NR 565 / NR565 ADVANCED PHARMACOLOGY FINAL
EXAM. QUESTIONS AND ANSWERS.
NR565 ADVANCED PHARMACOLOGY FINAL EXAM.
QUESTIONS AND ANSWERS.
Signs and symptoms of hypothyroidism - ANSWER- Face is pale, puffy, and
expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance
to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism - ANSWER- Heart Rate is Rapid; Possible
arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat production, increased body
temperature, intolerance to heat, and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase in metabolic rate
Severe hypothyroidism - ANSWER- Myxedema
Hypothyroid Treatment - ANSWER- Levothyroxine is the drug of choice for most
patients who require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal - ANSWER- Resolution of signs and
symptoms of hypothyroidism and restoration of normal laboratory values for serum
thyroid-stimulating hormone (TSH) and free thyroxine (T4).
Major forms of hyperthyroidism - ANSWER- Graves disease and toxic nodular goiter
(also known as Plummer disease).
Graves Disease - ANSWER- Most common cause of excessive thyroid hormone
secretion
,What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism
other than thyroid specific medications? - ANSWER- β-Blockers and nonradioactive
iodine may be used as adjunctive therapy.
β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid hormones.
Monitoring needs and intervals for Levothyroxine - ANSWER- Check TSH 6-8 weeks
after initiating therapy and after any dosage change.
Check TSH at least once a year after serum TSH is stabilized.
Hyperthyroid Treatment - ANSWER- thionamide drugs—methimazole and
propylthiouracil (PTU)—suppress synthesis of thyroid hormones.
Methimazole Therapeutic Goal - ANSWER- (1) reduction of thyroid hormone production
in Graves' disease, (2) control of hyperthyroidism until the effects of radiation on the
thyroid become manifest, (3) suppression of thyroid hormone production before subtotal
thyroidectomy, (4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Methimazole - ANSWER- Check CBC with
differential if signs or symptoms of infection. Check LFTs if signs or symptoms of liver
dysfunction.
High Risk Patients for Methimazole - ANSWER- Should be avoided in the first trimester
of pregnancy.
Methimazole Toxicity - ANSWER- Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning - ANSWER- Carries a risk for liver toxicity. Although rare, the
FDA recommends against using as a first-line treatment due to potential for hepatic
toxicity.
Effects of maternal hypothyroidism on offspring and appropriate patient teaching related
to need for treatment. - ANSWER- Can cause delay in mental development and
derangement of growth. In the absence of thyroid hormones, the child develops a large
and protruding tongue, potbelly, and dwarfish stature. Development of the nervous
system, bones, teeth, and muscles is impaired.
Congenital Hypothyroidism Treatment - ANSWER- requires replacement therapy with
thyroid hormones. If treatment is initiated within a few days of birth, physical and mental
development will be normal.
,replacement therapy should continue for 3 years, after which it should be stopped for 4
weeks to determine whether thyroid deficiency is permanent or transient.
Patient Teaching for Methimazole - ANSWER- Tell your healthcare providers that you
are taking this drug.
Check blood work as directed.
Taking this drug may cause harm to the unborn baby if you are pregnant, especially in
the first trimester.
If you are pregnant or become pregnant while taking this drug, call your healthcare
provider right away.
Tell your healthcare provider if you are breast-feeding to discuss risks to the baby.
Have your baby's thyroid checked if you are using this drug and breast-feeding.
Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare.
Sore throat and fever should be reported immediately.
Patient Teaching for Levothyroxine - ANSWER- works best if you take it on an empty
stomach, 30 to 60 minutes before breakfast.
take the medicine at the same time each day.
Ideal HbA1C goal for diabetic, non-pregnant adults - ANSWER- less than 7%.
HbA1C 8% - ANSWER- history of severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
HBA1C Value considered diagnostic of diabetes. - ANSWER- a value of 6.5% or greater
HbA1C Measuring Interval - ANSWER- every 3 months until value is <7%; every 6
months thereafter
HbA1C Goal for Older Adults - ANSWER- <7.5% [58 mmol/mol]), while those with
multiple coexisting chronic illnesses, cognitive impairment, or functional dependence
should have less stringent glycemic goals (such as A1C <8.0-8.5% [64-69 mmol/mol]).
