NURS 2516 Clinical Medications Worksheets(You will need to make additional copies of these forms)

Generic NameLevothyroxine

Trade NameSynthroid

Classificationhormones

Dose0.05 mg

RoutePO

Time/frequencyDaily

Peak1-3 wk 

Onsetunknown

Duration1-3 wk 

For IV meds, compatibility with IV drips and /or solutions

Mechanism of action and indications(Why med ordered)Principal effect is increasing metabolic rate of body tissues, ex: Promote gluconeogenesis, Increase utilization and mobilization of glycogen stores, Stimulate protein synthesis, Promote cell growth and differentiationIndicated for replacement/substitution in diminished or absent thyroid function (hypothyroidism)

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity, Recent MI, Thyrotoxicosis/ Use cautiously in pt’s with severe cardiac disease, renal insufficiency, uncorrected adrenocortical disorders, and swallowing difficulty. Geriatric patients are extremely sensitive to thyroid hormones in general and initial dosage should be markedly reduced. Interacts w/ adrenergics and beta blockers.

Common side effectsarrhythmias, tachycardia, insomnia, irritability, nervousness, weight loss,

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)May decrease response to beta blockers (pt takes Coreg)

Lab value alterations caused by medicineIf the pt becomes toxic, it will be manifested in hyperthyroidism that can range from a little serous to very serious depending on how high the levels of thyroid hormones are.

Be sure to teach the patient the following about this medicationInstruct patient to take medication as directed at the same time each day. Take missed doses as soon as remembered unless almost time for next dose. If more than 2-3 doses are missed, notify health care professional. Do not discontinue without consulting health care professional. Instruct patient and family on correct technique for checking pulse. Dose should be withheld and health care professional notified if resting pulse >100 bpm. Explain to patient that medication does not cure hypothyroidism; it provides a thyroid hormone. Therapy is lifelong. Advise patient to notify health care professional if headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, palpitations, weight loss >2 lb/wk, or any unusual symptoms occur. Emphasize importance of follow-up exams to monitor effectiveness of therapy. Thyroid function tests are performed at least yearly.

Nursing Process- Assessment(Pre-administration assessment)Check pulse rate, weigh pt, and ask pt about insomnia, irritability and nervousness.

AssessmentWhy would you hold or not give this med?You would hold the dose and contact the physician if the pulse was higher than 100 bpm and or if the patient has had significant weight loss.

EvaluationCheck after givingDiuresis, weight loss, Increased sense of well-being, energy, pulse rate and apetite, Normalization of skin texture and hair and correction of constipation