NR 565 Pharmacology Final Exam –
Comprehensive Study Guide, Key
Concepts, and Practice Review
Signs and symptoms of hypothyroidism Face is pale, puffy, and expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy,
fatigue, and intolerance to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism Heart Rate is Rapid; Possible arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat
production, increased body temperature, intolerance to heat,
and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase
in metabolic rate
Severe hypothyroidism Myxedema
Hypothyroid Treatment Levothyroxine is the drug of choice for most patients who
require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal Resolution of signs and symptoms of hypothyroidism and
restoration of normal laboratory values for serum thyroid-
stimulating hormone (TSH) and free thyroxine (T4).
Major forms of hyperthyroidism Graves disease and toxic nodular goiter (also known as
Plummer disease).
Graves Disease Most common cause of excessive thyroid hormone secretion
What adjunctive therapy is good to β-Blockers and nonradioactive iodine may be used as
prescribe to control symptoms of adjunctive therapy.
hyperthyroidism other than thyroid specific β-Blockers suppress tachycardia by blocking β-receptors on
medications? the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid
hormones.
Monitoring needs and intervals for Check TSH 6-8 weeks after initiating therapy and after
Levothyroxine any dosage change.
Check TSH at least once a year after serum TSH is stabilized.
Hyperthyroid Treatment thionamide drugs—methimazole and propylthiouracil (PTU)—
suppress synthesis of thyroid hormones.
,Methimazole Therapeutic Goal (1) reduction of thyroid hormone production in Graves'
disease, (2) control of hyperthyroidism until the effects of
radiation on the thyroid become manifest, (3) suppression of
thyroid hormone production before subtotal thyroidectomy,
(4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Check CBC with differential if signs or symptoms of infection.
Methimazole Check LFTs if signs or symptoms of liver dysfunction.
High Risk Patients for Methimazole Should be avoided in the first trimester of pregnancy.
Methimazole Toxicity Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning Carries a risk for liver toxicity. Although rare, the FDA
recommends against using as a first-line treatment due to
potential for hepatic toxicity.
Effects of maternal hypothyroidism on Can cause delay in mental development and derangement of
offspring and appropriate patient teaching growth. In the absence of thyroid hormones, the child
related to need for treatment. develops a large and protruding tongue, potbelly, and
dwarfish stature. Development of the nervous system,
bones, teeth, and muscles is impaired.
, Congenital Hypothyroidism Treatment requires replacement therapy with thyroid hormones. If
treatment is initiated within a few days of birth, physical and
mental development will be normal.
replacement therapy should continue for 3 years, after
which it should be stopped for 4 weeks to determine
whether thyroid deficiency is permanent or transient.
Patient Teaching for Methimazole Tell your healthcare providers that you are taking this drug.
Check blood work as directed.
Taking this drug may cause harm to the unborn baby if you are
pregnant, especially in the first trimester.
If you are pregnant or become pregnant while taking this
drug, call your healthcare provider right away.
Tell your healthcare provider if you are breast-feeding to
discuss risks to the baby.
Have your baby's thyroid checked if you are using this drug
and breast-feeding.
Agranulocytosis is the most dangerous toxicity risk for this
medication but is very rare. Sore throat and fever should be
reported immediately.
Patient Teaching for Levothyroxine works best if you take it on an empty stomach, 30 to 60
minutes before breakfast.
take the medicine at the same time each day.
Ideal HbA1C goal for diabetic, non- less than 7%.
pregnant adults
HbA1C 8% history of severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
HBA1C Value considered diagnostic of a value of 6.5% or greater
diabetes.
HbA1C Measuring Interval every 3 months until value is <7%; every 6 months thereafter
HbA1C Goal for Older Adults <7.5% [58 mmol/mol]), while those with multiple coexisting
chronic illnesses, cognitive impairment, or functional
dependence should have less stringent glycemic goals (such
as A1C <8.0-8.5% [64-69 mmol/mol]).
