NR565 Final Exam Study Guide
This study guide covers content for the question bank for this course. There are 100 questions
on the exam and more content in the exam study bank than will be seen on any given exam.
Therefore, you may note more than 100 topic items noted in this study guide. However, there
may also be more than one question for a topic listed so you should know each one well. Some
items listed are more specific than others. If the item listed seems vague, if it’s a more general
question and to be more specific would be to risk the integrity of the question itself.
Number of Questions on Exam: 100
Point Value of Each Question:2
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand,
apply)
Time Limit: 120 minutes
Number of Attempts: 1
Use of Support Materials: Not Allowed
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in
Course Announcements
Tips on Using this Study Guide
1. Review the topics each week to take notes as you move through the course and focus your
reading and content review in the course.
2. You can make notes directly on each tab for the respective week or print out and hand
write your notes.
3. If you choose to print, you will want to adjust the size of columns so the table width will fit
on a printed page.
4. Re-write your notes if you type them to connect the content to your memory more readily
as the activity of writing and saying it again as you write it creates repetition that helps
commit the content to memory.
5. Create your own practice questions that are clinical scenario based to move the content
from a memorization (Remember) level of learning to an application type of learning. Much
of your exam will be at the application level so it's not enough to memorize your notes.
6. Review your study guide and notes as often as you can. Read them out loud so you hear
the words externally as well as internally. The more senses you can engage while studying,
the more likely you are to remember it.
messages.downloaded_
,Chapter 48
Glycemic Goals in Type 2 Diabetes
• The process of maintaining glucose levels within a normal range around the clock is
often referred to as tight glycemia control.
• A1c less than 7%
• Premeal plasma glucose 70-130 mg/dL
• Peak post meal plasma glucose less than 180 mg/dL
Diabetic Nephropathy Prevention
1st generation vs 2nd generation Sulfonylurea
• Both generations reduce glucose levels to the same extent.
• The 2nd generation agents are much more potent than the 1st generation agents, and
hence dosages are much lower
• 2nd generation agents, significant drug–drug interactions are less common, and the
outcomes tend to be milder
• 1st generation Tolbutamide, tolazamide, chlorpropamide
• 2nd generation immediate release (Glucotrol), sustained release (Glucotrol XL)
DDP4I: Adverse Effects
• Upper respiratory infection, pancreatitis, hypersensitivity
DDP4I: MOA
• DDP-4 inhibitors work by inhibiting the dipeptidyl peptidase-4 enzyme, which results in
the prolonged activity of incretin hormones. Incretins help increase insulin release in
response to meals and decrease hepatic glucose production without directly releasing
insulin.
GLP-1 receptor agonists: MOA
• Incretin mimetic that acts by activating GLP-1 receptors leading to slowed gastric
emptying and insulin release, inhibited postprandial
glucagon release, and suppress appetite.
GLP-1 receptor agonists: Monitoring
• Monitor renal function
• Patients should monitor blood glucose regularly
Glycemic Control Targets
• A1c less than 7%
• Premeal plasma glucose 70-130 mg/dL
• Peak post meal plasma glucose less than 180 mg/dL
Incretin Mimetics
• Incretin mimetics activate receptors for GLP- 1 and thereby cause the same effects as
messages.downloaded_
, Chapter 49
• Hypothyroidism Treatment in Infants
• Must be determined if it’s permanent or transient
• Clinical presentation: can cause delays in mental development and derangement of
growth. May have large and protruding tongue, potbelly, and dwarfish stature
• Causes: results from failure in thyroid development. Autoimmune disease, severe
iodine deficiency, TSH deficiency, exposure to radioactive iodine in utero
• Therapeutic strategies: require replacement therapy. The first few days of life need to
be started to minimize adverse effects. Beyond 3-4 weeks may cause severe defects.
It should be continued for 3 years.
