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NR 565 Midterm Exam Questions
With Answers || Graded A+
Hypothyroidism - ANSWER underproduction of the hormone thyroxine (T4)
(yellow)
Too little thyroxine=slower metabolism
fatigue, depressed mood, slow heart rate, constipation, weight gain, and
irregular menstrual periods.
MC in >60 women
Hyperthyroidism - ANSWER overproduction of thyroid hormones:
triiodothyronine (T3) (green), and thyroxine (T4) (yellow)
What active hormones are produced by the thyroid? - ANSWER
triiodothyronine (T3) and thyroxine (T4, tetraiodothyronine)
4 steps to synthesis of thyroid hormoness - ANSWER 1. Uptake
2. Activation (Oxidation by peroxidase)
3. Iodination of Tyrosine
4. Coupling of Iodinated Tyrosine
3 Principle Actions of Thyroid Hormones - ANSWER (1) stimulation of energy
use
(2) stimulation of the heart
(3) promotion of growth and development
Most sensitive method for diagnosing hypothyroidism - ANSWER Serum TSH
Levothyroxine Dosage in adults - ANSWER 100-125ug for 70kg adult
ORAL
Older adults- start at 25-50ug daily
Levothyroxine dose in Myxedema Coma - ANSWER 200-500 ug once
INJECTION
Addition dose of 100-300 ug can be given a day later
Levothyroxine dose for Congenital Hypothyroidism - ANSWER <3mo: 10-
15mg/kg
3-5mo: 8-10mg/kg
, 2
6-11mo: 6-8mg/kg
1-5yrs: 5-6mg/kg
6-12 yrs: 4-5mg/kg
ORAL
Dose DECREASES with age.
Dose adjusted to normalize TSH and free T4
Levothyroxine dose for simple goiter - ANSWER 100-200ug
ORAL
Baseline data for levothyroxine - ANSWER Serum levels of TSH and free T4
What are thionamide drugs - ANSWER For hyperthyroidism
ex. methimazole and propylthiouracil (PTU)
Suppresses synthesis of thyroid hormones
long term-hyperthyroidism
short-term- subtotal thyroidectomy or tx with radioactive iodine
Frequency of therapy for Methimazole and Propylthiouracil - ANSWER
Methimazole: Initial therapy-3 times a day
Maintenance therapy- Once a day
Propyltiouracil:
Initial therapy- 3 or 4 times a day
Maintenance therapy- 2 or 3 times a day
What is a first-line drug for hyperthyroidism - ANSWER Methimazole
(Tapazole)
Methimazole - ANSWER inhibits thyroid hormone synthesis--> DOES NOT
DESTROY EXISTING STORES OF THYROID HORMONE
SAFER and more convenient than PTU and preferred more
EXCEPT in those who are pregnant or breastfeeding and those who are in
thyrotoxic crisis
May take 3-12 weeks to produce euthyroid state
Baseline data for methimazole - ANSWER Obtain serum levels of thyroid-
stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4).
Check baseline CBC and LFTs prior to initiation.
