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NURS 6521N- Advanced Pharmacology Week 7 Case Study; Mary’s TSH (20) is high

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NURS 6521N- Advanced Pharmacology

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NURS 6521N- Advanced Pharmacology

Mary’s TSH (20) is high, MCV (78) is low, MCHC (26) is low, ferritin (9) is low, and lastly, TIBC (418) is normal. From her current history of present illness (HPI), Mary seems to have anemia and hypothyroidism. Given Mary’s diagnosis of hypothyroidism and her current medications, the most appr...

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Uploaded on September 19, 2024
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nurs 6521n advanced pharmacology week 7 case stud

Institution NURS 6521N- Advanced Pharmacology
Course NURS 6521N- Advanced Pharmacology

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Week 7 Case Study

Walden University

NURS 6521N- Advanced Pharmacology

Scored 98% with this assignment. Instructor was a tough grader.

Mary’s TSH (20) is high, MCV (78) is low, MCHC (26) is low, ferritin (9) is low, and

lastly, TIBC (418) is normal. From her current history of present illness (HPI), Mary seems to

have anemia and hypothyroidism. Given Mary’s diagnosis of hypothyroidism and her current

medications, the most appropriate medication to start her on would be levothyroxine which is a

synthetic form of thyroid hormone that helps to replace the deficient thyroid hormone in patients

,with hypothyroidism. The goal of therapy is to restore Mary to a euthyroid state which can be

readily accomplished in almost all patients by the oral administration of synthetic thyroxine

(UpToDate, 2024).

Levothyroxine (Synthroid) is the standard of care for the treatment and replacement of

hypothyroidism (UCLA Health, 2024). It is also called LT4 and is the equivalent of the natural

form of thyroid hormone produced by the body. I would start Mary with a low dose of

Levothyroxine 25 mcg once daily since she is young rather than 12.5 mcg which would be the

preferred starting dose for the elderly. (Medscape, 2024). During her follow-up, her dose will be

gradually increased based on her TSH, T3, AND T4 blood levels.

To monitor Mary’s response to levothyroxine, I would check her thyroid function tests

regularly, specifically, her TSH levels. The goal of treatment is to normalize her TSH levels,

typically aiming for a TSH within the normal range (0.4-5.0 mIU/L). TSH is produced in the

pituitary gland in response to low levels of thyroid hormones in the blood. In addition to

monitoring her thyroid level, Mary’s symptoms and overall well-being will be assessed such as

fatigue, dry skin, cold intolerance, and constipation (UCLA Health, 2024). By tracking these

improvements, the effectiveness of her medication will tell if her symptoms are improving or

not.

In terms of education, the timing of meals relative to taking levothyroxine can affect the

rate at which the medication is absorbed (Drugs.com, 2024). Therefore, Mary will be taught to

take this medication on a consistent schedule every morning before meals and to avoid large

fluctuations in her blood levels. Mary will be also taught to take her levothyroxine on an empty

stomach at least 30 minutes before breakfast or any other medications to ensure optimal

, absorption. She would be taught to avoid taking levothyroxine with calcium supplements, iron

supplements, or antacids containing aluminum or magnesium.

According to Medscape, (2024) and Drug.com, (2024), levothyroxine and Ibuprofen

when taken together do not have any interactions but I would advise Mary to take Ibuprofen

cautiously. Since she is taking Ibuprofen 400 mg once daily as needed, there is no need to

readjust her dose as this is a low dose for ibuprofen. Also, according to Medscape, (2024),

Ethinyl estradiol/levonorgestrel (combined oral contraceptive) does not have any interaction with

levothyroxine but Mary will be taught to take this medication with caution. Lastly, according to

Medscape, (2024), Kelp does not have any interactions with Levothyroxine, Ibuprofen, or her

combined oral contraceptives. Since she is taking Levothyroxine in the morning before breakfast,

she should have no problems taking her combined oral contraceptives at a different time during

the day. Including the kelp and ibuprofen.

Lastly, although not mentioned, Mary also has anemia. I would place her on some iron

pills based on her laboratory results and since she has a history of Iron deficiency anemia that

has not been treated. Her prescription will be ferrous sulfate 200 mg tablet orally, extended-

release once daily (Medscape, 2024).

First prescription

Patient’s name/DOB: Mary.

Patient’s age: 35

Patient allergies: NKDA. Licensee number: Contact information: Walden University, 888-969-

8601. Prescriber DEA number: 54321. Number of tablets to dispense: 33. Number of refills:

none. The patient will follow up after 30 days to assess treatment. Indication: hypothyroidism.

Rx: Medication / Strength / Frequency/dose: Levothyroxine 25 mcg by mouth, once daily.

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