Nr 565 Final Exam Study Guide
Advanced Pharmacology
Fundamentals - Chamberlain
What labs are used to diagnose Thyroid? - ✔✔✔ANSWER-TSH, total T4 and
T3, free T4 and T3
Timeframe for re-check of labs after starting levothyroxine - ✔✔✔ANSWER-
6-8 wks after starting therapy
Signs and symptoms of hypothyroidism - ✔✔✔ANSWER-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 - ✔✔✔ANSWER-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 - ✔✔✔ANSWER-
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) - ✔✔✔ANSWER-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:
- ✔✔✔ANSWER-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 -
✔✔✔ANSWER-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 - ✔✔✔ANSWER-less than 7%, less than 8% in patients
with severe hypoglycemia, limited life expectancy, or advanced microvascular or
macrovascular complications
A1c - Older Adult goal - ✔✔✔ANSWER-
When should insulin be considered? - ✔✔✔ANSWER-Type 1 Diabetics All
are on insulin
Type 2 Diabetics
Step 3 - Three drug combination (inclusive of metformin)
Advanced Pharmacology
Fundamentals - Chamberlain
What labs are used to diagnose Thyroid? - ✔✔✔ANSWER-TSH, total T4 and
T3, free T4 and T3
Timeframe for re-check of labs after starting levothyroxine - ✔✔✔ANSWER-
6-8 wks after starting therapy
Signs and symptoms of hypothyroidism - ✔✔✔ANSWER-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 - ✔✔✔ANSWER-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 - ✔✔✔ANSWER-
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) - ✔✔✔ANSWER-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:
- ✔✔✔ANSWER-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 -
✔✔✔ANSWER-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 - ✔✔✔ANSWER-less than 7%, less than 8% in patients
with severe hypoglycemia, limited life expectancy, or advanced microvascular or
macrovascular complications
A1c - Older Adult goal - ✔✔✔ANSWER-
When should insulin be considered? - ✔✔✔ANSWER-Type 1 Diabetics All
are on insulin
Type 2 Diabetics
Step 3 - Three drug combination (inclusive of metformin)
