Clinical Medications Worksheets
Generic Name Trade Name Classification
levothyroxine Synthroid Thyroid preparations
Peak Onset Duration
1-3 wk unknown 1-3 wk
Why is your patient getting this medication
Replacement/substitution in diminished or absent thyroid
function.
Mechanism of action and indications
(Why med ordered)
Levothyroxine acts like the endogenous thyroid hormone
thyroxine (T4, a tetra-iodinated tyrosine derivative). In the liver
and kidney, T4 is converted to T3, the active metabolite. In
order to increase solubility, the thyroid hormones attach to
thyroid hormone binding proteins, thyroxin-binding globulin,
and thyroxin-binding prealbumin (transthyretin). Transport and
binding to thyroid hormone receptors in the cytoplasm and
nucleus then takes place. Thus by acting as a replacement for
natural thyroxine, symptoms of thyroxine deficiency are
relieved.
Interactions with other patient drugs, OTC or herbal
medicines (ask patient specifically)
Lanoxin: The clearance of or sensitivity to digitalis glycosides
may be increased in previously hypothyroid patients when a
euthyroid state is achieved after the addition of thyroid
hormones.
Lantus, NovoLog: The efficacy of oral hypoglycemic agents
and insulin may be diminished by certain drugs, including
thiazides and other diuretics, corticosteroids, estrogens,
progestins, thyroid hormones, human growth hormone,
phenothiazines, atypical antipsychotics, sympathomimetic
amines, protease inhibitors, phenytoin, clozapine, megestrol,
danazol, isoniazid, asparaginase, pegaspargase, diazoxide,
temsirolimus, as well as pharmacologic dosages of nicotinic
acid and adrenocorticotropic agents. These drugs may interfere
with blood glucose control because they can cause
hyperglycemia, glucose intolerance, new-onset diabetes
mellitus, and/or exacerbation of preexisting diabetes.
Food interactions: Consumption of certain foods as well as
the timing of meals relative to dosing may affect the absorption
of T4 thyroid hormone (i.e., levothyroxine). T4 absorption is
increased by fasting and decreased by foods such as soybean
flour (e.g., infant formula), cotton seed meal, walnuts, dietary
fiber, calcium, and calcium fortified juices.
Synthroid (levothyroxine)
Dose Route Time/frequency
125 mcg PO qd
Normal dosage range
Hypothyroidism--50 mcg as a single dose initially; may be increased q
2-3 wk; usual maintenance dose is 75-125 mcg/day (1.5 mcg/kg/day).
Severe hypothyroidism--12.5-25 mcg/day; may increase q 2-4 wk by 25
mcg/day; usual maintenance dose is 75-125 mcg/day (1.5 mcg/kg/day).
Geriatric Patients and Patients with Increased Sensitivity to
Thyroid Hormones: 12.5-25 mcg as a single dose initially; may be
increased q 6-8 wk; usual maintenance dose is 75 mcg/day.
For IV meds, compatibility with IV drips and/or solutions
N/A
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Hypersensitivity, recent MI, thyrotoxicosis. Cardiovascular disease
(initiate therapy with lower doses), secere renal insufficiency,
uncorrected adrenocortical disorders, swallowing difficulty.
Desiccated thyroid preparations (Armour thyroid, Thyrar) appear on
Beers list due to concerns about cardiac effects. Also, Geriatric patients
areextremely sensitive to thyroid hormones in general and initial
dosage should be markedly reduced. Myxedematous patients
(extremely sensitive to thyroid hormones--initial dosage should be
markedly reduced).
Common side effects
Insomnia, irritability, nervousness, CARIOVASCULAR COLLAPSE,
arrhythmias, tachycardia, weight loss
Lab value alterations caused by medicine
Monitor thyroid function studies prior to and during therapy. Monitor
blood and urine glucose in diabetic patients. Insulin or oral
hypoglycemic dose may need to be increased.
Be sure to teach the patient the following about this medication
Instruct 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. Caution patient not to change brands of thyroid
preparations, as this may affect drug bioavailability. 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.
Caution patient to avoid taking other medications concurrently with
thyroid preparations unless instructed by health care professional.
Instruct patient to inform health care professional of thyroid therapy.
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)
Assess apical pulse and blood pressure prior to and
periodically during therapy. Assess for
tachyarrhythmias and chest pain.
Synthroid (levothyroxine)
Assessment Evaluation
Why would you hold or not give this med? Check after giving
Overdose is manifested as hyperthyroidism Lab values approaching normal
(tachycardia, chest pain, nervousness, (TSH: 0.4-4.5 U/ml, T3 Total: 60-
insomnia, diaphoresis, tremors, weight loss). 181 ng/mL, T4 Total: 5.5-12.3
Usual treatment is to withhold dose for 2-6 ng/mL), free from hypothyroid
days. Acute overdose is treated by induction symptoms
of emesis or gastric lavage, followed by
activated charcoal. Sympathetic
overstimulation may be controlled by
antiadrenergic drugs (beta blockers), such as
propranolol. Oxygen and supportive measures
to control symptoms such as fever are also
used. Hypersensitivity. Cardiac
complications. Resting pulse >100.