Levothyroxine Administration
• Absorption: is reduced by food. Should be taken on an empty stomach in the morning,
at least 30 to 60 minutes before breakfast
• Conversion to triiodothyronine (T3): most is converted to T3. Most done need T3 along
with levothyroxine
• Half-life: prolong half-life of 7 days. Take one month to reach plateau. Delayed effects
Levothyroxine: Drug interactions
• Patients should separate admin by 4 hours due to decreased absorption
• Proton pump inhibitors (Lansoprazole) and antiacids
• Calcium, magnesium, and Iron supplements
• Warfarin: accelerates the degradation of vitamin K dependent clotting factors. Warfarin
is enhanced so dose must be reduced
• Catecholamines: increase cardiac responsiveness. Increased risk of
dysrhythmias
• Increase requirements for insulin and digoxin
Levothyroxine: Adverse Effects
• Thyrotoxicosis
• Osteoporosis
• Atrial Fibrillation
Levothyroxine Monitoring
• 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
endogenous incretins taken with each meal.
• Slow gastric emptying, stimulate Metformin: MOA
glucose- dependent release of • Inhibits glucose production in the liver,
insulin, inhibit postprandial release reducing the liver’s contribution to high
of glucagon, and glucose levels. Reduces glucose
suppress appetite absorption
Incretin Mimetics in Pregnancy in the GI tract. Sensitizes insulin
• Doses of exenatide only three times receptors in target tissues, such as fat
the human dose caused fetal harm, and muscle cells.
manifesting as reduced growth and Metformin: Pregnancy
skeletal abnormalities • Deficiency of folic acid during
• Only use if benefits outweigh the risks pregnancy can impair development of
• Insulin would be a better option the CNS, resulting in neural tube
Meglitinides vs sulfonylureas defects, which manifest as
• Have the same agents that have the anencephaly or spina bifida.
same mechanism which stimulates the • Nonetheless, metformin appears to be a
pancreatic insulin release. The safe drug for use during pregnancy.
difference between them Metformin: Side Effects
is glinides are short acting and are • GU symptoms: decreased appetite,
nausea, diarrhea
messages.downloaded_
This study guide covers content for the question bank for this course. There are 100 questions
on the exam and more content in the exam study bank than will be seen on any given exam.
Therefore, you may note more than 100 topic items noted in this study guide. However, there
may also be more than one question for a topic listed so you should know each one well. Some
items listed are more specific than others. If the item listed seems vague, if it’s a more general
question and to be more specific would be to risk the integrity of the question itself.
Number of Questions on Exam: 100
Point Value of Each Question:2
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand,
apply)
Time Limit: 120 minutes
Number of Attempts: 1
Use of Support Materials: Not Allowed
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in
Course Announcements
Tips on Using this Study Guide
1. Review the topics each week to take notes as you move through the course and focus your
reading and content review in the course.
2. You can make notes directly on each tab for the respective week or print out and hand
write your notes.
3. If you choose to print, you will want to adjust the size of columns so the table width will fit
on a printed page.
4. Re-write your notes if you type them to connect the content to your memory more readily
as the activity of writing and saying it again as you write it creates repetition that helps
commit the content to memory.
5. Create your own practice questions that are clinical scenario based to move the content
from a memorization (Remember) level of learning to an application type of learning. Much
of your exam will be at the application level so it's not enough to memorize your notes.
6. Review your study guide and notes as often as you can. Read them out loud so you hear
the words externally as well as internally. The more senses you can engage while studying,
the more likely you are to remember it.
messages.downloaded_
,Chapter 48
Glycemic Goals in Type 2 Diabetes
• The process of maintaining glucose levels within a normal range around the clock is
often referred to as tight glycemia control.
• A1c less than 7%
• Premeal plasma glucose 70-130 mg/dL
• Peak post meal plasma glucose less than 180 mg/dL
Diabetic Nephropathy Prevention
1st generation vs 2nd generation Sulfonylurea
• Both generations reduce glucose levels to the same extent.
