NR565 Final Complete Questions And Answers With
Latest Study Updates
What labs are used to diagnose hypo/hyper thyroid? ANS ✅ TSH, T3, and T4. High TSH = hypo and low
TSH = hyper. Opposites.
Timeframe for re-check of labs after starting levothyroxine ANS ✅ 6-8 weeks (long half-life). Yearly after
stable.
Signs and symptoms of hypothyroidism ANS ✅ Dry hair, puffy face, goiter in the neck, slow heartbeat,
weight gain, constipation, infertility, increased risk of miscarriages, irregular menstrual cycle, cold
intolerance.
Drug of choice for hypothyroidism ANS ✅ Levothyroxine (Synthroid)
§ Signs and symptoms of hyperthyroidism ANS ✅ Hair loss, bulging eyes, goiter, rapid heartbeat, weight
loss, diarrhea, menstrual periods loss often or longer.
Drug of choice for hyperthyroidism ANS ✅ Methimazole (Tapazole)
Treatment of thyroid storm ANS ✅ high doses of potassium iodide or strong iodine solution are given to
suppress thyroid hormone release. Methimazole is given to suppress thyroid hormone synthesis. Beta
blocker given to reduce HR. additional measures include sedation, cooling, and giving glucocorticoids
and IV fluids.
Result of not treating hypothyroidism during pregnancy: ANS ✅ Permanent neuro-psychological deficits
in the child. Decrease IQ/neuropsychological function. First trimester.
Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the
hyperthyroidism itself): ANS ✅ Beta blockers (tachycardia) - propranolol/atenolol most popular.Non-
radioactive iodine. ADJUNCTIVE THERAPY.
,Drug/Food/Supplement interactions with levothyroxine: ANS ✅ Do not take antacids, Calcium or Iron,
how to take it (morning 30-60 min b4 eat.
How to confirm a diagnosis of DM prior to beginning treatment: ANS ✅ Fasting plasma glucose above
126. A random plasma glucose of over 200 plus symptoms of diabetes, an oral glucose tolerance test of
two hours, plasma glucose of over 200, or a A1C higher than 6.5.
A1c general goals ANS ✅ <7, patients that experience severe hypoglycemia/have a limited life
expectancy may have an A1C goal of <8.
A1c older adults ANS ✅ <8, those with multiple coexisting chronic illnesses, cognitive impairment, or
functional dependence should have less stringent glycemic goals such as <8.0-8.5.
When should insulin be considered? ANS ✅ For treatment of persistent hyperglycemia starting at a
threshold of >180.
Early introduction of insulin should be considered if there is evidence of ongoing weight loss, if
symptoms of hyperglycemia are present, or whenA1C levels >10% or BGS >300
At what time interval should A1c be re-checked?
How often should an A1C be monitored when stable or when unstable? ANS ✅ Every 2-3 months and
max of 4 times a year. If <7, every 6 months.
At least two times a year if meeting goals and quarterly if meds have changed or not meeting goals.
Action of Insulin ANS ✅ Anabolic, energy conservation, promotes cellular growth and division.
Pioglitazone contraindications: ANS ✅ Heart failure (severe = no, mild = caution) and bladder cancer.
Causes fluid retention.
GLP-1 (abbreviation and examples) ANS ✅ Glucagonlike Peptide - Subcutaneous injections - Dulaglutide
(Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).
, SGLT2i (abbreviation and examples) ANS ✅ Sodium Glucose Cotransporter 2 Inhibitors - Canagliflozin
(Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance).
DPP4-I (abbreviation and examples) ANS ✅ Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin, Saxagliptin,
Linagliptin, Alogliptin.
TZD (abbreviation and examples) ANS ✅ Thiazolidinediones - Rosiglitazone & Pioglitazone
Which drug class should be considered for diabetes prior to insulin? ANS ✅ It is recommended that a
GLP-1 be considered before starting insulin. Metformin first always unless contraindicated.
Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin ANS ✅ Basal and bolus
insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD)
Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the
basal insulin dose and the other 24 units is rapid-acting.
How is total daily dose (TDD) of insulin calculated ANS ✅ TDD is calculated by taking the total weight in
kg and multiply by 0.6 units.
Know the carbohydrate-to insulin ratio when calculating basal insulin ANS ✅ Mealtime dose is
calculated using the 450 rule for regular insulin and 500 rule for rapid acting insulin then divide by TDD.
The answer (rounded) = the ratio of 1:the # answer. That means that if the meal is 60g of carbs, 60
divided by the # in answer = # of units of rapid-acting insulin.
GLP-1 MOA ANS ✅ slows gastric emptying, stimulates glucose dependent insulin release, and
suppresses glucagon release and reduces appetite
DPP-4i MOA ANS ✅ Enhance the activity of incretins and thereby increase insulin release, reduce
glucagon
TZD MOA ANS ✅ Decreases insulin resistance and increase glucose uptake by muscle and adipose tissue
Latest Study Updates
What labs are used to diagnose hypo/hyper thyroid? ANS ✅ TSH, T3, and T4. High TSH = hypo and low
TSH = hyper. Opposites.
