NR565 Final Exam Study Guide note cards

The first-line medication for type 2 DM is metformin.  ADA and other professional guidelines inform prescribing decisions.  Combination injectable therapy should be considered for immediate implementation in patients with an A1C of 10% or higher.  TZDs, like Actos, can precipitate CHF and should be avoided in patients with heart failure.  Older adults should be started on lower doses of levothyroxine.  Radioactive iodine treatment results in lifelong hypothyroidism.  When treating hypothyroidism, TSH levels should be monitored every 6-8 weeks until the patient achieves a euthyroid state. - Signs and symptoms of hypothyroidism and hyperthyroidism (pp. 418-419) Hypothyroidism: The face is pale, puffy, & expressionless. The skin is cold & dry. The hair is brittle, & hair loss occurs. Heart rate & temperature are lowered. The patient may c/o lethargy, fatigue, & cold intolerance. Mentation may be impaired. Thyroid enlargement may occur if reduced levels of T3 & T4 promote excessive release of TSH. Hyperthyroidism: Heartbeat is rapid & strong, & dysrhythmias & angina may develop. The CNS is stimulated, resulting in nervousness, insomnia, rapid thought flow, & rapid speech. Skeletal muscles may weaken & atrophy. Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, & skin that is warm & moist. Increased appetite, but weight loss may occur if caloric intake fails to match the increase in metabolic rate. (Exophthalmos w/Graves’ disease). - What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than thyroid specific medications? Know drug classes and examples of those drug classes. (pp. 419, 423) Beta-blockers & nonradioactive iodine may be used as adjunctive therapy for hyperthyroidism. Beta-blockers: Suppress tachycardia by blocking beta-receptors on the heart. (“-lol”) Nonradioactive iodine: Inhibits synthesis & release of thyroid hormones. (Lugol Solution = mixture