NR-565 FINAL STUDY GUIDE: ADVANCED PHARMACOLOGY | PRACTICE QUESTIONS &
ANSWERS | COMPREHENSIVE EXAM REVIEW 2026/2027
Advanced Pharmacology Fundamentals
Thyroid
Diagnosis & Evaluation
Labs used for diagnosis: TSH, T3, and T4 levels are checked. In hypothyroidism, TSH is
elevated (>6) while T3 and T4 are decreased; in hyperthyroidism, TSH is low (<0.3), T4 is
normal, and T3 is high.
Etiology: Factors like exogenous T4 ingestion, non-thyroidal illness, or amiodarone-
induced dysfunction can affect TSH, T4, and T3 levels.
Baseline Data & Monitoring: Serum levels of TSH, T3, and T4 are obtained. CBC and LFTs
are checked before treatment initiation. Monitoring includes CBC with differential for
infection signs and LFTs for liver dysfunction.
Treatment
Thyroid Storm: Managed with Propylthiouracil (PTU), potassium iodide, methimazole, β-
blockers, sedation, cooling, glucocorticoids, and IV fluids.
Effects of Untreated Hypothyroidism in Pregnancy: Can lead to neuropsychological
damage in the fetus, emphasizing the importance of early diagnosis and treatment.
Medication Interactions with Levothyroxine: Absorption can be reduced by food,
histamine 2 receptor blockers, proton pump inhibitors, and other drugs like iron
supplements and magnesium salts.
Levothyroxine Dosage Adjustments: Insulin and digoxin requirements may increase.
Drugs like phenytoin, carbamazepine, and rifampin can accelerate levothyroxine
metabolism.
Warfarin Interaction: Levothyroxine accelerates degradation of vitamin K–dependent
clotting factors, enhancing warfarin effects.
Catecholamines Interaction: Thyroid hormones increase cardiac responsiveness to
catecholamines, necessitating caution in patients receiving levothyroxine.
Diabetes
, Diagnosis Confirmation: Includes fasting plasma glucose, oral glucose tolerance test,
and hemoglobin A1c levels.
A1C Goals: Reflect average blood glucose levels over 2-3 months, with specific ranges
indicating prediabetes and diabetes.
Older Adult Goals: Glycemic goals vary based on existing chronic illnesses, with
considerations for hypoglycemia risk and insulin therapy.
Diabetes Management
Insulin Consideration
Injectable therapy should be considered for patients with A1C > 10%, fasting blood
glucose > 300, or marked symptoms.
Insulin initiation for persistent hyperglycemia should start at a threshold of >180.
Insulin is recommended for type 1 DM, gestational diabetes, and when A1C goals are not
met.
Re-check insulin at least two times per year if goals are met, quarterly if goals are not
met or medications have changed.
Drug Classifications and Considerations
Pioglitazone Contraindications: Caution in patients with mild heart failure, avoid in
severe heart failure, active bladder cancer, or history of bladder cancer.
Abbreviations: GLP-1 (Glucagon-Like Peptide 1), TZD (Thiazolidinediones), DPP4-I
(Dipeptidyl peptidase-4 inhibitors), SGLT2i (Sodium-glucose co-transporter 2 inhibitors).
Common Diabetic Medications: Metformin, GLP-1 agonists, SGLT2 inhibitors, DPP-4
inhibitors, TZDs, Sulfonylureas.
First Line Treatment: Metformin is recommended before starting insulin.
Hypoglycemia Concerns: Sulfonylureas, insulin, meglitinides, and amylin analogues pose
a risk of hypoglycemia.
Insulin Dosage and Calculation
Basal vs. Rapid-Acting Insulin: Basal insulin to rapid-acting insulin ratio in total daily
dose (TDD) is 50% to 50%.
Carbohydrate-to-Insulin Ratio: Calculate TDD based on patient weight, determine basal
and rapid-acting insulin doses accordingly.
ANSWERS | COMPREHENSIVE EXAM REVIEW 2026/2027
Advanced Pharmacology Fundamentals
Thyroid
Diagnosis & Evaluation
Labs used for diagnosis: TSH, T3, and T4 levels are checked. In hypothyroidism, TSH is
elevated (>6) while T3 and T4 are decreased; in hyperthyroidism, TSH is low (<0.3), T4 is
normal, and T3 is high.
Etiology: Factors like exogenous T4 ingestion, non-thyroidal illness, or amiodarone-
induced dysfunction can affect TSH, T4, and T3 levels.
Baseline Data & Monitoring: Serum levels of TSH, T3, and T4 are obtained. CBC and LFTs
are checked before treatment initiation. Monitoring includes CBC with differential for
infection signs and LFTs for liver dysfunction.
Treatment
Thyroid Storm: Managed with Propylthiouracil (PTU), potassium iodide, methimazole, β-
blockers, sedation, cooling, glucocorticoids, and IV fluids.
Effects of Untreated Hypothyroidism in Pregnancy: Can lead to neuropsychological
damage in the fetus, emphasizing the importance of early diagnosis and treatment.
Medication Interactions with Levothyroxine: Absorption can be reduced by food,
histamine 2 receptor blockers, proton pump inhibitors, and other drugs like iron
supplements and magnesium salts.
Levothyroxine Dosage Adjustments: Insulin and digoxin requirements may increase.
Drugs like phenytoin, carbamazepine, and rifampin can accelerate levothyroxine
metabolism.
Warfarin Interaction: Levothyroxine accelerates degradation of vitamin K–dependent
clotting factors, enhancing warfarin effects.
Catecholamines Interaction: Thyroid hormones increase cardiac responsiveness to
catecholamines, necessitating caution in patients receiving levothyroxine.
Diabetes
, Diagnosis Confirmation: Includes fasting plasma glucose, oral glucose tolerance test,
and hemoglobin A1c levels.
A1C Goals: Reflect average blood glucose levels over 2-3 months, with specific ranges
indicating prediabetes and diabetes.
Older Adult Goals: Glycemic goals vary based on existing chronic illnesses, with
considerations for hypoglycemia risk and insulin therapy.
Diabetes Management
Insulin Consideration
Injectable therapy should be considered for patients with A1C > 10%, fasting blood
glucose > 300, or marked symptoms.
Insulin initiation for persistent hyperglycemia should start at a threshold of >180.
Insulin is recommended for type 1 DM, gestational diabetes, and when A1C goals are not
met.
Re-check insulin at least two times per year if goals are met, quarterly if goals are not
met or medications have changed.
Drug Classifications and Considerations
Pioglitazone Contraindications: Caution in patients with mild heart failure, avoid in
severe heart failure, active bladder cancer, or history of bladder cancer.
Abbreviations: GLP-1 (Glucagon-Like Peptide 1), TZD (Thiazolidinediones), DPP4-I
(Dipeptidyl peptidase-4 inhibitors), SGLT2i (Sodium-glucose co-transporter 2 inhibitors).
Common Diabetic Medications: Metformin, GLP-1 agonists, SGLT2 inhibitors, DPP-4
inhibitors, TZDs, Sulfonylureas.
First Line Treatment: Metformin is recommended before starting insulin.
Hypoglycemia Concerns: Sulfonylureas, insulin, meglitinides, and amylin analogues pose
a risk of hypoglycemia.
Insulin Dosage and Calculation
Basal vs. Rapid-Acting Insulin: Basal insulin to rapid-acting insulin ratio in total daily
dose (TDD) is 50% to 50%.
Carbohydrate-to-Insulin Ratio: Calculate TDD based on patient weight, determine basal
and rapid-acting insulin doses accordingly.
