NR565 Final Exam Study Guide.LATEST
NR565 Final Exam Study Guide
Week 5
Key Points
• The first-line medication for type 2 DM is metformin.
• ADA and other professional guidelines inform prescribing decisions.
• Combination injectable therapy should be considered for immediate implementation in
patients with an A1C of 10% or higher.
• TZDs, like Actos, can precipitate CHF and should be avoided in patients with heart failure.
• Older adults should be started on lower doses of levothyroxine.
• Radioactive iodine treatment results in lifelong hypothyroidism.
• When treating hypothyroidism, TSH levels should be monitored every 6-8 weeks until the
patient achieves a euthyroid state.
- Signs and symptoms of hypothyroidism and hyperthyroidism (pp. 418-419)
Hypothyroidism: The face is pale, puffy, & expressionless. The skin is cold & dry. The hair is brittle, & hair
loss occurs. Heart rate & temperature are lowered. The patient may c/o lethargy, fatigue, & cold
intolerance. Mentation may be impaired. Thyroid enlargement may occur if reduced levels of T 3 & T4
promote excessive release of TSH.
Hyperthyroidism: Heartbeat is rapid & strong, & dysrhythmias & angina may develop. The CNS is
stimulated, resulting in nervousness, insomnia, rapid thought flow, & rapid speech. Skeletal muscles may
weaken & atrophy. Metabolic rate is raised, resulting in increased heat production, increased body
temperature, intolerance to heat, & skin that is warm & moist. Increased appetite, but weight loss may
occur if caloric intake fails to match the increase in metabolic rate. (Exophthalmos w/Graves’ disease).
- What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other
than thyroid specific medications? Know drug classes and examples of those drug classes. (pp.
419, 423)
Beta-blockers & nonradioactive iodine may be used as adjunctive therapy for hyperthyroidism.
Beta-blockers: Suppress tachycardia by blocking beta-receptors on the heart. (“-lol”)
Nonradioactive iodine: Inhibits synthesis & release of thyroid hormones. (Lugol Solution = mixture
containing 5% elemental iodine & 10% potassium iodine).
- Monitoring needs and intervals for thyroid medications. (pp. 421, 423)
Hypothyroidism: Levothyroxine (T4) (Brand-name: Levoxyl, Synthroid)
Therapeutic Goal: Resolution of signs & symptoms of hypothyroidism & restoration of normal lab values
,NR565 Final Exam Study Guide.LATEST
for serum TSH & free T4.
Baseline Data: Obtain serum levels of TSH & free T4.
,NR565 Final Exam Study Guide.LATEST
Monitoring: Check TSH 6-8 weeks after initiating therapy & after any dosage change. Check TSH at least
once a year after serum TSH is stabilized.
Identifying High-Risk Patients: Use w/caution in those patients with cardiovascular disease & start w/lower
doses in older adult patients.
Evaluating Therapeutic Effects: Look for a reversal of signs of thyroid deficiency & an absence of signs of
thyroid excess. In children, normalization of intellectual function, growth, & development should occur.
Monthly measurements of height provide a good index of thyroid sufficiency. Lab tests should indicate
normal plasma levels of TSH & T4. Measure TSH levels at least 1x/year.
Minimizing Adverse Effects: Overdose may cause thyrotoxicosis. Symptoms include tachycardia, angina,
tremor, nervousness, insomnia, sweating, & heat intolerance.
Hyperthyroidism: Methimazole (a thionamide) (Brand-name: Tapazole)
Therapeutic Goal: Methimazole has 4 indications—reduction of thyroid hormone production in Graves’
disease, control of hyperthyroidism until the effects of radiation on the thyroid become manifest,
suppression of thyroid hormone production before subtotal thyroidectomy, & treatment of thyrotoxic
crisis.
Baseline Data: Obtain serum levels of TSH, T3, & T4. Check baseline CBC & LFTs prior to initiation.
Monitoring: Check CBC w/differential if signs or symptoms of infection. Check LFTs if signs or symptoms of
liver dysfunction.
Identifying High-Risk Patients: Methimazole should be avoided in the 1st trimester of pregnancy & in
women who are breastfeeding.
Evaluating Therapeutic Effects: Monitor for weight gain, decreased heart rate, & other indications that
levels of thyroid hormone have declined. Lab tests should indicate a decrease in serum free T3 & free T4.
Minimizing Adverse Effects:
Agranulocytosis: Inform patients about early signs of agranulocytosis, including fever or sore
throat. If follow-up blood tests reveal leukopenia, methimazole should be stopped.
Hypothyroidism: Methimazole may cause excessive reductions in thyroid hormone synthesis. If signs
of hypothyroidism develop or if plasma levels of T3 & T4 become subnormal, dosage should be
reduced.
- Propylthiouracil (PTU) carries a risk for liver toxicity. Although rare, the FDA recommends against
using PTU as a first-line treatment due to potential for hepatic toxicity. (p. 422)
Also a thionamide, PTU suppresses synthesis of thyroid hormones. Its therapeutic uses include pregnant
women in the 1st trimester, thyroid storm, & patients w/intolerance to methimazole. It has caused rare
, NR565 Final Exam Study Guide.LATEST
cases of liver injury. Onset is sudden & progression is rapid.
