NR565 Pharmacology Final exam with
complete solutions
Signs and symptoms of hypothyroidism - ANSWER- 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 - ANSWER- 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 loss occurs if caloric intake fails to match the increase in metabolic rate
Severe hypothyroidism - ANSWER- Myxedema
Hypothyroid Treatment - ANSWER- Levothyroxine is the drug of choice for most
patients who require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal - ANSWER- 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 - ANSWER- Graves disease and toxic nodular
goiter (also known as Plummer disease).
Graves Disease - ANSWER- 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? - ANSWER- 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 - ANSWER- 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 - ANSWER- thionamide drugs—methimazole and
propylthiouracil (PTU)—suppress synthesis of thyroid hormones.
Methimazole Therapeutic Goal - ANSWER- (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 subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Methimazole - ANSWER- Check CBC with
differential if signs or symptoms of infection. Check LFTs if signs or symptoms of
liver dysfunction.
High Risk Patients for Methimazole - ANSWER- Should be avoided in the first
trimester of pregnancy.
Methimazole Toxicity - ANSWER- Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning - ANSWER- 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. - ANSWER- 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 - ANSWER- requires replacement therapy
with thyroid hormones. 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- less than 7%.
HbA1C 8% - ANSWER- history of severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
HBA1C Value considered diagnostic of diabetes. - ANSWER- a value of 6.5% or
greater
HbA1C Measuring Interval - ANSWER- every 3 months until value is <7%; every 6
months thereafter
HbA1C Goal for Older Adults - ANSWER- <7.5% [58 mmol/mol]), while those with
multiple 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 - ANSWER- -Fasting
plasma glucose ≥126 mg/dL
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes
complete solutions
Signs and symptoms of hypothyroidism - ANSWER- 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 - ANSWER- 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 loss occurs if caloric intake fails to match the increase in metabolic rate
Severe hypothyroidism - ANSWER- Myxedema
Hypothyroid Treatment - ANSWER- Levothyroxine is the drug of choice for most
patients who require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal - ANSWER- 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 - ANSWER- Graves disease and toxic nodular
goiter (also known as Plummer disease).
Graves Disease - ANSWER- 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? - ANSWER- 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 - ANSWER- 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 - ANSWER- thionamide drugs—methimazole and
propylthiouracil (PTU)—suppress synthesis of thyroid hormones.
Methimazole Therapeutic Goal - ANSWER- (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 subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Methimazole - ANSWER- Check CBC with
differential if signs or symptoms of infection. Check LFTs if signs or symptoms of
liver dysfunction.
High Risk Patients for Methimazole - ANSWER- Should be avoided in the first
trimester of pregnancy.
Methimazole Toxicity - ANSWER- Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning - ANSWER- 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. - ANSWER- 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 - ANSWER- requires replacement therapy
with thyroid hormones. 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 - ANSWER- 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 - ANSWER- 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 - ANSWER- less than 7%.
HbA1C 8% - ANSWER- history of severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
HBA1C Value considered diagnostic of diabetes. - ANSWER- a value of 6.5% or
greater
HbA1C Measuring Interval - ANSWER- every 3 months until value is <7%; every 6
months thereafter
HbA1C Goal for Older Adults - ANSWER- <7.5% [58 mmol/mol]), while those with
multiple 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 - ANSWER- -Fasting
plasma glucose ≥126 mg/dL
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes
