomethasone and Fluticasone inhalers for your patient.
1. For long-term management, not acute
2. Nasal inhalation: may take 2-3 weeks to see the effects
3. Rinse the mouth out with water after using to avoid thrush
Describe the mechanism of action of anticoagulant heparin
Inactivates factor Xa and thrombin to prevent clot formation
Explain three labs that should be monitored if a patient is taking the antithyroid Propylthiouracil.
1. Monitor thyroid function, T3 and T4
2. Monitor CBC periodically for WBCs
3. Monitor for agranulocytosis, STOP if sore throat/fever/infection
Describe the machanism of action for H2 antagonists: ranitidine and include how it is different from PPI or antacids.
Blocks parietal to REDUCE acidity of gastric juice production in stomach.
Antacids neutralize existing gastric fluids; PPI inhibit production
What is the response for a patient taking alendronate who reports experiencing muscular leg pain?
Analgesics such as acetaminophen can be administered
Provide patient education on the effects of the antihistamine diphenhydramine.
Anticholinergic effects (dry mouth, constipation, dry eyes, urinary retention)
Encourage sucking on hard candy, sips of water for dry mouth, Educate patients against driving/heavy machinery while taking, Take at bedtime due to drowsiness
List at least 3 education points for a patient prescribed warfarin.
1. Educate patients to keep lab appointments, INR every 2-4 weeks (daily if in hospital)
2. Educate the patient to report bleeding: bruising, petechiae, hematoma, black stools
3. Educate the patient to wear a bracelet identifying warfarin therapy
4. Educate patient to avoid alcohol, NSAIDs, aspirin
5. Educate patient about bleeding precautions: soft toothbrush, electric razor, avoid accidental injury (sports)
6 Educate patient not to increase vitamin K-containing foods: green leafy vegetables, cabbage, broccoli, sprouts, mayo, canola oil, soybean oil (decrease effects).