NR 565 Final Exam Study Guide
What labs are used to diagnose Thyroid? - ANS-TSH, total T4 and T3, free T4 and T3
Timeframe for re-check of labs after starting levothyroxine - ANS-6-8 wks after starting
therapy
Signs and symptoms of hypothyroidism - ANS-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 - ANS-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 - ANS-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) - ANS-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: -
ANS-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 - ANS-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 - ANS-less than 7%, less than 8% in patients with severe
hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular
complications
A1c - Older Adult goal - ANS-
When should insulin be considered? - ANS-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? - ANS-every 3 months until A1C drops
below 7% and then every 6 months thereafter.
Action of Insulin - ANS-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 - ANS-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
What labs are used to diagnose Thyroid? - ANS-TSH, total T4 and T3, free T4 and T3
Timeframe for re-check of labs after starting levothyroxine - ANS-6-8 wks after starting
therapy
Signs and symptoms of hypothyroidism - ANS-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 - ANS-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 - ANS-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) - ANS-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: -
ANS-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 - ANS-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 - ANS-less than 7%, less than 8% in patients with severe
hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular
complications
A1c - Older Adult goal - ANS-
When should insulin be considered? - ANS-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? - ANS-every 3 months until A1C drops
below 7% and then every 6 months thereafter.
Action of Insulin - ANS-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 - ANS-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
