NR508 Week 7 Grand Rounds replies/post
“In participation responses to presentations, discusses a drug that could be prescribed
for the condition DIFFERENT than those presented. Presents an alternate treatment plan
from the Walmart or Target $4 RX list, and offers reasons for the change or if the drug is
not on the list, why? Uses scholarly, evidenced based references to support responses.”
Great Presentation, lots of good information was covered! Great follow up slide as well! The list narrows
when discussing medications for Hypothyroidism. The only $4 thyroid replacement therapy is
Levothyroxine which you discussed in your presentation. I will point out that the $4 prescription is a 30-
day supply while there is also a $10 90 supply available as well if the practitioner writes the order as
such which will save the patient $2 overall in filling a 90-day supply.
I will give a clinical scenario where a patient was previously prescribed Levothyroxine but now her
practitioner is switching her to a non-synthetic form, Armour Thyroid, due to some adverse reactions to
the synthetic form. This is a Desiccated thyroid extract that is made from animal (pigs) thyroid glands. In
an article written by McAninch & Bianco (2016) they noted a study showing a patient preference to
desiccated thyroid extract over L-Thyroxine monotherapy and patients happened to experience weight
loss in conjunction with therapy. Usual starting dose of Armour Thyroid is 30mg with incremental dosing
of 15mg every 2-4 weeks depending on lab values. If patient has a history of cardiac disorders or angina,
then an initial starting dose of 15mg is recommended. Maintenance dosing is between 60-120mg/day.
Drug interactions may occur with anticoagulants as thyroid hormone appears to intensification
catabolism of vitamin K.
Questions:
Electronic Medical Records are improving the safety of prescribing medications? True
Which Hormone is considered the most natural for supplementation? T4 Supplementation
The preferred hormone replacement treatment during pregnancy is Levothyroxine? True, safe during
pregnancy and for babies.
What is the most common cause of hypothyroidism in the United States? Autoimmune disease
Patients with a TSH greater than 10 micro units/ml should be treated? True
McAninch, E. A., & Bianco, A. C. (2016). The History and Future of Treatment of Hypothyroidism. Annals
Of Internal Medicine, 164(1), 50-56. doi:10.7326/M15-1799
Great topic and presentation as it effects many women in todays society. I myself know of a handful of
friends that are dealing with PCOS and it has become a daily stressor on their lives. I did have a difficult
time hearing all of what you had to say due to the mic going in and out, so I did look up some of the
answers as to you may have discussed them when I was unable to pick up what you were saying on the
microphone. As you mentioned all of the medications on the $4 prescribing list I will discuss another,
there was an oral contraceptive on $9 list but alas not on the $4 list.
“In participation responses to presentations, discusses a drug that could be prescribed
for the condition DIFFERENT than those presented. Presents an alternate treatment plan
from the Walmart or Target $4 RX list, and offers reasons for the change or if the drug is
not on the list, why? Uses scholarly, evidenced based references to support responses.”
Great Presentation, lots of good information was covered! Great follow up slide as well! The list narrows
when discussing medications for Hypothyroidism. The only $4 thyroid replacement therapy is
Levothyroxine which you discussed in your presentation. I will point out that the $4 prescription is a 30-
day supply while there is also a $10 90 supply available as well if the practitioner writes the order as
such which will save the patient $2 overall in filling a 90-day supply.
I will give a clinical scenario where a patient was previously prescribed Levothyroxine but now her
practitioner is switching her to a non-synthetic form, Armour Thyroid, due to some adverse reactions to
the synthetic form. This is a Desiccated thyroid extract that is made from animal (pigs) thyroid glands. In
an article written by McAninch & Bianco (2016) they noted a study showing a patient preference to
desiccated thyroid extract over L-Thyroxine monotherapy and patients happened to experience weight
loss in conjunction with therapy. Usual starting dose of Armour Thyroid is 30mg with incremental dosing
of 15mg every 2-4 weeks depending on lab values. If patient has a history of cardiac disorders or angina,
then an initial starting dose of 15mg is recommended. Maintenance dosing is between 60-120mg/day.
Drug interactions may occur with anticoagulants as thyroid hormone appears to intensification
catabolism of vitamin K.
Questions:
Electronic Medical Records are improving the safety of prescribing medications? True
Which Hormone is considered the most natural for supplementation? T4 Supplementation
The preferred hormone replacement treatment during pregnancy is Levothyroxine? True, safe during
pregnancy and for babies.
What is the most common cause of hypothyroidism in the United States? Autoimmune disease
Patients with a TSH greater than 10 micro units/ml should be treated? True
McAninch, E. A., & Bianco, A. C. (2016). The History and Future of Treatment of Hypothyroidism. Annals
Of Internal Medicine, 164(1), 50-56. doi:10.7326/M15-1799
Great topic and presentation as it effects many women in todays society. I myself know of a handful of
friends that are dealing with PCOS and it has become a daily stressor on their lives. I did have a difficult
time hearing all of what you had to say due to the mic going in and out, so I did look up some of the
answers as to you may have discussed them when I was unable to pick up what you were saying on the
microphone. As you mentioned all of the medications on the $4 prescribing list I will discuss another,
there was an oral contraceptive on $9 list but alas not on the $4 list.
