featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
NR565 Final Study Guide with complete
solutions
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 5
Thyroid
o Diagnosis & Evaluation
What labs are used to diagnose?
- Serum TSH levels = most sensitive for detecting hypothyroidism
- TSH level > 6 is indicative of hypothyroidism
- 0.3-6 is normal TSH level
- Measuring total or free T4 (free T4 is preferred)
Timeframe for re-check of labs after starting levothyroxine
- Need to recheck TSH levels 6-8 weeks after initiating therapy
AND at any dosage change
- Need to monitor therapeutic effects and takes 1 month to establish
plasma levels
Signs and symptoms of hypo and hyperthyroidism
- HYPOTHYROIDISM
- Can be caused by sx removal of thyroid
- Insufficient iodine in diet
- Autoimmune – Hashimoto’s dx
- Tx is lifelong
- T3 and T4 levels going to be low and TSH will be high
o Puffy and pale face
o Cold/dry skin
o Brittle hair
o Hair loss
o HR and temp lowered (bradycardia)
o Lethargy and fatigue
o Intolerance to cold
o Weight gain
o Constipation
o Depression
- HYPERTHRYOIDISM
o Graves’ disease or toxic nodular goiter (plummer dz)
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
,featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
Overactive thyroid
Excessive thyroid secretion due to autoimmune
process attacking thyroid
o TSH levels going to be low and T3/T4 going to be high
o Rapid/ strong HR
o Increased risk of dysrhythmias
o Nervousness
o Insomnia
o Rapid speech
o Weakened muscles/atrophy
o Increase body temp
o Intolerance to heat
o Increased appetite
o Diarrhea
o Exomphalos can occur = bulging eyes
Dry eye can occur
o Treatment
Treatment of thyroid storm – excessive levels of thyroid hormone
- Pt. experiences:
o Hyperthermia
o Severe tachycardia
o Restlessness / agitation
o Tremors
** can lead to coma and death AND hypotension which can lead to heart failure
- Can occur when undergoing surgery or with major illness
- Pt. is given high dose of potassium iodide to suppress TH release
- Methimazole (tapazole) given to suppress TH synthesis
- BB given to reduce HR
- May also initiative IV fluids, cooling, sedation, corticosteroids
Result of not treating hypothyroidism during pregnancy
- May cause permanent neuropsychological deficits
- Can reduce child IQ
- Dose of thyroid medication needs to be increased by about 50%
especially in 1st trimester
Medication to treat symptoms of hyperthyroidism (notice this is
treating symptoms and not the hyperthyroidism itself)
- Methimazole = first line drug for tx of the disease
o Block TH synthesis
o Prevents oxidation of iodide
o Toxicity = agranulocytosis (sore throat and fever)
Need to monitor CBC for WBC count for infection
Need LFT for hepatic function
o Not indicated for pregnancy. Would use PTU instead
o Tx will last 1-2 years
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
,featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
- Surgery to remove thyroid
- Radioactive iodine
- BB to reduce HR
Drug/Food/Supplement interactions with levothyroxine
** these medications reduce the absorption of levothyroxine
- Histamine 2 receptor blockers
- PPI
- Sucralfate
- Cholestyramine
- Colestipol
- Aluminum containing antacids
- Calcium supplements
- Iron supplements
- Magnesium salts
- Orlistat
** these medications accelerate levothyroxine metabolism
- Phenytoin
- Carbamazepine
- Sertraline
- Rifampin
- Catecholamines
- ** insulin digoxin, and warfarin may need to be increased if pt.
takes these
Synthroid dose
o 100 – 125 mcg in adults
o 25- 50 mcg in older adults because of slower metabolism by liver
Elderly can experience palpitations with Synthroid
o Medication should be taken on an empty stomach, 30 minutes before a meal and
in the morning
Taking at nighttime can keep patients awake
o May develop thyroid toxicosis from Synthroid
Tachycardia
Angina
Tremors
Nervousness
Insomnia
Sweating
Heat intolerance
Diabetes
o How to confirm a diagnosis prior to beginning treatment
- Fasting plasma glucose > or equal to 126
- Random plasma glucose > or equal to 200 PLUS symptoms of
diabetes
- Oral glucose tolerance test: 2-h plasma glucose > or equal to 200
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
, featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
** patient must be tested on two separate days and a combo of
either test can confirm diagnosis if they are BOTH positive
- A1C 6.5% or higher
- Pre-diabetes is 5.7% - 6.4%
o A1C
General goals
- Considered the standard test for diabetes
- Keep A1C less than 7%
- Reflect glucose levels from previous 2-3 months
- Patients with A1C of 9% or more start with step 2 = dual therapy
with metformin plus another antidiabetic agent
- Patients with 10% or > start combination injectable immediately
Older Adult goal
- Less than 8%
When should insulin be considered?