Criteria for the Diagnosis of Diabetes Mellitus - ANSWER- -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/dLcor
-Hemoglobin A1c 6.5% or higher
, T1DM Etiology and MOA - ANSWER- Autoimmune process; Loss of pancreatic β cells;
T2DM Etiology and MOA - ANSWER- Unknown—but there is a strong familial
association, suggesting that heredity is a risk factor; Insulin resistance and inappropriate
insulin secretion
the total daily dose (TDD) of insulin calculation - ANSWER- total weight of the patient in
kilograms (kg), multiplied by 0.6 units
Basal insulin replacement - ANSWER- 50% of the total daily insulin dose which
replaces insulin from fasting (overnight) and between meals.
Bolus insulin replacement - ANSWER- 50% of the total daily insulin dose and provides
carbohydrate coverage and high blood sugar correction.
Biguanides Drug Class - ANSWER- Metformin
Metformin - ANSWER- Decreases glucose production by the liver (glucogenesis),
increases tissue response to insulin;
Decrease glucose absorption; Increase glucose uptake
drug of choice for initial therapy in most patients with type 2 diabetes
Metformin contraindications - ANSWER- renal disease, acidosis from hepatic disease,
alcoholics, or in patients with hypoxia.
Metformin Major AE - ANSWER- Gastrointestinal (GI) symptoms: decreased appetite,
nausea, diarrhea
Lactic acidosis (rarely)
Sulfonylureas Prototype/MOA - ANSWER- Glyburide (Prototype Drug)
-Promote insulin secretion by the pancreas; may also increase tissue response to
insulin;
-stimulate beta cells of the pancreas to secrete more insulin
Sulfonylureas AE - ANSWER- high risk of severe hypoglycemia;
photosensitivity; therefore, patient education is needed regarding sunscreen.
blood dyscrasias
EXAM. QUESTIONS AND ANSWERS.
NR565 ADVANCED PHARMACOLOGY FINAL EXAM.
QUESTIONS AND ANSWERS.
Signs and symptoms of hypothyroidism - ANSWER- Face is pale, puffy, and
expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance
to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism - ANSWER- Heart Rate is Rapid; Possible
arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat production, increased body
temperature, intolerance to heat, and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase in metabolic rate
Severe hypothyroidism - ANSWER- Myxedema
Hypothyroid Treatment - ANSWER- Levothyroxine is the drug of choice for most
patients who require thyroid hormone replacement.
Levothyroxine (Synthroid) Therapeutic Goal - ANSWER- Resolution of signs and
symptoms of hypothyroidism and restoration of normal laboratory values for serum
thyroid-stimulating hormone (TSH) and free thyroxine (T4).
Major forms of hyperthyroidism - ANSWER- Graves disease and toxic nodular goiter
(also known as Plummer disease).
Graves Disease - ANSWER- Most common cause of excessive thyroid hormone
secretion
,What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism
other than thyroid specific medications? - ANSWER- β-Blockers and nonradioactive
iodine may be used as adjunctive therapy.
β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid hormones.
Monitoring needs and intervals for Levothyroxine - ANSWER- Check TSH 6-8 weeks
after initiating therapy and after any dosage change.
Check TSH at least once a year after serum TSH is stabilized.
Hyperthyroid Treatment - ANSWER- thionamide drugs—methimazole and
propylthiouracil (PTU)—suppress synthesis of thyroid hormones.
Methimazole Therapeutic Goal - ANSWER- (1) reduction of thyroid hormone production
in Graves' disease, (2) control of hyperthyroidism until the effects of radiation on the
thyroid become manifest, (3) suppression of thyroid hormone production before subtotal
thyroidectomy, (4) treatment of thyrotoxic crisis.
Monitoring needs and intervals for Methimazole - ANSWER- Check CBC with
differential if signs or symptoms of infection. Check LFTs if signs or symptoms of liver
dysfunction.
High Risk Patients for Methimazole - ANSWER- Should be avoided in the first trimester
of pregnancy.
