12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
Benfamiliar nwith ntheninteractivenactivitiesnthroughoutncoursenmodules.n Youncoul
d n seenvariationsnofnthosensamenquestionsnon nyour nexams.
Weekn5
• Thyroid
o Diagnosisn&nEvaluation
▪ Whatnlabsnarenusedntondiagnose?
▪ Timeframenfor nre-checknofnlabs nafter nstarti ng nlev othyr oxine
▪ Signsnandnsymptomsnofnhy pon andnhy perthyroidism
o Treatment
▪ Treatmentnofnthyroidnstorm
▪ Resultnofnnot ntreati ng nhy pothyr oidi sm nduri ng npregnancy
▪ Medicationntontreat nsym ptomsnof nhyperthyroi dism n(notic enthisnisntreating
symptomsnandnnotnthenhy perthyr oidism nitself)
▪ Drug/Food/Supplementn interactionsn withn lev othyroxine
• Diabetes
o How ntonconfirm nandiagnosisnprior ntonbeginni ng ntreatment
o A1C
▪ General n goals
▪ Older nAdultn goal
▪ Whennshouldninsulinn benconsidered?
▪ Atnwhatntimeninterval nshoul dnitnbenre-c heck ed?
o ActionnofnInsulin
o Pioglitazonen contraindications
o Benfamiliar nwithnabbr eviations nofndiabeticndrug ncl assi ficationsn( GLP-
1,nTZD,n DPP4-I,nSGLT 2i)
o Whichndrug nclassnshouldnbenc onsiderednfor ndi abetesnpri or ntonins ulin?
• Rationofnbasal ninsulinntonrapi d-ac ting nins ulinninntotal ndailyndosen(TDD) nofnins ulin
• Know nthencar bohy drate- to nins ulin nrationw hennc alcul ati ng nbas al ni nsulin
o Simplencalculationn(Noncalc ulatorsn arenall owednandnwill nnotnbenneeded)
• Mechanism n ofnAction
o GLP-1
o TZD
o DPP-4i
o Sulfonylureas
o SGLT2i
• Whichndiabeticnmedi cation(s) ncom enwithnanconc ernnofnhypoglycemia?
• Thyroid
o Diagnosisn&nEvaluation
▪ Whatnlabsnarenusedntondiagnose?
▪ Timeframenfor nre-checknofnlabs nafter nstarti ng nlev othyr oxine
▪ Signsnandnsymptomsnofnhy pon andnhy perthyroidism
about:blank 1/42
,12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
o Treatment
▪ Treatmentnofnthyroidnstorm
▪ Resultnofnnot ntreati ng nhy pothyr oidi sm nduri ng npregnancy
▪ Medicationntontreat nsym ptomsnof nhyperthyroi dism n(notic enthisnisntreating
symptomsnandnnotnthenhy perthyr oidism nitself)
▪ Drug/Food/Supplementn interactionsn withn lev othyroxine
• Diabetes
o How ntonconfirm nandiagnosisnprior ntonbeginni ng ntreatment
o A1C
▪ General n goals
▪ Older nAdultn goal
▪ Whennshouldninsulinn benconsidered?
▪ Atnwhatntimeninterval nshoul dnitnbenre-c heck ed?
o ActionnofnInsulin
o Pioglitazonen contraindications
o Benfamiliar nwithnabbr eviations nofndiabeticndrug ncl assi ficationsn( GLP-
1,nTZD,n DPP4-I,nSGLT 2i)
o Whichndrug nclassnshouldnbenc onsiderednfor ndi abetesnpri or ntonins ulin?
• Rationofnbasal ninsulinntonrapi d-ac ting nins ulinninntotal ndailyndosen(TDD) nofnins ulin
• Know nthencar bohy drate- to nins ulin nrationw hennc alcul ati ng nbas al ni nsulin
o Simplencalculationn(Noncalc ulatorsn arenall owednandnwill nnotnbenneeded)
• Mechanism n ofnAction
o GLP-1
o TZD
o DPP-4i
o Sulfonylureas
o SGLT2i
• Whichndiabeticnmedi cation(s) ncom enwithnanconc ernnofnhypoglycemia?
>The nmostncommon nlab ntestsnused nto ndiagnosenthyroid nconditionsnarent
hyroid-
stimulatingnhormonen(TSH)nandnfreenthyroxinen(FT4).nTSHnlevelsnarentypic
allynhigh ninnhypothyroidismnandnlowninnhyperthyroidism.nFT4 nlevelsnare nt
ypicallynlownin nhypothyroidism nand nhigh nin nhyperthyroidism.
• >Labs nshould nbe nrechecked n4-6 nweeks nafternstarting nlevothyroxine.