- When the patient does not meet goals using metformin and
lifestyle changes
- When A1C > 10%
At what time interval should it be re-checked?
- Rechecked every 3 months until value drops to 7%
- Checked every 6 month thereafter
o Action of Insulin
- Increases glucose uptake, oxidation, and storage
- Increases glycogen synthesis
- Decreases glycogenolysis (breakdown into glucose)
- Increases amino acid uptake in muscle
- Decreases amino acid release by muscle
- Increases protein synthesis in muscle
- Increases triglyceride synthesis
- Decreases release of free fatty acids to the liver
- Decreases oxidation of free fatty acids to ketoacids
o Pioglitazone contraindications (TZD)
- Contraindicated in patients with heart failure secondary to renal
retention of fluids
o Be familiar with abbreviations of diabetic drug classifications
- GLP-1: glucagon-like peptide-1 receptor agonists
- TZD: Thiazolidinediones or glitazones
- DPP4-I: dipeptidyl peptidase-4 inhibitors
- SGLT2i: sodium glucose cotransporter 2 inhibitors
o Which drug class should be considered for diabetes prior to insulin?
- GLP1-RA
Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin
- 50% basal insulin and 50% rapid acting
- TDD = 0.6 X pt. weight in kg
Know the carbohydrate-to insulin ratio when calculating basal insulin
o Simple calculation (No calculators are allowed and will not be needed)
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
NR565 Final Study Guide with complete
solutions
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 5
Thyroid
o Diagnosis & Evaluation
What labs are used to diagnose?
- Serum TSH levels = most sensitive for detecting hypothyroidism
- TSH level > 6 is indicative of hypothyroidism
- 0.3-6 is normal TSH level
- Measuring total or free T4 (free T4 is preferred)
Timeframe for re-check of labs after starting levothyroxine
- Need to recheck TSH levels 6-8 weeks after initiating therapy
AND at any dosage change
- Need to monitor therapeutic effects and takes 1 month to establish
plasma levels
Signs and symptoms of hypo and hyperthyroidism
- HYPOTHYROIDISM
- Can be caused by sx removal of thyroid
- Insufficient iodine in diet
- Autoimmune – Hashimoto’s dx
- Tx is lifelong
- T3 and T4 levels going to be low and TSH will be high
o Puffy and pale face
o Cold/dry skin
o Brittle hair
o Hair loss
o HR and temp lowered (bradycardia)
o Lethargy and fatigue
o Intolerance to cold
o Weight gain
o Constipation
o Depression
- HYPERTHRYOIDISM
o Graves’ disease or toxic nodular goiter (plummer dz)
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
,featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
Overactive thyroid
Excessive thyroid secretion due to autoimmune
process attacking thyroid
o TSH levels going to be low and T3/T4 going to be high
o Rapid/ strong HR
o Increased risk of dysrhythmias
o Nervousness
o Insomnia
o Rapid speech
o Weakened muscles/atrophy
o Increase body temp
o Intolerance to heat
o Increased appetite
o Diarrhea
o Exomphalos can occur = bulging eyes
Dry eye can occur
o Treatment
Treatment of thyroid storm – excessive levels of thyroid hormone
- Pt. experiences:
o Hyperthermia
o Severe tachycardia
o Restlessness / agitation
o Tremors
** can lead to coma and death AND hypotension which can lead to heart failure
- Can occur when undergoing surgery or with major illness
- Pt. is given high dose of potassium iodide to suppress TH release
- Methimazole (tapazole) given to suppress TH synthesis
- BB given to reduce HR
- May also initiative IV fluids, cooling, sedation, corticosteroids
Result of not treating hypothyroidism during pregnancy
- May cause permanent neuropsychological deficits
- Can reduce child IQ
- Dose of thyroid medication needs to be increased by about 50%
especially in 1st trimester
Medication to treat symptoms of hyperthyroidism (notice this is
treating symptoms and not the hyperthyroidism itself)