Methimazole Toxicity - ANSWER- Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning - ANSWER- Carries a risk for liver toxicity. Although rare, the
FDA recommends against using as a first-line treatment due to potential for hepatic
toxicity.
Effects of maternal hypothyroidism on offspring and appropriate patient teaching related
to need for treatment. - ANSWER- Can cause delay in mental development and
derangement of growth. In the absence of thyroid hormones, the child develops a large
and protruding tongue, potbelly, and dwarfish stature. Development of the nervous
system, bones, teeth, and muscles is impaired.
Congenital Hypothyroidism Treatment - ANSWER- requires replacement therapy with
thyroid hormones. If treatment is initiated within a few days of birth, physical and mental
development will be normal.
,replacement therapy should continue for 3 years, after which it should be stopped for 4
weeks to determine whether thyroid deficiency is permanent or transient.
Patient Teaching for Methimazole - ANSWER- Tell your healthcare providers that you
are taking this drug.
Check blood work as directed.
Taking this drug may cause harm to the unborn baby if you are pregnant, especially in
the first trimester.
If you are pregnant or become pregnant while taking this drug, call your healthcare
provider right away.
Tell your healthcare provider if you are breast-feeding to discuss risks to the baby.
Have your baby's thyroid checked if you are using this drug and breast-feeding.
Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare.
Sore throat and fever should be reported immediately.
Patient Teaching for Levothyroxine - ANSWER- works best if you take it on an empty
stomach, 30 to 60 minutes before breakfast.
take the medicine at the same time each day.
Ideal HbA1C goal for diabetic, non-pregnant adults - ANSWER- less than 7%.
HbA1C 8% - ANSWER- history of severe hypoglycemia, limited life expectancy, or
advanced microvascular or macrovascular complications
HBA1C Value considered diagnostic of diabetes. - ANSWER- a value of 6.5% or greater
HbA1C Measuring Interval - ANSWER- every 3 months until value is <7%; every 6
months thereafter
HbA1C Goal for Older Adults - ANSWER- <7.5% [58 mmol/mol]), while those with
multiple coexisting chronic illnesses, cognitive impairment, or functional dependence
should have less stringent glycemic goals (such as A1C <8.0-8.5% [64-69 mmol/mol]).
Criteria for the Diagnosis of Diabetes Mellitus - ANSWER- -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/dLcor
-Hemoglobin A1c 6.5% or higher
, T1DM Etiology and MOA - ANSWER- Autoimmune process; Loss of pancreatic β cells;
T2DM Etiology and MOA - ANSWER- Unknown—but there is a strong familial
association, suggesting that heredity is a risk factor; Insulin resistance and inappropriate
insulin secretion
the total daily dose (TDD) of insulin calculation - ANSWER- total weight of the patient in
kilograms (kg), multiplied by 0.6 units
Basal insulin replacement - ANSWER- 50% of the total daily insulin dose which
replaces insulin from fasting (overnight) and between meals.
Bolus insulin replacement - ANSWER- 50% of the total daily insulin dose and provides
carbohydrate coverage and high blood sugar correction.
Biguanides Drug Class - ANSWER- Metformin
Metformin - ANSWER- Decreases glucose production by the liver (glucogenesis),
increases tissue response to insulin;
Decrease glucose absorption; Increase glucose uptake
drug of choice for initial therapy in most patients with type 2 diabetes
Metformin contraindications - ANSWER- renal disease, acidosis from hepatic disease,
alcoholics, or in patients with hypoxia.
Metformin Major AE - ANSWER- Gastrointestinal (GI) symptoms: decreased appetite,
nausea, diarrhea
Lactic acidosis (rarely)
Sulfonylureas Prototype/MOA - ANSWER- Glyburide (Prototype Drug)
-Promote insulin secretion by the pancreas; may also increase tissue response to
insulin;
-stimulate beta cells of the pancreas to secrete more insulin
Sulfonylureas AE - ANSWER- high risk of severe hypoglycemia;
photosensitivity; therefore, patient education is needed regarding sunscreen.
blood dyscrasias
