NR565 Pharmacology Final questions and answers

NR565 Pharmacology Final questions and answers

Signs and symptoms of hypothyroidism - answersFace is pale, puffy, and expressionless.
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Skin is cold and dry.
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hair is brittle, and hair loss occurs.
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Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance to cold.
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Mentation may be impaired. ak ak ak




Signs and symptoms of hyperthyroidism - answersHeart Rate is Rapid; Possible arrhythmia/angina
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Nervousness, insomnia, rapid thought flow, and rapid speech ak ak ak ak ak ak ak




Skeletal muscles may weaken and atrophy ak ak ak ak ak




Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and sk
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that is warm and moist
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Weight loss occurs if caloric intake fails to match the increase in metabolic rate
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Severe hypothyroidism - answersMyxedema ak ak ak




Hypothyroid Treatment - answersLevothyroxine is the drug of choice for most patients who require thyroid hormone
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replacement.
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Levothyroxine (Synthroid) Therapeutic Goal - answersResolution of signs and symptoms of hypothyroidism and ak ak ak ak ak ak ak ak ak ak ak ak




restoration of normal laboratory values for serum thyroid-stimulating hormone (TSH) and free thyroxine (T4).
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Major forms of hyperthyroidism - answersGraves disease and toxic nodular goiter (also known as Plummer disease).
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Graves Disease - answersMost common cause of excessive thyroid hormone secretion
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What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than thyroid specific
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medications? - answersβ-Blockers and nonradioactive iodine may be used as adjunctive therapy.
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β-Blockers suppress tachycardia by blocking β-receptors on the heart. ak ak ak ak ak ak ak ak ak




Nonradioactive iodine inhibits synthesis and release of thyroid hormones. ak ak ak ak ak ak ak ak




Monitoring needs and intervals for Levothyroxine - answersCheck TSH 6-8 weeks after initiating therapy and after any
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dosage change.
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Check TSH at least once a year after serum TSH is stabilized.
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Hyperthyroid Treatment - answersthionamide drugs—methimazole and propylthiouracil (PTU)—suppress synthesis ak ak ak ak ak ak ak ak ak




thyroid hormones.
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Methimazole Therapeutic Goal - answers(1) reduction of thyroid hormone production in Graves' disease, (2) control of
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hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone
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production before subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
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Monitoring needs and intervals for Methimazole - answersCheck CBC with differential if signs or symptoms of infection
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Check LFTs if signs or symptoms of liver dysfunction.
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High Risk Patients for Methimazole - answersShould be avoided in the first trimester of pregnancy.
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,Methimazole Toxicity - answersAgranulocytosis is the most dangerous toxicity. ak ak ak ak ak ak ak ak




PTU High Risk Warning - answersCarries a risk for liver toxicity. Although rare, the FDA recommends against using as a
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first-line treatment due to potential for hepatic toxicity.
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Effects of maternal hypothyroidism on offspring and appropriate patient teaching related to need for treatment. -
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answersCan cause delay in mental development and derangement of growth. In the absence of thyroid hormones, the
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child develops a large and protruding tongue, potbelly, and dwarfish stature. Development of the nervous system, bone
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teeth, and muscles is impaired.
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Congenital Hypothyroidism Treatment - answersrequires replacement therapy with thyroid hormones. If treatment is ak ak ak ak ak ak ak ak ak ak ak ak




initiated within a few days of birth, physical and mental development will be normal.
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replacement therapy should continue for 3 years, after which it should be stopped for 4 weeks to determine whether ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak




thyroid deficiency is permanent or transient.
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Patient Teaching for Methimazole - answersTell your healthcare providers that you are taking this drug.
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Check blood work as directed. ak ak ak ak




