Clinical Medications Worksheets
Normal dosage range
--50 mcg as a single dose initially; may be increased q2-3 wk; usual maintenance dose is 75-125 mcg/day (1.5 mcg/kg/day).
--12.5-25 mcg/day; may increase q 2-4 wk by 25mcg/day; usual maintenance dose is 75-125 mcg/day (1.5 mcg/kg/day).
Geriatric Patients and Patients with Increased Sensitivity toThyroid Hormones:
12.5-25 mcg as a single dose initially; may beincreased q 6-8 wk; usual maintenance dose is 75 mcg/day.
Why is your patient getting this medication
Replacement/substitution in diminished or absent thyroidfunction.
For IV meds, compatibility with IV drips and/or solutions
Mechanism of action and indications
(Why med ordered)
Levothyroxine acts like the endogenous thyroid hormonethyroxine (T
, a tetra-iodinated tyrosine derivative). In the liver and kidney, T
is converted to T
, the active metabolite. Inorder to increase solubility, the thyroid hormones attach tothyroid hormone binding proteins, thyroxin-binding globulin,and thyroxin-binding prealbumin (transthyretin). Transport and binding to thyroid hormone receptors in the cytoplasm andnucleus then takes place. Thus by acting as a replacement for natural thyroxine, symptoms of thyroxine deficiency arerelieved.
Nursing Implications (what to focus on)
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 onBeers list due to concerns about cardiac effects. Also, Geriatric patientsareextremely sensitive to thyroid hormones in general and initialdosage should be markedly reduced. Myxedematous patients(extremely sensitive to thyroid hormones--initial dosage should bemarkedly reduced).
Common side effects
Insomnia, irritability, nervousness, CARIOVASCULAR COLLAPSE,arrhythmias, tachycardia, weight loss
Interactions with other patient drugs, OTC or herbalmedicines
(ask patient specifically)
: The clearance of or sensitivity to digitalis glycosidesmay be increased in previously hypothyroid patients when aeuthyroid state is achieved after the addition of thyroidhormones.
: The efficacy of oral hypoglycemic agentsand insulin may be diminished by certain drugs, includingthiazides and other diuretics, corticosteroids, estrogens, progestins, thyroid hormones, human growth hormone, phenothiazines, atypical antipsychotics, sympathomimeticamines, protease inhibitors, phenytoin, clozapine, megestrol,danazol, isoniazid, asparaginase, pegaspargase, diazoxide,temsirolimus, as well as pharmacologic dosages of nicotinicacid and adrenocorticotropic agents. These drugs may interferewith blood glucose control because they can causehyperglycemia, glucose intolerance, new-onset diabetesmellitus, and/or exacerbation of preexisting diabetes.
: Consumption of certain foods as well asthe timing of meals relative to dosing may affect the absorptionof T4 thyroid hormone (i.e., levothyroxine). T4 absorption isincreased by fasting and decreased by foods such as soybeanflour (e.g., infant formula), cotton seed meal, walnuts, dietaryfiber, calcium, and calcium fortified juices.
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 oralhypoglycemic 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 eachday. 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 professionalnotified if resting pulse >100 bpm. Explain to patient that medicationdoes not cure hypothyroidism; it provides a thyroid hormone. Therapyis lifelong. Caution patient not to change brands of thyroid preparations, as this may affect drug bioavailability. Advise patient tonotify 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 withthyroid 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.