lOMoARcPSD|12703449
NR565 Final Exam Study Guide from facebook group
Advanced Pharmacology Fundamentals (Chamberlain University)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Mika Washington ()
, lOMoARcPSD|12703449
NR565 Final Exam Study Guide
Week 5
Key Points
The 昀椀rst-line medica琀椀on for type 2 DM is me琀昀ormin.
ADA and other professional guidelines inform prescribing decisions.
Combina琀椀on injectable therapy should be considered for immediate implementa琀椀on in pa琀椀ents
with an A1C of 10% or higher.
TZDs, like Actos, can precipitate CHF and should be avoided in pa琀椀ents with heart failure.
Older adults should be started on lower doses of levothyroxine.
Radioac琀椀ve iodine treatment results in lifelong hypothyroidism.
When trea琀椀ng hypothyroidism, TSH levels should be monitored every 6-8 weeks un琀椀l the pa琀椀ent
achieves a euthyroid state.
- Signs and symptoms of hypothyroidism and hyperthyroidism (pp. 418-419)
Hypothyroidism: The face is pale, pu昀昀y, & expressionless. The skin is cold & dry. The hair is bri琀琀le, & hair
loss occurs. Heart rate & temperature are lowered. The pa琀椀ent may c/o lethargy, fa琀椀gue, & cold
intolerance. Menta琀椀on may be impaired. Thyroid enlargement may occur if reduced levels of T 3 & T4
promote excessive release of TSH.
Hyperthyroidism: Heartbeat is rapid & strong, & dysrhythmias & angina may develop. The CNS is
s琀椀mulated, resul琀椀ng in nervousness, insomnia, rapid thought 昀氀ow, & rapid speech. Skeletal muscles may
weaken & atrophy. Metabolic rate is raised, resul琀椀ng in increased heat produc琀椀on, increased body
temperature, intolerance to heat, & skin that is warm & moist. Increased appe琀椀te, but weight loss may
occur if caloric intake fails to match the increase in metabolic rate. (Exophthalmos w/Graves’ disease).
- What adjunc琀椀ve therapy is good to prescribe to control symptoms of hyperthyroidism other than
thyroid speci昀椀c medica琀椀ons? Know drug classes and examples of those drug classes. (pp. 419, 423)
Beta-blockers & nonradioac琀椀ve iodine may be used as adjunc琀椀ve therapy for hyperthyroidism.
Beta-blockers: Suppress tachycardia by blocking beta-receptors on the heart. (“-lol”)
Nonradioac琀椀ve iodine: Inhibits synthesis & release of thyroid hormones. (Lugol Solu琀椀on = mixture
containing 5% elemental iodine & 10% potassium iodine).
- Monitoring needs and intervals for thyroid medica琀椀ons. (pp. 421, 423)
Hypothyroidism: Levothyroxine (T4) (Brand-name: Levoxyl, Synthroid)
Therapeu琀椀c Goal: Resolu琀椀on of signs & symptoms of hypothyroidism & restora琀椀on of normal lab values for
serum TSH & free T4.
Baseline Data: Obtain serum levels of TSH & free T4.
Downloaded by Mika Washington ()
, lOMoARcPSD|12703449
Monitoring: Check TSH 6-8 weeks a昀琀er ini琀椀a琀椀ng therapy & a昀琀er any dosage change. Check TSH at least
once a year a昀琀er serum TSH is stabilized.
Iden琀椀fying High-Risk Pa琀椀ents: Use w/cau琀椀on in those pa琀椀ents with cardiovascular disease & start w/lower
doses in older adult pa琀椀ents.
Evalua琀椀ng Therapeu琀椀c E昀昀ects: Look for a reversal of signs of thyroid de昀椀ciency & an absence of signs of
thyroid excess. In children, normaliza琀椀on of intellectual func琀椀on, growth, & development should occur.
Monthly measurements of height provide a good index of thyroid su昀케ciency. Lab tests should indicate
normal plasma levels of TSH & T4. Measure TSH levels at least 1x/year.
Minimizing Adverse E昀昀ects: Overdose may cause thyrotoxicosis. Symptoms include tachycardia, angina,
tremor, nervousness, insomnia, swea琀椀ng, & heat intolerance.
