NR565 FINAL COMPREHENSIVE
EXAMINATION TEST QUESTIONS AND
SOLUTIONS FULLY VERIFIED
●● Timeframe for re-check of labs after starting levothyroxine
Answer: 6-8 weeks (long half-life). Yearly after stable.
●● Signs and symptoms of hypothyroidism
Answer: Dry hair, puffy face, goiter in the neck, slow heartbeat, weight
gain, constipation, infertility, increased risk of miscarriages, irregular
menstrual cycle, cold intolerance.
●● Drug of choice for hypothyroidism
Answer: Levothyroxine (Synthroid)
●● § Signs and symptoms of hyperthyroidism
Answer: Hair loss, bulging eyes, goiter, rapid heartbeat, weight loss,
diarrhea, menstrual periods loss often or longer.
●● Drug of choice for hyperthyroidism
Answer: Methimazole (Tapazole)
,●● Treatment of thyroid storm
Answer: high doses of potassium iodide or strong iodine solution are
given to suppress thyroid hormone release. Methimazole is given to
suppress thyroid hormone synthesis. Beta blocker given to reduce HR.
additional measures include sedation, cooling, and giving
glucocorticoids and IV fluids.
●● Result of not treating hypothyroidism during pregnancy:
Answer: Permanent neuro-psychological deficits in the child. Decrease
IQ/neuropsychological function. First trimester.
●● Medication to treat symptoms of hyperthyroidism (notice this is
treating symptoms and not the hyperthyroidism itself):
Answer: Beta blockers (tachycardia) - propranolol/atenolol most
popular.Non-radioactive iodine. ADJUNCTIVE THERAPY.
●● Drug/Food/Supplement interactions with levothyroxine:
Answer: Do not take antacids, Calcium or Iron, how to take it (morning
30-60 min b4 eat.
●● How to confirm a diagnosis of DM prior to beginning treatment:
Answer: Fasting plasma glucose above 126. A random plasma glucose of
over 200 plus symptoms of diabetes, an oral glucose tolerance test of
two hours, plasma glucose of over 200, or a A1C higher than 6.5.
,●● A1c general goals
Answer: <7, patients that experience severe hypoglycemia/have a
limited life expectancy may have an A1C goal of <8.
●● A1c older adults
Answer: <8, those with multiple coexisting chronic illnesses, cognitive
impairment, or functional dependence should have less stringent
glycemic goals such as <8.0-8.5.
●● When should insulin be considered?
Answer: For treatment of persistent hyperglycemia starting at a
threshold of >180.
Early introduction of insulin should be considered if there is evidence of
ongoing weight loss, if symptoms of hyperglycemia are present, or
whenA1C levels >10% or BGS >300
●● At what time interval should A1c be re-checked?
How often should an A1C be monitored when stable or when unstable?
Answer: Every 2-3 months and max of 4 times a year. If <7, every 6
months.
At least two times a year if meeting goals and quarterly if meds have
changed or not meeting goals.
, ●● Action of Insulin
Answer: Anabolic, energy conservation, promotes cellular growth and
division.
●● Pioglitazone contraindications:
Answer: Heart failure (severe = no, mild = caution) and bladder cancer.
Causes fluid retention.
●● GLP-1 (abbreviation and examples)
Answer: Glucagonlike Peptide - Subcutaneous injections - Dulaglutide
(Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).
●● SGLT2i (abbreviation and examples)
Answer: Sodium Glucose Cotransporter 2 Inhibitors - Canagliflozin
(Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance).
●● DPP4-I (abbreviation and examples)
Answer: Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin, Saxagliptin,
Linagliptin, Alogliptin.
●● TZD (abbreviation and examples)
Answer: Thiazolidinediones - Rosiglitazone & Pioglitazone
EXAMINATION TEST QUESTIONS AND
SOLUTIONS FULLY VERIFIED
●● Timeframe for re-check of labs after starting levothyroxine
Answer: 6-8 weeks (long half-life). Yearly after stable.
●● Signs and symptoms of hypothyroidism
Answer: Dry hair, puffy face, goiter in the neck, slow heartbeat, weight
gain, constipation, infertility, increased risk of miscarriages, irregular
menstrual cycle, cold intolerance.
●● Drug of choice for hypothyroidism
Answer: Levothyroxine (Synthroid)
●● § Signs and symptoms of hyperthyroidism
Answer: Hair loss, bulging eyes, goiter, rapid heartbeat, weight loss,
diarrhea, menstrual periods loss often or longer.
●● Drug of choice for hyperthyroidism
Answer: Methimazole (Tapazole)
,●● Treatment of thyroid storm
Answer: high doses of potassium iodide or strong iodine solution are
given to suppress thyroid hormone release. Methimazole is given to
suppress thyroid hormone synthesis. Beta blocker given to reduce HR.
additional measures include sedation, cooling, and giving
glucocorticoids and IV fluids.
●● Result of not treating hypothyroidism during pregnancy:
Answer: Permanent neuro-psychological deficits in the child. Decrease
IQ/neuropsychological function. First trimester.
●● Medication to treat symptoms of hyperthyroidism (notice this is
treating symptoms and not the hyperthyroidism itself):
Answer: Beta blockers (tachycardia) - propranolol/atenolol most
popular.Non-radioactive iodine. ADJUNCTIVE THERAPY.
●● Drug/Food/Supplement interactions with levothyroxine:
Answer: Do not take antacids, Calcium or Iron, how to take it (morning
30-60 min b4 eat.
●● How to confirm a diagnosis of DM prior to beginning treatment:
Answer: Fasting plasma glucose above 126. A random plasma glucose of
over 200 plus symptoms of diabetes, an oral glucose tolerance test of
two hours, plasma glucose of over 200, or a A1C higher than 6.5.
,●● A1c general goals
Answer: <7, patients that experience severe hypoglycemia/have a
limited life expectancy may have an A1C goal of <8.
●● A1c older adults
Answer: <8, those with multiple coexisting chronic illnesses, cognitive
impairment, or functional dependence should have less stringent
glycemic goals such as <8.0-8.5.
●● When should insulin be considered?
Answer: For treatment of persistent hyperglycemia starting at a
threshold of >180.
Early introduction of insulin should be considered if there is evidence of
ongoing weight loss, if symptoms of hyperglycemia are present, or
whenA1C levels >10% or BGS >300
●● At what time interval should A1c be re-checked?
How often should an A1C be monitored when stable or when unstable?
Answer: Every 2-3 months and max of 4 times a year. If <7, every 6
months.
At least two times a year if meeting goals and quarterly if meds have
changed or not meeting goals.
, ●● Action of Insulin
Answer: Anabolic, energy conservation, promotes cellular growth and
division.
●● Pioglitazone contraindications:
Answer: Heart failure (severe = no, mild = caution) and bladder cancer.
Causes fluid retention.
●● GLP-1 (abbreviation and examples)
Answer: Glucagonlike Peptide - Subcutaneous injections - Dulaglutide
(Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).
●● SGLT2i (abbreviation and examples)
Answer: Sodium Glucose Cotransporter 2 Inhibitors - Canagliflozin
(Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance).
●● DPP4-I (abbreviation and examples)
Answer: Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin, Saxagliptin,
Linagliptin, Alogliptin.
●● TZD (abbreviation and examples)
Answer: Thiazolidinediones - Rosiglitazone & Pioglitazone