Taking this drug may cause harm to the unborn baby if you are pregnant, especially in the first trimester.
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If you are pregnant or become pregnant while taking this drug, call your healthcare provider right away.
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Tell your healthcare provider if you are breast-feeding to discuss risks to the baby.
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Have your baby's thyroid checked if you are using this drug and breast-feeding.
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Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare. Sore throat and fever should be ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak




reported immediately.
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Patient Teaching for Levothyroxine - answersworks best if you take it on an empty stomach, 30 to 60 minutes before
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breakfast.
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take the medicine at the same time each day.
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Ideal HbA1C goal for diabetic, non-pregnant adults - answersless than 7%.
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HbA1C 8% - answershistory of severe hypoglycemia, limited life expectancy, or advanced microvascular or
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macrovascular complications
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HBA1C Value considered diagnostic of diabetes. - answersa value of 6.5% or greater
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HbA1C Measuring Interval - answersevery 3 months until value is <7%; every 6 months thereafter
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HbA1C Goal for Older Adults - answers<7.5% [58 mmol/mol]), while those with multiple coexisting chronic illnesses,
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cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0-8.5% [64
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69 mmol/mol]).
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Criteria for the Diagnosis of Diabetes Mellitus - answers-Fasting plasma glucose ≥126 mg/dL
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-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes ak ak ak ak ak ak ak ak ak




-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLcor
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-Hemoglobin A1c 6.5% or higher ak ak ak ak




T1DM Etiology and MOA - answersAutoimmune process; Loss of pancreatic β cells;
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T2DM Etiology and MOA - answersUnknown—but there is a strong familial association, suggesting that heredity is a ris
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factor; Insulin resistance and inappropriate insulin secretion
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,the total daily dose (TDD) of insulin calculation - answerstotal weight of the patient in kilograms (kg), multiplied by 0.6 un
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Basal insulin replacement - answers50% of the total daily insulin dose which replaces insulin from fasting (overnight) an
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between meals.
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Bolus insulin replacement - answers50% of the total daily insulin dose and provides carbohydrate coverage and high
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blood sugar correction.
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Biguanides Drug Class - answersMetformin ak ak ak ak




Metformin - answersDecreases glucose production by the liver (glucogenesis), increases tissue response to insulin;
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Decrease glucose absorption; Increase glucose uptake ak ak ak ak ak




drug of choice for initial therapy in most patients with type 2 diabetes
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Metformin contraindications - answersrenal disease, acidosis from hepatic disease, alcoholics, or in patients with
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hypoxia.
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Metformin Major AE - answersGastrointestinal (GI) symptoms: decreased appetite, nausea, diarrhea
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Lactic acidosis (rarely) ak ak




Sulfonylureas Prototype/MOA - answersGlyburide (Prototype Drug) ak ak ak ak ak




-Promote insulin secretion by the pancreas; may also increase tissue response to insulin;
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-stimulate beta cells of the pancreas to secrete more insulin ak ak ak ak ak ak ak ak ak




Sulfonylureas AE - answershigh risk of severe hypoglycemia; ak ak ak ak ak ak ak ak




photosensitivity; therefore, patient education is needed regarding sunscreen. ak ak ak ak ak ak ak ak




blood dyscrasias ak ak




weight gain. ak




Sulfonylureas Contraindication - answersshould be avoided in patients with impaired hepatic or renal function. ak ak ak ak ak ak ak ak ak ak ak ak ak




Meglitinides (Glinides) Prototype/MOA - answers-Repaglinide (Prototype Drug) ak ak ak ak ak ak




-stimulation of pancreatic insulin release though shorter acting then sulfonylureas and are taken with each meal
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-Facilitates calcium influx in pancreatic β cells, which leads to increased insulin release ak ak ak ak ak ak ak ak ak ak ak ak




Meglitinides Main AE - answersHypoglycemia ak ak ak ak




Meglitinides Contraindications - answersUse with caution in patients with liver impairment and those taking gemfibrozi
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Thiazolidinediones (Glitazones) Prototype/MOA - answers-Pioglitazone (Prototype Drug) ak ak ak ak ak ak




-enhance insulin sensitivity/decrease insulin resistance in muscle tissue and reduce glucagon production in the liver
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-Mainly an add on to Metformin ak ak ak ak ak




Thiazolidinediones (TZDs) Main AE - answersHypoglycemia but only in the presence of excessive insulin ak ak ak ak ak ak ak ak ak ak ak ak ak




Heart failure ak




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