NR565||(NR 565) Final Exam Question
(2024/2025) GRADED A+ VERIFIED
ADVANCED PHARMACOLOGY WELL
STATED CHAMBERLAIN
What labs are used to diagnose Thyroid? (CORRECT ANSWER)TSH,
total T4 and T3, free T4 and T3
Timeframe for re-check of labs after starting levothyroxine (CORRECT
ANSWER)6-8 wks after starting therapy
Signs and symptoms of hypothyroidism (CORRECT ANSWER)Face:
Pale, puffy, expressionless
Skin: Cold and dry
Hair: Brittle and hair loss
Heart rate and temp are lowered
Complaints by patient: lethargy, fatigue, intolerance to cold
Mentation may be impaired
Thyroid enlargement if ↓'d levels of T3 and T4 promoting excessive
release of TSH
Treatment of thyroid storm (CORRECT ANSWER)High dose potassium
iodide or strong iodine solution to suppress thyroid hormone release,
methimazole to suppress thyroid hormone synthesis,
beta blocker to reduce heart rate, sedation cooling glucocorticoids and
IV fluids
Result of not treating hypothyroidism during pregnancy (CORRECT
ANSWER)permanent neurological defects, ↓'d IQ, large protruding
tongue, potbelly dwarfish stature, impaired development of nervous
system bone teeth and muscles.
,Medication to treat symptoms of hyperthyroidism (notice this is treating
symptoms and not the hyperthyroidism itself) (CORRECT
ANSWER)Metoprolol could be used to treat tachycardia experienced
with hyperthyroidism, but it does not treat hyperthyroidism itself.
Drug/Food/Supplement interactions with levothyroxine Absorption
REDUCED by: (CORRECT ANSWER)Histamine 2 receptor blockers
(Cimetidine [Tagamet])
Proton pump inhibitors (Lansoprazole)
Sucralfate (Carafate)
Cholestyramine (Questran)
Colestipol (Colestid)
Aluminum containing antacids (maalox, mylanta)
Calcium supplements (tums, os-cal)
Iron supplements
Magnesium salts
Orlistat (Xenical)
* 4 hours between levothyroxine and the above meds is recommended
and food reduces absorption as well
How to confirm a diagnosis of DM prior to beginning treatment
(CORRECT ANSWER)Hemoglobin A1C > 6.5%,
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/dL
A1C General goals (CORRECT ANSWER)less than 7%, less than 8%
in patients with severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
A1c - Older Adult goal (CORRECT ANSWER)
, When should insulin be considered? (CORRECT ANSWER)Type 1
Diabetics All are on insulin
Type 2 Diabetics
Step 3 - Three drug combination (inclusive of metformin)
Step 4 - Three drug therapy and basal insulin fails to reach goals after 3-
6 months - injectable regimen inclusive of insulin and possibly GLP-1
receptor agonist.
EXCEPTIONS: patient with A1C greater than 9% or greater start dual
therapy (start at step 2) and patients with A1C greater than 10 % and
fasting blood glucose of 300 or more or symptomatic may be started on
combination injectable therapy immediately
At what time interval should A1c be re-checked? (CORRECT
ANSWER)every 3 months until A1C drops below 7% and then every 6
months thereafter.
