NR565 Pharmacology Final QUESTIONS AND VERIFIED SOLUTIONS
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
prescribe to control symptoms of hyperthyroidism other than thyroid specific
medications? - ✔✔β-Blockers and nonradioactive iodine may be used as adjunctive
therapy. β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid hormones. Monitoring
needs and intervals for Levothyroxine - ✔✔Check TSH 6-8 weeks after initiating therapy
and after 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 Methimazole - ✔✔Check CBC with differential if signs or
symptoms of infection. 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 offspring and appropriate patient teaching related to need for
treatment. - ✔✔Can cause delay in mental development and derangement of growth. In
, the absence of thyroid hormones, the child 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-pregnant
adults - ✔✔less than 7%. HbA1C 8% - ✔✔history of severe hypoglycemia, limited life
expectancy, or advanced microvascular or macrovascular complications HBA1C Value
considered diagnostic of diabetes. - ✔✔a value of 6.5% or greater 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 Mellitus - ✔✔-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/dLcor -Hemoglobin A1c 6.5% or higher T1DM Etiology and MOA -
✔✔Autoimmune process; Loss of pancreatic β cells; T2DM Etiology and MOA -
✔✔Unknown—but there is a strong familial association, suggesting that heredity is a risk
factor; Insulin resistance and inappropriate insulin secretion the total daily dose (TDD) of
insulin calculation - ✔✔total weight of the patient in kilograms (kg), multiplied by 0.6 units
Basal insulin replacement - ✔✔50% of the total daily insulin dose which replaces insulin
from fasting (overnight) and between meals. Bolus insulin replacement - ✔✔50% of the
total daily insulin dose and provides carbohydrate coverage and high blood sugar
correction. Biguanides Drug Class - ✔✔Metformin Metformin - ✔✔Decreases glucose
production by the liver (glucogenesis), increases tissue response to insulin; Decrease
glucose absorption; Increase glucose uptake drug of choice for initial therapy in most
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
prescribe to control symptoms of hyperthyroidism other than thyroid specific
medications? - ✔✔β-Blockers and nonradioactive iodine may be used as adjunctive
therapy. β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid hormones. Monitoring
needs and intervals for Levothyroxine - ✔✔Check TSH 6-8 weeks after initiating therapy
and after 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 Methimazole - ✔✔Check CBC with differential if signs or
symptoms of infection. 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 offspring and appropriate patient teaching related to need for
treatment. - ✔✔Can cause delay in mental development and derangement of growth. In
, the absence of thyroid hormones, the child 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-pregnant
adults - ✔✔less than 7%. HbA1C 8% - ✔✔history of severe hypoglycemia, limited life
expectancy, or advanced microvascular or macrovascular complications HBA1C Value
considered diagnostic of diabetes. - ✔✔a value of 6.5% or greater 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 Mellitus - ✔✔-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/dLcor -Hemoglobin A1c 6.5% or higher T1DM Etiology and MOA -
✔✔Autoimmune process; Loss of pancreatic β cells; T2DM Etiology and MOA -
✔✔Unknown—but there is a strong familial association, suggesting that heredity is a risk
factor; Insulin resistance and inappropriate insulin secretion the total daily dose (TDD) of
insulin calculation - ✔✔total weight of the patient in kilograms (kg), multiplied by 0.6 units
Basal insulin replacement - ✔✔50% of the total daily insulin dose which replaces insulin
from fasting (overnight) and between meals. Bolus insulin replacement - ✔✔50% of the
total daily insulin dose and provides carbohydrate coverage and high blood sugar
correction. Biguanides Drug Class - ✔✔Metformin Metformin - ✔✔Decreases glucose
production by the liver (glucogenesis), increases tissue response to insulin; Decrease
glucose absorption; Increase glucose uptake drug of choice for initial therapy in most