- Methimazole = first line drug for tx of the disease
o Block TH synthesis
o Prevents oxidation of iodide
o Toxicity = agranulocytosis (sore throat and fever)
Need to monitor CBC for WBC count for infection
Need LFT for hepatic function
o Not indicated for pregnancy. Would use PTU instead
o Tx will last 1-2 years
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
,featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
- Surgery to remove thyroid
- Radioactive iodine
- BB to reduce HR
Drug/Food/Supplement interactions with levothyroxine
** these medications reduce the absorption of levothyroxine
- Histamine 2 receptor blockers
- PPI
- Sucralfate
- Cholestyramine
- Colestipol
- Aluminum containing antacids
- Calcium supplements
- Iron supplements
- Magnesium salts
- Orlistat
** these medications accelerate levothyroxine metabolism
- Phenytoin
- Carbamazepine
- Sertraline
- Rifampin
- Catecholamines
- ** insulin digoxin, and warfarin may need to be increased if pt.
takes these
Synthroid dose
o 100 – 125 mcg in adults
o 25- 50 mcg in older adults because of slower metabolism by liver
Elderly can experience palpitations with Synthroid
o Medication should be taken on an empty stomach, 30 minutes before a meal and
in the morning
Taking at nighttime can keep patients awake
o May develop thyroid toxicosis from Synthroid
Tachycardia
Angina
Tremors
Nervousness
Insomnia
Sweating
Heat intolerance
Diabetes
o How to confirm a diagnosis prior to beginning treatment
- Fasting plasma glucose > or equal to 126
- Random plasma glucose > or equal to 200 PLUS symptoms of
diabetes
- Oral glucose tolerance test: 2-h plasma glucose > or equal to 200
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
, featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
** patient must be tested on two separate days and a combo of
either test can confirm diagnosis if they are BOTH positive
- A1C 6.5% or higher
- Pre-diabetes is 5.7% - 6.4%
o A1C
General goals
- Considered the standard test for diabetes
- Keep A1C less than 7%
- Reflect glucose levels from previous 2-3 months
- Patients with A1C of 9% or more start with step 2 = dual therapy
with metformin plus another antidiabetic agent
- Patients with 10% or > start combination injectable immediately
Older Adult goal
- Less than 8%
When should insulin be considered?
- When the patient does not meet goals using metformin and
lifestyle changes
- When A1C > 10%
At what time interval should it be re-checked?
- Rechecked every 3 months until value drops to 7%
- Checked every 6 month thereafter
o Action of Insulin
- Increases glucose uptake, oxidation, and storage
- Increases glycogen synthesis
- Decreases glycogenolysis (breakdown into glucose)
- Increases amino acid uptake in muscle
- Decreases amino acid release by muscle
- Increases protein synthesis in muscle
- Increases triglyceride synthesis
- Decreases release of free fatty acids to the liver
- Decreases oxidation of free fatty acids to ketoacids
o Pioglitazone contraindications (TZD)
- Contraindicated in patients with heart failure secondary to renal
retention of fluids
o Be familiar with abbreviations of diabetic drug classifications
- GLP-1: glucagon-like peptide-1 receptor agonists
- TZD: Thiazolidinediones or glitazones
- DPP4-I: dipeptidyl peptidase-4 inhibitors
- SGLT2i: sodium glucose cotransporter 2 inhibitors
o Which drug class should be considered for diabetes prior to insulin?
- GLP1-RA
Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin
- 50% basal insulin and 50% rapid acting
- TDD = 0.6 X pt. weight in kg
Know the carbohydrate-to insulin ratio when calculating basal insulin
o Simple calculation (No calculators are allowed and will not be needed)
featuring complete and verified questions and answers
NR565
designed
Final Study
to strengthenNR565
Guide with complete
Final Study
solutions.pdf
Guide
NR565
with complete
Final Study
solutions
Guide with complete solutions.pdf