Criteria for the Diagnosis of Diabetes -Fasting plasma glucose ≥126 mg/dL
Mellitus -Random plasma glucose ≥ 200 mg/dL plus symptoms of
diabetes
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200
mg/dLcor
-Hemoglobin A1c 6.5% or higher
T1DM Etiology and MOA Autoimmune process; Loss of pancreatic β cells;
Comprehensive Study Guide, Key
Concepts, and Practice Review
Signs and symptoms of hypothyroidism Face is pale, puffy, and expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy,
fatigue, and intolerance to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism Heart Rate is Rapid; Possible arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat
production, increased body temperature, intolerance to heat,
and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase
in metabolic rate
Severe hypothyroidism Myxedema
Hypothyroid Treatment Levothyroxine is the drug of choice for most patients who
require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal Resolution of signs and symptoms of hypothyroidism and
restoration of normal laboratory values for serum thyroid-
stimulating hormone (TSH) and free thyroxine (T4).
Major forms of hyperthyroidism Graves disease and toxic nodular goiter (also known as
Plummer disease).
Graves Disease Most common cause of excessive thyroid hormone secretion
What adjunctive therapy is good to β-Blockers and nonradioactive iodine may be used as
prescribe to control symptoms of adjunctive therapy.
hyperthyroidism other than thyroid specific β-Blockers suppress tachycardia by blocking β-receptors on
medications? the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid
hormones.
Monitoring needs and intervals for Check TSH 6-8 weeks after initiating therapy and after
Levothyroxine any dosage change.
Check TSH at least once a year after serum TSH is stabilized.
Hyperthyroid Treatment thionamide drugs—methimazole and propylthiouracil (PTU)—
suppress synthesis of thyroid hormones.
,Methimazole Therapeutic Goal (1) reduction of thyroid hormone production in Graves'
disease, (2) control of hyperthyroidism until the effects of
radiation on the thyroid become manifest, (3) suppression of
thyroid hormone production before subtotal thyroidectomy,
(4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Check CBC with differential if signs or symptoms of infection.
Methimazole Check LFTs if signs or symptoms of liver dysfunction.
High Risk Patients for Methimazole Should be avoided in the first trimester of pregnancy.
Methimazole Toxicity Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning Carries a risk for liver toxicity. Although rare, the FDA
recommends against using as a first-line treatment due to
potential for hepatic toxicity.
Effects of maternal hypothyroidism on Can cause delay in mental development and derangement of
offspring and appropriate patient teaching growth. In the absence of thyroid hormones, the child
related to need for treatment. develops a large and protruding tongue, potbelly, and
dwarfish stature. Development of the nervous system,
bones, teeth, and muscles is impaired.
, Congenital Hypothyroidism Treatment requires replacement therapy with thyroid hormones. If
treatment is initiated within a few days of birth, physical and
mental development will be normal.
replacement therapy should continue for 3 years, after
which it should be stopped for 4 weeks to determine
whether thyroid deficiency is permanent or transient.
Patient Teaching for Methimazole Tell your healthcare providers that you are taking this drug.
Check blood work as directed.
Taking this drug may cause harm to the unborn baby if you are
pregnant, especially in the first trimester.
If you are pregnant or become pregnant while taking this
drug, call your healthcare provider right away.
Tell your healthcare provider if you are breast-feeding to
discuss risks to the baby.
Have your baby's thyroid checked if you are using this drug
and breast-feeding.
Agranulocytosis is the most dangerous toxicity risk for this
medication but is very rare. Sore throat and fever should be
reported immediately.
Patient Teaching for Levothyroxine works best if you take it on an empty stomach, 30 to 60
minutes before breakfast.
take the medicine at the same time each day.
Ideal HbA1C goal for diabetic, non- less than 7%.
pregnant adults
HbA1C 8% history of severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
HBA1C Value considered diagnostic of a value of 6.5% or greater
diabetes.
HbA1C Measuring Interval every 3 months until value is <7%; every 6 months thereafter
HbA1C Goal for Older Adults <7.5% [58 mmol/mol]), while those with multiple coexisting
chronic illnesses, cognitive impairment, or functional
dependence should have less stringent glycemic goals (such
as A1C <8.0-8.5% [64-69 mmol/mol]).
Criteria for the Diagnosis of Diabetes -Fasting plasma glucose ≥126 mg/dL
Mellitus -Random plasma glucose ≥ 200 mg/dL plus symptoms of
diabetes
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200
mg/dLcor
-Hemoglobin A1c 6.5% or higher
T1DM Etiology and MOA Autoimmune process; Loss of pancreatic β cells;