Hyperthyroidism: Methimazole (a thionamide) (Brand-name: Tapazole)
Therapeu琀椀c Goal: Methimazole has 4 indica琀椀ons—reduc琀椀on of thyroid hormone produc琀椀on in Graves’
disease, control of hyperthyroidism un琀椀l the e昀昀ects of radia琀椀on on the thyroid become manifest,
suppression of thyroid hormone produc琀椀on before subtotal thyroidectomy, & treatment of thyrotoxic
crisis.
Baseline Data: Obtain serum levels of TSH, T3, & T4. Check baseline CBC & LFTs prior to ini琀椀a琀椀on.
Monitoring: Check CBC w/di昀昀eren琀椀al if signs or symptoms of infec琀椀on. Check LFTs if signs or symptoms of
liver dysfunc琀椀on.
Iden琀椀fying High-Risk Pa琀椀ents: Methimazole should be avoided in the 1st trimester of pregnancy & in
women who are breas琀昀eeding.
Evalua琀椀ng Therapeu琀椀c E昀昀ects: Monitor for weight gain, decreased heart rate, & other indica琀椀ons that
levels of thyroid hormone have declined. Lab tests should indicate a decrease in serum free T 3 & free T4.
Minimizing Adverse E昀昀ects:
Agranulocytosis: Inform pa琀椀ents about early signs of agranulocytosis, including fever or sore throat.
If follow-up blood tests reveal leukopenia, methimazole should be stopped.
Hypothyroidism: Methimazole may cause excessive reduc琀椀ons in thyroid hormone synthesis. If signs
of hypothyroidism develop or if plasma levels of T3 & T4 become subnormal, dosage should be
reduced.
- Propylthiouracil (PTU) carries a risk for liver toxicity. Although rare, the FDA recommends against using
PTU as a 昀椀rst-line treatment due to poten琀椀al for hepa琀椀c toxicity. (p. 422)
Also a thionamide, PTU suppresses synthesis of thyroid hormones. Its therapeu琀椀c uses include pregnant
women in the 1st trimester, thyroid storm, & pa琀椀ents w/intolerance to methimazole. It has caused rare
cases of liver injury. Onset is sudden & progression is rapid.
Downloaded by Mika Washington ()
NR565 Final Exam Study Guide from facebook group
Advanced Pharmacology Fundamentals (Chamberlain University)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Mika Washington ()
, lOMoARcPSD|12703449
NR565 Final Exam Study Guide
Week 5
Key Points
The 昀椀rst-line medica琀椀on for type 2 DM is me琀昀ormin.
ADA and other professional guidelines inform prescribing decisions.
Combina琀椀on injectable therapy should be considered for immediate implementa琀椀on in pa琀椀ents
with an A1C of 10% or higher.
TZDs, like Actos, can precipitate CHF and should be avoided in pa琀椀ents with heart failure.
Older adults should be started on lower doses of levothyroxine.
Radioac琀椀ve iodine treatment results in lifelong hypothyroidism.
When trea琀椀ng hypothyroidism, TSH levels should be monitored every 6-8 weeks un琀椀l the pa琀椀ent
achieves a euthyroid state.
- Signs and symptoms of hypothyroidism and hyperthyroidism (pp. 418-419)
Hypothyroidism: The face is pale, pu昀昀y, & expressionless. The skin is cold & dry. The hair is bri琀琀le, & hair
loss occurs. Heart rate & temperature are lowered. The pa琀椀ent may c/o lethargy, fa琀椀gue, & cold
intolerance. Menta琀椀on may be impaired. Thyroid enlargement may occur if reduced levels of T 3 & T4
promote excessive release of TSH.
Hyperthyroidism: Heartbeat is rapid & strong, & dysrhythmias & angina may develop. The CNS is
s琀椀mulated, resul琀椀ng in nervousness, insomnia, rapid thought 昀氀ow, & rapid speech. Skeletal muscles may
weaken & atrophy. Metabolic rate is raised, resul琀椀ng in increased heat produc琀椀on, increased body
temperature, intolerance to heat, & skin that is warm & moist. Increased appe琀椀te, but weight loss may
occur if caloric intake fails to match the increase in metabolic rate. (Exophthalmos w/Graves’ disease).
