NSG 533 COMPREHENSIVE NURSING
ASSESSMENT 2026 COMPLETE
QUESTIONS AND ANSWERS
◉ Why are thyroid replacement drugs considered to have a narrow
therapeutic index ( NTI )and what does that mean clinically?
Answer: The therapeutic index (TI) is the range of doses at which a
medication is effective without unacceptable adverse events. Drugs
with a narrow TI (NTIs) have a narrow window between their
effective doses and those at which they produce adverse toxic
effects. Oral Bioavailability: (erratic) 40-80%brand vs generic Highly
protein bound (99%)Half-lifeEuthyroid = 6-7 daysHypothyroid = 9-
10 daysSteady State: @ 6 weeks or 4-5 t1/2 's ... this is the bases for
monitoring @ six weeks from start or changes!
Consider changes such as brand to generic, different generics
manufactures, different pharmacies, etcAny such change will require
repeat lab monitoring @ ~ 6 weeks to confirm the same clinical
response
◉ What are some drug-drug, drug-food interactions associated with
thyroid replacement
Answer: drug binding interactions, di-valent cations, amiodarone,
certain antibiotics
,◉ RECOMMENDATION 13 Methimazole should be used in virtually
every patient who chooses antithyroid drug therapy for GD, except
during the first trimester of pregnancy when propylthiouracil is
preferred, in the treatment of thyroid storm (inhibition of peripheral
conversion), and in patients with minor reactions to methimazole
who refuse radioactive iodine therapy or surgeryDelayed onset
Answer:
◉ Beta-blockers role in therapy?
Answer: So .. beta blockers are used for Symptomatic relief of
hyperthyroidism until more definative therapy is instituted and
thyroid levels retun to normal or near normal..
Reduction of peripheral manifestations
Tachycardia, sweating, severe tremor, nervousness
Inhibition of peripheral conversion of thyroid hormones at higher
doses (propranolol ONLY)
Small therapeutic effect in magnitude
thyrotoxicosis
◉ Why does amiodarone pose a unique concern to thyroid disorders
Answer: "Amiodarone-normal thyroid autoregulation is lost because
of the relatively high iodine content" .. this fact can lead to a situation
where amiodarone can cauase BOTH hyper- and hypo- thyroidism,
depending on the patient, through several process
blocking thyroid peroxidase
,blocking proteolysis of Tg and thyroid hormone
altering organification, etc
◉ What would you recommend if a patient is taking Nexium and
Plavix together?
Answer: As we have seen through our discussions, there is a lot of
information (including an FDA issued statement in the package
insert) describing the drug interaction and reduced efficacy of
clopidogrel if used with a PPI (primarily omeprazole) (or in patients
who are genetically slow CYP2C19 metabolizers); however there is
also evidence based information indicating the interaction is not as
significant as originally thought. Bottom line: Despite
pharmacokinetic evidence that omeprazole interferes with
clopidogrel metabolism, COGENT trial found addition of omeprazole
to clopidogrel reduced gastrointestinal events without increasing
cardiovascular events.
◉ Note there is no significant difference in efficacy among the
H2RAs when given at equipotent dosesCimetidine is associated with
numerous clinically significant DIs
Dose reduction in renal and hepatic insufficiency and in the elderly
Duration of suppression ranges from 6-10 hours and varies with
dose
Note there is no significant difference in efficacy among the PPIs
when given at equipotent doses
, Food may affect absorption. Given 30-60' before a meal. More
flexibility in term of dosing with newer agents (eg.
dexlansoprazole)Delayed onset: 3-4 days for full inhibition
Duration of action up to 24 hours due to covalent, irreversible
inhibition of proton pump
Answer:
◉ Patients with known osteoporosis can remain on PPI therapy.
Concern for hip fractures and osteoporosis should not affect the
decision to use PPI long-term except in patients with other risk
factors for hip fracture
Answer:
◉ Final thoughts on GERD:
Answer: ◦Therapy for GERD other than acid suppression, including
prokinetic therapy and/or baclofen, should not be used in GERD
patients without diagnostic evaluation.
◦For patients with partial response to once daily therapy with a PPI,
tailored therapy with adjustment of dose timing and/or twice daily
dosing should be considered in patients with night-time symptoms,
variable schedules, and/or sleep
◦In patients with partial response to PPI therapy, increasing the
dose to twice daily therapy or switching to a different PPI may
provide additional symptom relief.
