An 84-year-old client with coronary artery disease has a new prescription for liothyronine 25 mcg daily. Which action should the nurse take?
1Administer 50 mcg now because older adults with cardiac disease metabolize thyroid hormone more rapidly.
2Hold and clarify the 25-mcg starting dose; older adults with cardiac disease should start at 5 mcg daily.✓ Correct answer
3Administer 25 mcg and wait until the next annual visit to assess for angina or other cardiac symptoms.
4Crush the 25-mcg tablet into an enteral feeding because changing the route will reduce cardiac exposure.
Explanation
Older adults and clients with underlying cardiac disease should start liothyronine at 5 mcg daily and increase in 5-mcg increments to reduce cardiac adverse-reaction risk.
Why this is correct Liothyronine can increase heart rate and contractility and precipitate angina or arrhythmia. The label specifies a 5-mcg daily start for older adults or clients with cardiac disease.
Easy analogy or mental picture A sensitive engine starts at idle, not at highway speed.
Memory hook Older heart: start T3 low and increase slowly.
NCLEX decision rule Apply age and cardiovascular status before accepting the usual adult starting dose.
Why the other choices are wrong Dose escalation and delayed monitoring increase cardiac risk, while an unverified route change does not solve the dose problem.
References
1DailyMed: Liothyronine SodiumFive-microgram start in older adults or cardiac disease
Thyroid replacement safetyCheck age, coronary disease, baseline pulse and rhythm, starting dose, titration interval, and symptoms of overtreatment.