Pharmacology Thyroid meds #7

Question

The nurse is caring for a patient with hypothyroidism who receives levothyroxine daily and is scheduled for a procedure under sedation. The nurse contacts the health provider because of the risk of adverse effects when administering which of the ordered medication?

Answers

  1. Benzodiazepine premedication
    • Rationale:

      This answer is correct because when benzodiazepines are taken with levothyroxine, sedation and respiratory depression can be increased and cause unsafe levels of sedation. Any procedure requiring sedation should be reported to the anesthesia provider and health provider since this is a common presurgical medication.

  2. Proton pump inhibitor premedication
    • Rationale:

      This answer is not correct because proton pump inhibitor premedication poses no severe medication reaction or interaction with levothyroxine. Proton pump inhibitors (PPIs) are a class of medication which treat peptic ulcers and gastroesophageal reflux disease (GERD). This is given prior to surgery to prevent reflux and aspiration pneumonia.

  3. Diphenhydramine premedication
    • Rationale:

      This answer is not correct because diphenhydramine premedication poses no severe medication reaction or interaction with levothyroxine. This medication is an antihistamine and helps dry secretions and decrease allergic responses, if given prior to surgery.

  4. Metoclopramide premedication
    • Rationale:

      This answer is not correct because metoclopramide premedication poses no severe medication reaction or interaction with levothyroxine. Metoclopramide is a prokinetic agent used as an anti-nausea medication.

Overview

The benzodiazepine class of medication may increase sedation and respiratory depression when taken with levothyroxine.

Explanation

Benzodiazepines and hypnotic and may increase sedation and respiratory depression when taken with levothyroxine. Levothyroxin has a half-life of 6-7 days and peak in 1-3 weeks with duration of 1-3 weeks, so any procedure requiring sedation should require notification of anesthesia provider and health provider. Proton pump inhibitors, benadryl, and reglan do not pose severe reactions with levothyroxine.

Learning Outcomes

Benzodiazepine medications decrease anxiety and cause sedation. When taken with levothyroxine, sedation and respiratory depression can be increased and cause unsafe levels of sedation. Levothyroxine is a life-long therapy treatment for hypothyroidism. It has a half-life of 6-7 days and peaks in 1-3 weeks with duration of 1-3 weeks. Any procedure requiring sedation should be reported to the anesthesia provider and health provider.

Test Taking Tip

Always be cautious and monitor patients carefully when taking medications that have additive effects, especially when affecting the patient’s ABCs (airwary, breathing, and circulation).

Video Rationale