NR565 Pharmacology Final | questions and answers 2023/24 | updated | 100% verified

NR565 Pharmacology Final | questions and answers 2023/24 | updated | 100% verified Signs and symptoms of hypothyroidism - Face is pale, puffy, and expressionless. Skin is cold and dry. hair is brittle, and hair loss occurs. Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance to cold. Mentation may be impaired. Signs and symptoms of hyperthyroidism - Heart Rate is Rapid; Possible arrhythmia/angina Nervousness, insomnia, rapid thought flow, and rapid speech Skeletal muscles may weaken and atrophy Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and skin that is warm and moist Weight lo ss occurs if caloric intake fails to match the increase in metabolic rate Severe hypothyroidism - Myxedema Hypothyroid Treatment - Levothyroxine is the drug of choice for most patients who require thyroid hormone replacement. Levothyroxine (Synthroid) Therapeutic Goal - Resolution of signs and symptoms of hypothyroidism and restoration of normal laboratory values for serum thyroid -stimulating hormone (TSH) and free thyroxine (T4). Major forms of hyperthyroidism - Graves disease and toxic nodular goi ter (also known as Plummer disease). Graves Disease - Most common cause of excessive thyroid hormone secretion What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than thyroid specific medications? - β-Blockers and nonradioactive iodine may be used as adjunctive therapy. β-Blockers suppress tachycardia by blocking β -receptors on the heart. Nonradioactive iodine inhibits synthesis and release of thyroid hormones. Monitoring needs and intervals for Levothyroxine - Check TSH 6 -8 weeks after initiating therapy and after any dosage change. Check TSH at least once a year after serum TSH is stabilized. Hyperthyroid Treatment - thionamide drugs —methimazole and propylthiouracil (PTU) —suppress synthesis of thyroid hormo nes. Methimazole Therapeutic Goal - (1) reduction of thyroid hormone production in Graves' disease, (2) control of hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone production before subtota l thyroidectomy, (4) treatment of thyrotoxic crisis. Monitoring needs and intervals for Methimazole - Check CBC with differential if signs or symptoms of infection. Check LFTs if signs or symptoms of liver dysfunction. High Risk Patients for Methimazole - Should be avoided in the first trimester of pregnancy. Methimazole Toxicity - Agranulocytosis is the most dangerous toxicity. PTU High Risk Warning - Carries a risk for liver toxicity. Although rare, the FDA recommends against using as a first -line treatment due to potential for hepatic toxicity. Effects of maternal hypothyroidism on offspring and appropriate patient teaching related to need for treatment. - Can cause delay in mental development and derangement of growth. In the absence of thyroid hormones, the child develops a large and protruding tongue, potbelly, and dwarfish stature. Development of the nervous system, bones, teeth, and muscles is impaired. Congenital Hypothyroidism Treatment - requires replacement therapy with thyroid hormone s. If treatment is initiated within a few days of birth, physical and mental development will be normal. replacement therapy should continue for 3 years, after which it should be stopped for 4 weeks to determine whether thyroid deficiency is permanent or transient. Patient Teaching for Methimazole - Tell your healthcare providers that you are taking this drug. Check blood work as directed. Taking this drug may cause harm to the unborn baby if you are pregnant, especially in the first trimester. If you are pregnant or become pregnant while taking this drug, call your healthcare provider right away. Tell your healthcare provider if you are breast -feeding to discuss risks to the baby. Have your baby's thyroid checked if you are using this drug and breast -feeding. Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare. Sore throat and fever should be reported immediately. Patient Teaching for Levothyroxine - works best if you take it on an empty stomach, 30 to 60 minutes before breakfast. take the medicine at the same time each day. Ideal HbA1C goal for diabetic, non -pregnant adults - less than 7%. HbA1C 8% - history of severe hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular c omplications HBA1C Value considered diagnostic of diabetes. - a value of 6.5% or greater HbA1C Measuring Interval - every 3 months until value is <7%; every 6 months thereafter HbA1C Goal for Older Adults - <7.5% [58 mmol/mol]), while those with mult iple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0 -8.5% [64 -69 mmol/mol]). Criteria for the Diagnosis of Diabetes Mellitus - -Fasting plasma glucose ≥126 mg/dL -Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes -Oral glucose tolerance test (OGTT): 2 -h plasma glucose ≥200 mg/dLcor -Hemoglobin A1c 6.5% or higher T1DM Etiology and MOA - Autoimmune process; Loss of pancreatic β cells; T2DM Etiology and MOA - Unknown —but there is a strong familial association, suggesting that heredity is a risk factor; Insulin resistance and inappropriate insulin secretion the total daily dose (TDD) of insulin calculation - total weight of the patient in kilograms (kg), mu ltiplied by 0.6 units Basal insulin replacement - 50% of the total daily insulin dose which replaces insulin from fasting (overnight) and between meals. Bolus insulin replacement - 50% of the total daily insulin dose and provides carbohydrate coverage and high blood sugar correction. Biguanides Drug Class - Metformin Metformin - Decreases glucose production by the liver (glucogenesis), increases tissue response to insulin; Decrease glucose absorption; Increase glucose uptake drug of choice for ini tial therapy in most patients with type 2 diabetes Metformin contraindications - renal disease, acidosis from hepatic disease, alcoholics, or in patients with hypoxia. Metformin Major AE - Gastrointestinal (GI) symptoms: decreased appetite, nausea, diarrhea Lactic acidosis (rarely) Sulfonylureas Prototype/MOA - Glyburide (Prototype Drug) -Promote insulin secretion by the pancreas; may also increase tissue response to insulin; -stimulate beta cells of the pancreas to secrete more insulin Sulfonylureas AE - high risk of severe hypoglycemia; photosensitivity; therefore, patient education is needed regarding sunscreen. blood dyscrasias weight gain. Sulfonylureas Contraindication - should be avoided in patients with impaired hepatic or renal function. Meglitinides (Glinides) Prototype/MOA - -Repaglinide (Prototype Drug) -stimulation of pancreatic insulin release though shorter acting then sulfonylureas and are taken with each meal -Facilitates calcium influx in pancreatic β cells, wh ich leads to increased insulin release Meglitinides Main AE - Hypoglycemia Meglitinides Contraindications - Use with caution in patients with liver impairment and those taking gemfibrozil. Thiazolidinediones (Glitazones) Prototype/MOA - -Pioglitazone (Prototype Drug) -enhance insulin sensitivity/decrease insulin resistance in muscle tissue and reduce glucagon production in the liver -Mainly an add on to Metformin