Radioactive Iodine in Graves Disease - ANSWER Used to destroy thyroid
tissue
, 3
want remission without complete destruction of gland
however delayed hypothyroidism due to excessive thyroid damage is frequent
complication
Radioactive Iodine - ANSWER Destruction of thyroid tissue produced
primarily by emission of beta particles
Don't travel outside of thyroid
initial effects days to weeks, full effects develop 2-3 months
66% cured with single exposure, others 2-3 tx more
Don't give to very young, pregnancy or breastfeeding
Dosage dependent on thyroid sixe and rate of thyroidal iodine uptake
Graves- usual 4-10mCi
Nonradioactive Iodine: Lugo Solution - ANSWER AKA "strong iodine
solution"
5%elemental iodine and 10% potassium iodide
Mechanism of action for Nonradioactive Iodine - ANSWER Paradoxical
suppressant effect on the thyroid
1st- high conc. of iodide decrease iodine uptake by thyroid
2nd- high conc. of iodide inhibit thyroid hormone synthesis by suppressing both
the iodination of tyrosine and coupling of iodinated tyrosine residues
3rd- high con. of iodine inhibit release of thyroid hormone into blood
All 3 combine to decrease circulating levels of T3 and T4
not sustained indefinitely
Therapeutic use Nonradioactive iodine - ANSWER prep for thyroidectomy
initial effect w/in 24 hours
peak effect in 10-15 days
usually methimazole then nonradioactive iodine
Usually given with PTY last 10 days before surgery
also in thyrotoxic crisus
Dosage and administration of nonradioactive iodine - ANSWER 5-7 drops 3
times daily for 10 days immediately preceding surgery
mix with juice or some other beverage
thyrotoxic crisis- 10 drops Q8hours
, 4
Insulin
MOA - ANSWER
Biguanides - ANSWER
Sulfonylureas
MOA - ANSWER
Meglitinides
MOA - ANSWER
Bacterostatic - ANSWER kills the bacteria
bacteriocidal - ANSWER kills the bacteria and stops the growth or spread of
the infection
Bacteriostatic drugs - ANSWER clindamycin
macrolides
sulfonamides
tetracyclines
Bactericidal drugs - ANSWER ahminoglycosides
beta-lactums
fluroquinolones
Metronidazole
Streptogramins
vancomycin
anti-microbial resistance - ANSWER 1.) not knowing if the pt had recent use of
antibiotics
2.) provider overuse of broad=spectrum antibiotics
3.) not performing susceptibility testing
4.) Age younger than 2 years or older than 65 years
5.) Daycare center attendance
6.) Exposure to young children
7.) Multiple medical co-morbidities
8.) Immunosuppression
subclasses of Beta-lactams PCNS - ANSWER natural PCNS
aminopenicillins
anti-staphylococcal PCNs
extended Spectrum PCNs
NR 565 Midterm Exam Questions
With Answers || Graded A+
Hypothyroidism - ANSWER underproduction of the hormone thyroxine (T4)
(yellow)
Too little thyroxine=slower metabolism
fatigue, depressed mood, slow heart rate, constipation, weight gain, and
irregular menstrual periods.
MC in >60 women
Hyperthyroidism - ANSWER overproduction of thyroid hormones:
triiodothyronine (T3) (green), and thyroxine (T4) (yellow)
What active hormones are produced by the thyroid? - ANSWER
triiodothyronine (T3) and thyroxine (T4, tetraiodothyronine)
4 steps to synthesis of thyroid hormoness - ANSWER 1. Uptake
2. Activation (Oxidation by peroxidase)
3. Iodination of Tyrosine
4. Coupling of Iodinated Tyrosine
3 Principle Actions of Thyroid Hormones - ANSWER (1) stimulation of energy
use
(2) stimulation of the heart
(3) promotion of growth and development
Most sensitive method for diagnosing hypothyroidism - ANSWER Serum TSH
Levothyroxine Dosage in adults - ANSWER 100-125ug for 70kg adult
ORAL
Older adults- start at 25-50ug daily
Levothyroxine dose in Myxedema Coma - ANSWER 200-500 ug once
INJECTION
Addition dose of 100-300 ug can be given a day later
Levothyroxine dose for Congenital Hypothyroidism - ANSWER <3mo: 10-
15mg/kg
3-5mo: 8-10mg/kg
, 2
6-11mo: 6-8mg/kg
1-5yrs: 5-6mg/kg
6-12 yrs: 4-5mg/kg
ORAL
Dose DECREASES with age.