ASSESSMENT 2026 COMPLETE
QUESTIONS AND ANSWERS
◉ Why are thyroid replacement drugs considered to have a narrow
therapeutic index ( NTI )and what does that mean clinically?
Answer: The therapeutic index (TI) is the range of doses at which a
medication is effective without unacceptable adverse events. Drugs
with a narrow TI (NTIs) have a narrow window between their
effective doses and those at which they produce adverse toxic
effects. Oral Bioavailability: (erratic) 40-80%brand vs generic Highly
protein bound (99%)Half-lifeEuthyroid = 6-7 daysHypothyroid = 9-
10 daysSteady State: @ 6 weeks or 4-5 t1/2 's ... this is the bases for
monitoring @ six weeks from start or changes!
Consider changes such as brand to generic, different generics
manufactures, different pharmacies, etcAny such change will require
repeat lab monitoring @ ~ 6 weeks to confirm the same clinical
response
◉ What are some drug-drug, drug-food interactions associated with
thyroid replacement
Answer: drug binding interactions, di-valent cations, amiodarone,
certain antibiotics
,◉ RECOMMENDATION 13 Methimazole should be used in virtually
every patient who chooses antithyroid drug therapy for GD, except
during the first trimester of pregnancy when propylthiouracil is
preferred, in the treatment of thyroid storm (inhibition of peripheral
conversion), and in patients with minor reactions to methimazole
who refuse radioactive iodine therapy or surgeryDelayed onset
Answer:
◉ Beta-blockers role in therapy?
Answer: So .. beta blockers are used for Symptomatic relief of
hyperthyroidism until more definative therapy is instituted and
thyroid levels retun to normal or near normal..
Reduction of peripheral manifestations
Tachycardia, sweating, severe tremor, nervousness
Inhibition of peripheral conversion of thyroid hormones at higher
doses (propranolol ONLY)
Small therapeutic effect in magnitude
thyrotoxicosis
◉ Why does amiodarone pose a unique concern to thyroid disorders
Answer: "Amiodarone-normal thyroid autoregulation is lost because
of the relatively high iodine content" .. this fact can lead to a situation
where amiodarone can cauase BOTH hyper- and hypo- thyroidism,
depending on the patient, through several process
blocking thyroid peroxidase
,blocking proteolysis of Tg and thyroid hormone
altering organification, etc
◉ What would you recommend if a patient is taking Nexium and
Plavix together?
Answer: As we have seen through our discussions, there is a lot of
information (including an FDA issued statement in the package
insert) describing the drug interaction and reduced efficacy of
clopidogrel if used with a PPI (primarily omeprazole) (or in patients
who are genetically slow CYP2C19 metabolizers); however there is
also evidence based information indicating the interaction is not as
significant as originally thought. Bottom line: Despite
pharmacokinetic evidence that omeprazole interferes with
clopidogrel metabolism, COGENT trial found addition of omeprazole
to clopidogrel reduced gastrointestinal events without increasing
cardiovascular events.
◉ Note there is no significant difference in efficacy among the
H2RAs when given at equipotent dosesCimetidine is associated with
numerous clinically significant DIs
Dose reduction in renal and hepatic insufficiency and in the elderly
Duration of suppression ranges from 6-10 hours and varies with
dose
Note there is no significant difference in efficacy among the PPIs
when given at equipotent doses
, Food may affect absorption. Given 30-60' before a meal. More
flexibility in term of dosing with newer agents (eg.
dexlansoprazole)Delayed onset: 3-4 days for full inhibition
Duration of action up to 24 hours due to covalent, irreversible
inhibition of proton pump
Answer:
◉ Patients with known osteoporosis can remain on PPI therapy.
Concern for hip fractures and osteoporosis should not affect the
decision to use PPI long-term except in patients with other risk
factors for hip fracture
Answer:
◉ Final thoughts on GERD:
Answer: ◦Therapy for GERD other than acid suppression, including
prokinetic therapy and/or baclofen, should not be used in GERD
patients without diagnostic evaluation.
◦For patients with partial response to once daily therapy with a PPI,
tailored therapy with adjustment of dose timing and/or twice daily
dosing should be considered in patients with night-time symptoms,
variable schedules, and/or sleep
◦In patients with partial response to PPI therapy, increasing the
dose to twice daily therapy or switching to a different PPI may
provide additional symptom relief.