Timeframe for re-check of labs after starting levothyroxine ANS ✅ 6-8 weeks (long half-life). Yearly after
stable.
Signs and symptoms of hypothyroidism ANS ✅ Dry hair, puffy face, goiter in the neck, slow heartbeat,
weight gain, constipation, infertility, increased risk of miscarriages, irregular menstrual cycle, cold
intolerance.
Drug of choice for hypothyroidism ANS ✅ Levothyroxine (Synthroid)
§ Signs and symptoms of hyperthyroidism ANS ✅ Hair loss, bulging eyes, goiter, rapid heartbeat, weight
loss, diarrhea, menstrual periods loss often or longer.
Drug of choice for hyperthyroidism ANS ✅ Methimazole (Tapazole)
Treatment of thyroid storm ANS ✅ high doses of potassium iodide or strong iodine solution are given to
suppress thyroid hormone release. Methimazole is given to suppress thyroid hormone synthesis. Beta
blocker given to reduce HR. additional measures include sedation, cooling, and giving glucocorticoids
and IV fluids.
Result of not treating hypothyroidism during pregnancy: ANS ✅ Permanent neuro-psychological deficits
in the child. Decrease IQ/neuropsychological function. First trimester.
Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the
hyperthyroidism itself): ANS ✅ Beta blockers (tachycardia) - propranolol/atenolol most popular.Non-
radioactive iodine. ADJUNCTIVE THERAPY.
,Drug/Food/Supplement interactions with levothyroxine: ANS ✅ Do not take antacids, Calcium or Iron,
how to take it (morning 30-60 min b4 eat.
How to confirm a diagnosis of DM prior to beginning treatment: ANS ✅ Fasting plasma glucose above
126. A random plasma glucose of over 200 plus symptoms of diabetes, an oral glucose tolerance test of
two hours, plasma glucose of over 200, or a A1C higher than 6.5.
A1c general goals ANS ✅ <7, patients that experience severe hypoglycemia/have a limited life
expectancy may have an A1C goal of <8.
A1c older adults ANS ✅ <8, those with multiple coexisting chronic illnesses, cognitive impairment, or
functional dependence should have less stringent glycemic goals such as <8.0-8.5.
When should insulin be considered? ANS ✅ For treatment of persistent hyperglycemia starting at a
threshold of >180.
Early introduction of insulin should be considered if there is evidence of ongoing weight loss, if
symptoms of hyperglycemia are present, or whenA1C levels >10% or BGS >300
At what time interval should A1c be re-checked?
How often should an A1C be monitored when stable or when unstable? ANS ✅ Every 2-3 months and
max of 4 times a year. If <7, every 6 months.
At least two times a year if meeting goals and quarterly if meds have changed or not meeting goals.
Action of Insulin ANS ✅ Anabolic, energy conservation, promotes cellular growth and division.
Pioglitazone contraindications: ANS ✅ Heart failure (severe = no, mild = caution) and bladder cancer.
Causes fluid retention.
GLP-1 (abbreviation and examples) ANS ✅ Glucagonlike Peptide - Subcutaneous injections - Dulaglutide
(Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).
, SGLT2i (abbreviation and examples) ANS ✅ Sodium Glucose Cotransporter 2 Inhibitors - Canagliflozin
(Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance).
DPP4-I (abbreviation and examples) ANS ✅ Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin, Saxagliptin,
Linagliptin, Alogliptin.
TZD (abbreviation and examples) ANS ✅ Thiazolidinediones - Rosiglitazone & Pioglitazone
Which drug class should be considered for diabetes prior to insulin? ANS ✅ It is recommended that a
GLP-1 be considered before starting insulin. Metformin first always unless contraindicated.
Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin ANS ✅ Basal and bolus
insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD)
Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the
basal insulin dose and the other 24 units is rapid-acting.
How is total daily dose (TDD) of insulin calculated ANS ✅ TDD is calculated by taking the total weight in
kg and multiply by 0.6 units.
Know the carbohydrate-to insulin ratio when calculating basal insulin ANS ✅ Mealtime dose is
calculated using the 450 rule for regular insulin and 500 rule for rapid acting insulin then divide by TDD.
The answer (rounded) = the ratio of 1:the # answer. That means that if the meal is 60g of carbs, 60
divided by the # in answer = # of units of rapid-acting insulin.
GLP-1 MOA ANS ✅ slows gastric emptying, stimulates glucose dependent insulin release, and
suppresses glucagon release and reduces appetite
DPP-4i MOA ANS ✅ Enhance the activity of incretins and thereby increase insulin release, reduce
glucagon
TZD MOA ANS ✅ Decreases insulin resistance and increase glucose uptake by muscle and adipose tissue
