NR 565 Final Exam Study Guide Questions and answers 2024-25

What labs are used to diagnose Thyroid? - CORRECT ANSWER TSH, total T4 and T3, free T4 and T3 Timeframe for re-check of labs after starting levothyroxine - CORRECT ANSWER 6-8 wks after starting therapy Signs and symptoms of hypothyroidism - CORRECT 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 - CORRECT 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 - CORRECT 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) - CORRECT 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: - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER When should insulin be considered? - CORRECT 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? - CORRECT ANSWER every 3 months until A1C drops below 7% and then every 6 months thereafter. Action of Insulin - CORRECT 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 - CORRECT ANSWER Pioglitazone is contraindicated in patients with severe heart failure and should be used with caution in patients with mild heart failure. Should not be used in patients that have active bladder cancer or history of bladder cancer Be familiar with abbreviations of diabetic drug classifications (GLP-1, TZD, DPP4-I, SGLT2i) - CORRECT ANSWER GLP-1: Glucagon-like Peptide -1 Receptor Agonist TZD: Thiazolidinediones (Glitazones) DPP-4i: Dipeptidyl Peptidase- 4 Inhibitors (Gliptins) SGLT2i: Sodium-Glucose Cotransporter 2 Inhibitors Which drug class should be considered for diabetes prior to insulin? - CORRECT ANSWER Biguanides (Metformin) Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin - CORRECT ANSWER •Basal insulin replacement encompasses approximately 50% of the total daily insulin dose which replaces insulin from fasting (overnight) and between meals. This dose is usually constant. Bolus insulin replacement encompasses approximately 50% of the total daily insulin dose Know the carbohydrate-to insulin ratio when calculating basal insulin - CORRECT ANSWER 500 / TDD : 1 unit TDD = 0.6 units/kg/day Mechanism of Action o GLP-1 - CORRECT ANSWER GLP-1: Augment effects of incretin hormone GLP-1 can ↑ insulin production and inhibits postprandial glucagon release Which diabetic medication(s) come with a concern of hypoglycemia? - CORRECT ANSWER sulfonylureas, glinides, GLP-1, amylin mimetics, glitazones Methylxanthines o Who is at risk for toxicity and why? - CORRECT ANSWER Older patients are at much higher risk for toxicity when taking methylxanthines (Systemic anticholinergics are included in BEERS criteria for potentially inappropriate use for older adult Wk. 6 module.) Patients with liver dysfunction (increased risk for toxicity) Untreated seizure disorder or peptic ulcer disease Asthma & COPD o Step 1 therapy - CORRECT ANSWER •SABA → PRN Complete this sentence: Manage with a ______ as needed. - CORRECT ANSWER SABA Symptoms associated with Intermittent classification of asthma *Symptoms *Nighttime Awakening *SABA USE - CORRECT ANSWER *2 d/week or less *2 times/month or less *2 d/week or less Know examples of drug classes (SABA) - CORRECT ANSWER oAlbuterol (Proventil), Levalbuterol (Xopenex) SABA Benefits of use - CORRECT ANSWER Activate the beta-adrenergic receptors in smooth muscle of the lung, thereby promoting bronchodilation and relieving