• The 2nd generation agents are much more potent than the 1st generation agents, and
hence dosages are much lower
• 2nd generation agents, significant drug–drug interactions are less common, and the
outcomes tend to be milder
• 1st generation Tolbutamide, tolazamide, chlorpropamide
• 2nd generation immediate release (Glucotrol), sustained release (Glucotrol XL)
DDP4I: Adverse Effects
• Upper respiratory infection, pancreatitis, hypersensitivity
DDP4I: MOA
• DDP-4 inhibitors work by inhibiting the dipeptidyl peptidase-4 enzyme, which results in
the prolonged activity of incretin hormones. Incretins help increase insulin release in
response to meals and decrease hepatic glucose production without directly releasing
insulin.
GLP-1 receptor agonists: MOA
• Incretin mimetic that acts by activating GLP-1 receptors leading to slowed gastric
emptying and insulin release, inhibited postprandial
glucagon release, and suppress appetite.
GLP-1 receptor agonists: Monitoring
• Monitor renal function
• Patients should monitor blood glucose regularly
Glycemic Control Targets
• A1c less than 7%
• Premeal plasma glucose 70-130 mg/dL
• Peak post meal plasma glucose less than 180 mg/dL
Incretin Mimetics
• Incretin mimetics activate receptors for GLP- 1 and thereby cause the same effects as
messages.downloaded_
, Chapter 49
• Hypothyroidism Treatment in Infants
• Must be determined if it’s permanent or transient
• Clinical presentation: can cause delays in mental development and derangement of
growth. May have large and protruding tongue, potbelly, and dwarfish stature
• Causes: results from failure in thyroid development. Autoimmune disease, severe
iodine deficiency, TSH deficiency, exposure to radioactive iodine in utero
• Therapeutic strategies: require replacement therapy. The first few days of life need to
be started to minimize adverse effects. Beyond 3-4 weeks may cause severe defects.
It should be continued for 3 years.
Levothyroxine Administration
• Absorption: is reduced by food. Should be taken on an empty stomach in the morning,
at least 30 to 60 minutes before breakfast
• Conversion to triiodothyronine (T3): most is converted to T3. Most done need T3 along
with levothyroxine
• Half-life: prolong half-life of 7 days. Take one month to reach plateau. Delayed effects
Levothyroxine: Drug interactions
• Patients should separate admin by 4 hours due to decreased absorption
• Proton pump inhibitors (Lansoprazole) and antiacids
• Calcium, magnesium, and Iron supplements
• Warfarin: accelerates the degradation of vitamin K dependent clotting factors. Warfarin
is enhanced so dose must be reduced
• Catecholamines: increase cardiac responsiveness. Increased risk of
dysrhythmias
• Increase requirements for insulin and digoxin
Levothyroxine: Adverse Effects
• Thyrotoxicosis
• Osteoporosis
• Atrial Fibrillation
Levothyroxine Monitoring
• 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
endogenous incretins taken with each meal.
• Slow gastric emptying, stimulate Metformin: MOA
glucose- dependent release of • Inhibits glucose production in the liver,
insulin, inhibit postprandial release reducing the liver’s contribution to high
of glucagon, and glucose levels. Reduces glucose
suppress appetite absorption
Incretin Mimetics in Pregnancy in the GI tract. Sensitizes insulin
• Doses of exenatide only three times receptors in target tissues, such as fat
the human dose caused fetal harm, and muscle cells.
manifesting as reduced growth and Metformin: Pregnancy
skeletal abnormalities • Deficiency of folic acid during
• Only use if benefits outweigh the risks pregnancy can impair development of
• Insulin would be a better option the CNS, resulting in neural tube
Meglitinides vs sulfonylureas defects, which manifest as
• Have the same agents that have the anencephaly or spina bifida.
same mechanism which stimulates the • Nonetheless, metformin appears to be a
pancreatic insulin release. The safe drug for use during pregnancy.
difference between them Metformin: Side Effects
is glinides are short acting and are • GU symptoms: decreased appetite,
nausea, diarrhea
messages.downloaded_