- What adjunc琀椀ve therapy is good to prescribe to control symptoms of hyperthyroidism other than
thyroid speci昀椀c medica琀椀ons? Know drug classes and examples of those drug classes. (pp. 419, 423)
Beta-blockers & nonradioac琀椀ve iodine may be used as adjunc琀椀ve therapy for hyperthyroidism.
Beta-blockers: Suppress tachycardia by blocking beta-receptors on the heart. (“-lol”)
Nonradioac琀椀ve iodine: Inhibits synthesis & release of thyroid hormones. (Lugol Solu琀椀on = mixture
containing 5% elemental iodine & 10% potassium iodine).
- Monitoring needs and intervals for thyroid medica琀椀ons. (pp. 421, 423)
Hypothyroidism: Levothyroxine (T4) (Brand-name: Levoxyl, Synthroid)
Therapeu琀椀c Goal: Resolu琀椀on of signs & symptoms of hypothyroidism & restora琀椀on of normal lab values for
serum TSH & free T4.
Baseline Data: Obtain serum levels of TSH & free T4.
Downloaded by Mika Washington ()
, lOMoARcPSD|12703449
Monitoring: Check TSH 6-8 weeks a昀琀er ini琀椀a琀椀ng therapy & a昀琀er any dosage change. Check TSH at least
once a year a昀琀er serum TSH is stabilized.
Iden琀椀fying High-Risk Pa琀椀ents: Use w/cau琀椀on in those pa琀椀ents with cardiovascular disease & start w/lower
doses in older adult pa琀椀ents.
Evalua琀椀ng Therapeu琀椀c E昀昀ects: Look for a reversal of signs of thyroid de昀椀ciency & an absence of signs of
thyroid excess. In children, normaliza琀椀on of intellectual func琀椀on, growth, & development should occur.
Monthly measurements of height provide a good index of thyroid su昀케ciency. Lab tests should indicate
normal plasma levels of TSH & T4. Measure TSH levels at least 1x/year.
Minimizing Adverse E昀昀ects: Overdose may cause thyrotoxicosis. Symptoms include tachycardia, angina,
tremor, nervousness, insomnia, swea琀椀ng, & heat intolerance.
Hyperthyroidism: Methimazole (a thionamide) (Brand-name: Tapazole)
Therapeu琀椀c Goal: Methimazole has 4 indica琀椀ons—reduc琀椀on of thyroid hormone produc琀椀on in Graves’
disease, control of hyperthyroidism un琀椀l the e昀昀ects of radia琀椀on on the thyroid become manifest,
suppression of thyroid hormone produc琀椀on before subtotal thyroidectomy, & treatment of thyrotoxic
crisis.
Baseline Data: Obtain serum levels of TSH, T3, & T4. Check baseline CBC & LFTs prior to ini琀椀a琀椀on.
Monitoring: Check CBC w/di昀昀eren琀椀al if signs or symptoms of infec琀椀on. Check LFTs if signs or symptoms of
liver dysfunc琀椀on.
Iden琀椀fying High-Risk Pa琀椀ents: Methimazole should be avoided in the 1st trimester of pregnancy & in
women who are breas琀昀eeding.
Evalua琀椀ng Therapeu琀椀c E昀昀ects: Monitor for weight gain, decreased heart rate, & other indica琀椀ons that
levels of thyroid hormone have declined. Lab tests should indicate a decrease in serum free T 3 & free T4.
Minimizing Adverse E昀昀ects:
Agranulocytosis: Inform pa琀椀ents about early signs of agranulocytosis, including fever or sore throat.
If follow-up blood tests reveal leukopenia, methimazole should be stopped.
Hypothyroidism: Methimazole may cause excessive reduc琀椀ons in thyroid hormone synthesis. If signs
of hypothyroidism develop or if plasma levels of T3 & T4 become subnormal, dosage should be
reduced.
- Propylthiouracil (PTU) carries a risk for liver toxicity. Although rare, the FDA recommends against using
PTU as a 昀椀rst-line treatment due to poten琀椀al for hepa琀椀c toxicity. (p. 422)
Also a thionamide, PTU suppresses synthesis of thyroid hormones. Its therapeu琀椀c uses include pregnant
women in the 1st trimester, thyroid storm, & pa琀椀ents w/intolerance to methimazole. It has caused rare
cases of liver injury. Onset is sudden & progression is rapid.
Downloaded by Mika Washington ()