Action of Insulin (CORRECT ANSWER)Anabolic-promotes
conservation of energy and buildup of energy stores (Glycogen)
Stimulates cellular transport (Uptake) of glucose, amino acids,
nucleotides & K
Promotes synthesis of complex molecules
Glucose ⇒ Glycogen, Amino Acids ⇒ Proteins, Fatty Acids ⇒
Triglycerides
Promotes cellular growth and division
Energy conservation
Pioglitazone contraindications (CORRECT ANSWER)Pioglitazone is
contraindicated in patients with severe heart failure and should be used
with caution in patients with mild heart failure. Should not be used in
patients that have active bladder cancer or history of bladder cancer
Be familiar with abbreviations of diabetic drug classifications (GLP-1,
TZD, DPP4-I, SGLT2i) (CORRECT ANSWER)GLP-1: Glucagon-like
Peptide -1 Receptor Agonist
TZD: Thiazolidinediones (Glitazones)
(2024/2025) GRADED A+ VERIFIED
ADVANCED PHARMACOLOGY WELL
STATED CHAMBERLAIN
What labs are used to diagnose Thyroid? (CORRECT ANSWER)TSH,
total T4 and T3, free T4 and T3
Timeframe for re-check of labs after starting levothyroxine (CORRECT
ANSWER)6-8 wks after starting therapy
Signs and symptoms of hypothyroidism (CORRECT ANSWER)Face:
Pale, puffy, expressionless
Skin: Cold and dry
Hair: Brittle and hair loss
Heart rate and temp are lowered
Complaints by patient: lethargy, fatigue, intolerance to cold
Mentation may be impaired
Thyroid enlargement if ↓'d levels of T3 and T4 promoting excessive
release of TSH
Treatment of thyroid storm (CORRECT ANSWER)High dose potassium
iodide or strong iodine solution to suppress thyroid hormone release,
methimazole to suppress thyroid hormone synthesis,
beta blocker to reduce heart rate, sedation cooling glucocorticoids and
IV fluids
Result of not treating hypothyroidism during pregnancy (CORRECT
ANSWER)permanent neurological defects, ↓'d IQ, large protruding
tongue, potbelly dwarfish stature, impaired development of nervous
system bone teeth and muscles.
,Medication to treat symptoms of hyperthyroidism (notice this is treating
symptoms and not the hyperthyroidism itself) (CORRECT
ANSWER)Metoprolol could be used to treat tachycardia experienced
with hyperthyroidism, but it does not treat hyperthyroidism itself.
Drug/Food/Supplement interactions with levothyroxine Absorption
REDUCED by: (CORRECT ANSWER)Histamine 2 receptor blockers
(Cimetidine [Tagamet])
Proton pump inhibitors (Lansoprazole)
Sucralfate (Carafate)
Cholestyramine (Questran)
Colestipol (Colestid)
Aluminum containing antacids (maalox, mylanta)
Calcium supplements (tums, os-cal)
Iron supplements
Magnesium salts
Orlistat (Xenical)
* 4 hours between levothyroxine and the above meds is recommended
and food reduces absorption as well
How to confirm a diagnosis of DM prior to beginning treatment
(CORRECT ANSWER)Hemoglobin A1C > 6.5%,
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/dL
A1C General goals (CORRECT ANSWER)less than 7%, less than 8%
in patients with severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
A1c - Older Adult goal (CORRECT ANSWER)
, When should insulin be considered? (CORRECT ANSWER)Type 1
Diabetics All are on insulin
Type 2 Diabetics
Step 3 - Three drug combination (inclusive of metformin)
Step 4 - Three drug therapy and basal insulin fails to reach goals after 3-
6 months - injectable regimen inclusive of insulin and possibly GLP-1
receptor agonist.
EXCEPTIONS: patient with A1C greater than 9% or greater start dual
therapy (start at step 2) and patients with A1C greater than 10 % and
fasting blood glucose of 300 or more or symptomatic may be started on
combination injectable therapy immediately
At what time interval should A1c be re-checked? (CORRECT
ANSWER)every 3 months until A1C drops below 7% and then every 6
months thereafter.
Action of Insulin (CORRECT ANSWER)Anabolic-promotes
conservation of energy and buildup of energy stores (Glycogen)
Stimulates cellular transport (Uptake) of glucose, amino acids,
nucleotides & K
Promotes synthesis of complex molecules
Glucose ⇒ Glycogen, Amino Acids ⇒ Proteins, Fatty Acids ⇒
Triglycerides
Promotes cellular growth and division
Energy conservation
Pioglitazone contraindications (CORRECT ANSWER)Pioglitazone is
contraindicated in patients with severe heart failure and should be used
with caution in patients with mild heart failure. Should not be used in
patients that have active bladder cancer or history of bladder cancer
Be familiar with abbreviations of diabetic drug classifications (GLP-1,
TZD, DPP4-I, SGLT2i) (CORRECT ANSWER)GLP-1: Glucagon-like
Peptide -1 Receptor Agonist
TZD: Thiazolidinediones (Glitazones)
