Mosby's 2014 Nursing Drug Reference (336 page)

Black Box Warning:

Hepatic disease

• Adult and child:
PO
200-400 mg q4hr for 1st 24 hr

• Adult:
PO
600-1200 mg/day

• Child:
PO
10 mg/kg/day in divided doses

• Adult:
PO
100 mg tid increasing to 300 mg q8hr if condition is severe; continue to euthyroid state then 100 mg daily-tid

• Child
>
6 yr:
PO
50 mg/day divided q8hr, titrate based on TSH/free T
₄
levels

• Neonate (unlabeled):
PO
5-10 mg/kg/day in divided doses q8hr

• 
With meals to decrease GI upset

• 
At same time each day to maintain product level

• 
At lowest dose that relieves symptoms

Increase:
effects—potassium/sodium iodide, lithium

Decrease:
anticoagulant effect—heparin, oral anticoagulants

Increase:
PT, AST, ALT, alk phos

• 
Hyperthyroidism:
weight loss, nervousness, insomnia, fever, diaphoresis, tremors;
hypothyroidism:
constipation, dry skin, weakness, headache; monitor T
₃
, T
₄
, which are increased; serum TSH, which is decreased; free thyroxine index, which is increased if dosage is too low; discontinue product 3-4 wk before RAIU

• 
Pulse, B/P, temp

• 
I&O ratio; check for edema: puffy hands, feet, periorbits; indicates hypothyroidism

• 
Weight daily; same clothing, scale, time of day

 
Blood dyscrasias:
CBC with differential; leukopenia, thrombocytopenia, agranulocytosis

 
Overdose:
peripheral edema, heat intolerance, diaphoresis, palpitations, dysrhythmias, severe tachycardia, increased temp, delirium, CNS irritability

 
Hypersensitivity:
rash, enlarged cervical lymph nodes; product may have to be discontinued

• 
Hypoprothrombinemia:
bleeding, petechiae, ecchymosis

• 
Clinical response: after 3 wk should include increased weight, pulse; decreased T
₄

• 
Bone marrow suppression:
sore throat, fever, fatigue

Black Box Warning:

Hepatotoxicity:
LFTs before, during treatment; jaundice, nausea, vomiting, abdominal pain, anorexia, diarrhea, fatigue

• 
Storage in light-resistant container

• 
Fluids to 3-4 L/day unless contraindicated

• 
Therapeutic response: weight gain, decreased pulse, decreased T
₄
, decreased B/P

• 
To abstain from breastfeeding after delivery

• 
To take pulse daily

• 
To report redness, swelling, sore throat, mouth lesions, which indicate blood dyscrasias; to report symptoms of hepatic dysfunction

• 
To keep graph of weight, pulse, mood

• 
To avoid OTC products that contain iodine

• 
That seafood, other iodine products may be restricted

• 
Not to discontinue product abruptly because thyroid crisis may occur; about stress response

• 
That response may take several months if thyroid is large

• 
About the symptoms/signs of overdose: periorbital edema, cold intolerance, mental depression

• 
About the symptoms of an inadequate dose: tachycardia, diarrhea, fever, irritability

• 
To take medication as prescribed; not to skip or double dose; that missed doses should be taken when remembered up to 1 hr before next dose

• 
To carry emergency ID listing condition, medication