NR565 Final Exam Study Guide
Week 5
Key Points
• The first-line medication for type 2 DM is metformin.
• ADA and other professional guidelines inform prescribing decisions.
• Combination injectable therapy should be considered for immediate implementation in
patients with an A1C of 10% or higher.
• TZDs, like Actos, can precipitate CHF and should be avoided in patients with heart failure.
• Older adults should be started on lower doses of levothyroxine.
• Radioactive iodine treatment results in lifelong hypothyroidism.
• When treating hypothyroidism, TSH levels should be monitored every 6-8 weeks until the
patient achieves a euthyroid state.
- Signs and symptoms of hypothyroidism and hyperthyroidism (pp. 418-419)
Hypothyroidism: The face is pale, puffy, & expressionless. The skin is cold & dry. The hair is brittle, & hair
loss occurs. Heart rate & temperature are lowered. The patient may c/o lethargy, fatigue, & cold
intolerance. Mentation may be impaired. Thyroid enlargement may occur if reduced levels of T 3 & T4
promote excessive release of TSH.
Hyperthyroidism: Heartbeat is rapid & strong, & dysrhythmias & angina may develop. The CNS is
stimulated, resulting in nervousness, insomnia, rapid thought flow, & rapid speech. Skeletal muscles may
weaken & atrophy. Metabolic rate is raised, resulting in increased heat production, increased body
temperature, intolerance to heat, & skin that is warm & moist. Increased appetite, but weight loss may
occur if caloric intake fails to match the increase in metabolic rate. (Exophthalmos w/Graves’ disease).
- What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other
than thyroid specific medications? Know drug classes and examples of those drug classes. (pp.
419, 423)
Beta-blockers & nonradioactive iodine may be used as adjunctive therapy for hyperthyroidism.
Beta-blockers: Suppress tachycardia by blocking beta-receptors on the heart. (“-lol”)
Nonradioactive iodine: Inhibits synthesis & release of thyroid hormones. (Lugol Solution = mixture
containing 5% elemental iodine & 10% potassium iodine).
- Monitoring needs and intervals for thyroid medications. (pp. 421, 423)
Hypothyroidism: Levothyroxine (T4) (Brand-name: Levoxyl, Synthroid)
Therapeutic Goal: Resolution of signs & symptoms of hypothyroidism & restoration of normal lab values
,NR565 Final Exam Study Guide.LATEST
for serum TSH & free T4.
Baseline Data: Obtain serum levels of TSH & free T4.
,NR565 Final Exam Study Guide.LATEST
Monitoring: Check TSH 6-8 weeks after initiating therapy & after any dosage change. Check TSH at least
once a year after serum TSH is stabilized.
Identifying High-Risk Patients: Use w/caution in those patients with cardiovascular disease & start w/lower
doses in older adult patients.
Evaluating Therapeutic Effects: Look for a reversal of signs of thyroid deficiency & an absence of signs of
thyroid excess. In children, normalization of intellectual function, growth, & development should occur.
Monthly measurements of height provide a good index of thyroid sufficiency. Lab tests should indicate
normal plasma levels of TSH & T4. Measure TSH levels at least 1x/year.
Minimizing Adverse Effects: Overdose may cause thyrotoxicosis. Symptoms include tachycardia, angina,
tremor, nervousness, insomnia, sweating, & heat intolerance.
Hyperthyroidism: Methimazole (a thionamide) (Brand-name: Tapazole)
Therapeutic Goal: Methimazole has 4 indications—reduction of thyroid hormone production in Graves’
disease, control of hyperthyroidism until the effects of radiation on the thyroid become manifest,
suppression of thyroid hormone production before subtotal thyroidectomy, & treatment of thyrotoxic
crisis.
Baseline Data: Obtain serum levels of TSH, T3, & T4. Check baseline CBC & LFTs prior to initiation.
Monitoring: Check CBC w/differential if signs or symptoms of infection. Check LFTs if signs or symptoms of
liver dysfunction.
Identifying High-Risk Patients: Methimazole should be avoided in the 1st trimester of pregnancy & in
women who are breastfeeding.
Evaluating Therapeutic Effects: Monitor for weight gain, decreased heart rate, & other indications that
levels of thyroid hormone have declined. Lab tests should indicate a decrease in serum free T3 & free T4.
Minimizing Adverse Effects:
Agranulocytosis: Inform patients about early signs of agranulocytosis, including fever or sore
throat. If follow-up blood tests reveal leukopenia, methimazole should be stopped.
Hypothyroidism: Methimazole may cause excessive reductions in thyroid hormone synthesis. If signs
of hypothyroidism develop or if plasma levels of T3 & T4 become subnormal, dosage should be
reduced.
- Propylthiouracil (PTU) carries a risk for liver toxicity. Although rare, the FDA recommends against
using PTU as a first-line treatment due to potential for hepatic toxicity. (p. 422)
Also a thionamide, PTU suppresses synthesis of thyroid hormones. Its therapeutic uses include pregnant
women in the 1st trimester, thyroid storm, & patients w/intolerance to methimazole. It has caused rare
, NR565 Final Exam Study Guide.LATEST
cases of liver injury. Onset is sudden & progression is rapid.
