NR565 / NR 565 Final Exam Question (Latest
): 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)
Step 4 - Three drug therapy and basal insulin fails to reach goals after 3-6 months -
injectable regimen inclusive of insulin and possibly GLP-1 receptor agonist.
EXCEPTIONS: patient with A1C greater than 9% or greater start dual therapy
(start at step 2) and patients with A1C greater than 10 % and fasting blood glucose
of 300 or more or symptomatic may be started on combination injectable therapy
immediately
At what time interval should A1c be re-checked? - ANSWER
every 3 months until A1C drops below 7% and then every 6 months thereafter.
Action of Insulin - ANSWER Anabolic-promotes conservation of
energy and buildup of energy stores (Glycogen)
Stimulates cellular transport (Uptake) of glucose, amino acids, nucleotides & K
Promotes synthesis of complex molecules
Glucose ⇒ Glycogen, Amino Acids ⇒ Proteins, Fatty Acids ⇒ Triglycerides
Promotes cellular growth and division
Energy conservation
Pioglitazone contraindications - ANSWER Pioglitazone is
contraindicated in patients with severe heart failure and should be used with
): 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)
Step 4 - Three drug therapy and basal insulin fails to reach goals after 3-6 months -
injectable regimen inclusive of insulin and possibly GLP-1 receptor agonist.
EXCEPTIONS: patient with A1C greater than 9% or greater start dual therapy
(start at step 2) and patients with A1C greater than 10 % and fasting blood glucose
of 300 or more or symptomatic may be started on combination injectable therapy
immediately
At what time interval should A1c be re-checked? - ANSWER
every 3 months until A1C drops below 7% and then every 6 months thereafter.
Action of Insulin - ANSWER Anabolic-promotes conservation of
energy and buildup of energy stores (Glycogen)
Stimulates cellular transport (Uptake) of glucose, amino acids, nucleotides & K
Promotes synthesis of complex molecules
Glucose ⇒ Glycogen, Amino Acids ⇒ Proteins, Fatty Acids ⇒ Triglycerides
Promotes cellular growth and division
Energy conservation
Pioglitazone contraindications - ANSWER Pioglitazone is
contraindicated in patients with severe heart failure and should be used with