Dose adjusted to normalize TSH and free T4
Levothyroxine dose for simple goiter - ANSWER 100-200ug
ORAL
Baseline data for levothyroxine - ANSWER Serum levels of TSH and free T4
What are thionamide drugs - ANSWER For hyperthyroidism
ex. methimazole and propylthiouracil (PTU)
Suppresses synthesis of thyroid hormones
long term-hyperthyroidism
short-term- subtotal thyroidectomy or tx with radioactive iodine
Frequency of therapy for Methimazole and Propylthiouracil - ANSWER
Methimazole: Initial therapy-3 times a day
Maintenance therapy- Once a day
Propyltiouracil:
Initial therapy- 3 or 4 times a day
Maintenance therapy- 2 or 3 times a day
What is a first-line drug for hyperthyroidism - ANSWER Methimazole
(Tapazole)
Methimazole - ANSWER inhibits thyroid hormone synthesis--> DOES NOT
DESTROY EXISTING STORES OF THYROID HORMONE
SAFER and more convenient than PTU and preferred more
EXCEPT in those who are pregnant or breastfeeding and those who are in
thyrotoxic crisis
May take 3-12 weeks to produce euthyroid state
Baseline data for methimazole - ANSWER Obtain serum levels of thyroid-
stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4).
Check baseline CBC and LFTs prior to initiation.
Radioactive Iodine in Graves Disease - ANSWER Used to destroy thyroid
tissue
, 3
want remission without complete destruction of gland
however delayed hypothyroidism due to excessive thyroid damage is frequent
complication
Radioactive Iodine - ANSWER Destruction of thyroid tissue produced
primarily by emission of beta particles
Don't travel outside of thyroid
initial effects days to weeks, full effects develop 2-3 months
66% cured with single exposure, others 2-3 tx more
Don't give to very young, pregnancy or breastfeeding
Dosage dependent on thyroid sixe and rate of thyroidal iodine uptake
Graves- usual 4-10mCi
Nonradioactive Iodine: Lugo Solution - ANSWER AKA "strong iodine
solution"
5%elemental iodine and 10% potassium iodide
Mechanism of action for Nonradioactive Iodine - ANSWER Paradoxical
suppressant effect on the thyroid
1st- high conc. of iodide decrease iodine uptake by thyroid
2nd- high conc. of iodide inhibit thyroid hormone synthesis by suppressing both
the iodination of tyrosine and coupling of iodinated tyrosine residues
3rd- high con. of iodine inhibit release of thyroid hormone into blood
All 3 combine to decrease circulating levels of T3 and T4
not sustained indefinitely
Therapeutic use Nonradioactive iodine - ANSWER prep for thyroidectomy
initial effect w/in 24 hours
peak effect in 10-15 days
usually methimazole then nonradioactive iodine
Usually given with PTY last 10 days before surgery
also in thyrotoxic crisus
Dosage and administration of nonradioactive iodine - ANSWER 5-7 drops 3
times daily for 10 days immediately preceding surgery
mix with juice or some other beverage
thyrotoxic crisis- 10 drops Q8hours
, 4
Insulin
MOA - ANSWER
Biguanides - ANSWER
Sulfonylureas
MOA - ANSWER
Meglitinides
MOA - ANSWER
Bacterostatic - ANSWER kills the bacteria
bacteriocidal - ANSWER kills the bacteria and stops the growth or spread of
the infection
Bacteriostatic drugs - ANSWER clindamycin
macrolides
sulfonamides
tetracyclines
Bactericidal drugs - ANSWER ahminoglycosides
beta-lactums
fluroquinolones
Metronidazole
Streptogramins
vancomycin
anti-microbial resistance - ANSWER 1.) not knowing if the pt had recent use of
antibiotics
2.) provider overuse of broad=spectrum antibiotics
3.) not performing susceptibility testing
4.) Age younger than 2 years or older than 65 years
5.) Daycare center attendance
6.) Exposure to young children
7.) Multiple medical co-morbidities
8.) Immunosuppression
subclasses of Beta-lactams PCNS - ANSWER natural PCNS
aminopenicillins
anti-staphylococcal PCNs
extended Spectrum PCNs
