NR 565|| (NR 565) Final Exam/ MIDTERM EXAM
Questions with accurate answers
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
Questions with accurate answers
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