• >Signs nand nsymptoms nofnhypothyroidism ninclude nfatigue,nweight ngain,
constipation,ndrynskin,nand ncoldnintolerance.nSigns nandnsymptomsnofn
hyperthyroidismnincludenweightnloss,nanxiety,ntremors,npalpitations,nan
d nheat nintolerance.
• Treatment;
• >Treatmentnofnthyroid nstorm nincludes naggressivensupportive ncarenand nbe
ta nblockers.
• Ifn left nuntreated,nhypothyroidismnduring npregnancyncan nlead n
to nmiscarriage,npreterm ndelivery,nornlownbirth nweight.
• >Medicationsnused ntontreatnsymptomsnofnhyperthyroidismnincludenbe
ta nblockers nand nanti-thyroid nmedications.
about:blank 2/42
,12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
• >Levothyroxine ncanninteract nwithna nnumbernofndrugs,nfoods,nandnsuppl
ements,nsonit nisnimportantnto ndiscuss nall npotential ninteractions nwith na
healthcare nprovidernbefore nstarting nthis nmedication.
Thyroid:nThyroid ndisorders narentypicallyndiagnosed nbased non nclinicalnsigns nand
nsymptoms,nin ncombination nwith nlaboratoryntesting.
1. Thyroid ndisorders narentypicallyndiagnosed nbasednonnclinicalnsigns na
nd nsymptoms,nin ncombination nwith nlaboratoryntesting.
2. The nmost ncommon nlaboratoryntestsnused ntondiagnosenthyroid ndisorders ninclu
de nthe nfollowing:
-Thyroid-stimulating nhormone n(TSH)
-Free nthyroxine n(FT4)
-Free ntriiodothyronine n(FT3)
-Thyroid nperoxidase n(TPO)nantibodies
-Thyroglobulin nantibodies
3. The ntimeframe nfornre-
checkingnlabsnafternstarting nlevothyroxine nvariesndepending non nthenind
ividual's nresponse nto ntherapy.
4. The nsigns nand nsymptoms nofnhypothyroidism ninclude nfatigue,nweight ngain,
constipation,ncoldnintolerance,nand nmusclencramps.nThe nsigns nand nsymptoms no
fnhyperthyroidismnincludenweightnloss,nanxiety,nirritability,nheatnintolerance,na
nd npalpitations.
Treatment
1. Treatmentnofnthyroid nstormnincludes naggressive nsupportivencare nand ni
mmediate ntreatment nofnthenunderlying ncause.nTreatmentsnmaynincludenbet
a nblockers,nsteroids,nand ncooling nmeasures.
2. Ifnhypothyroidism nis nnot ntreated nduring npregnancy,nit ncan nlead nto npreterm
labor,npreeclampsia,nlownbirth nweight,nand ncongenital nanomalies.
3. Medicationsnused ntontreat nsymptoms nofnhyperthyroidismninclude nbetanblocke
rs,nantithyroid ndrugs,nand nradioactive niodine.
4. Levothyroxine ncan ninteractnwithna nnumbernofndrugs,nfoods,nandnsupplement
s.nSome nofnthese ninteractions ncan nincreasenthenrisknofnsideneffects,nwhile nothe
rs ncan ndecrease nthe neffectiveness nofnlevothyroxine.
about:blank 3/42
, 12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
• Diabetes
o How ntonconfirm nandiagnosisnprior ntonbeginni ng ntreatment
o A1C
▪ General n goals
▪ Older nAdultn goal
▪ Whennshouldninsulinn benconsidered?
▪ Atnwhatntimeninterval nshoul dnitnbenre-c heck ed?
o ActionnofnInsulin
o Pioglitazonen contraindications
o Benfamiliar nwithnabbr eviations nofndiabeticndrug ncl assi ficationsn( GLP-
1,nTZD,n DPP4-I,nSGLT 2i)
o Whichndrug nclassnshouldnbenc onsiderednfor ndi abetesnpri or ntonins ulin?
• Rationofnbasal ninsulinntonrapi d-ac ting nins ulinninntotal ndailyndosen(TDD) nofnins ulin
• Know nthencar bohy drate- to nins ulin nrationw hennc alcul ati ng nbas al ni nsulin
o Simplencalculationn(Noncalc ulatorsn arenall owednandnwill nnotnbenneeded)
• Mechanism n ofnAction
o GLP-1
o TZD
o DPP-4i
o Sulfonylureas
o SGLT2i
• Whichndiabeticnmedi cation(s) ncom enwithnanconc ernnofnhypoglycemia?
Diabetes;
• >The nA1Cntest nis nusednto nconfirmnandiagnosis nofndiabetes nprior
nto nbeginning ntreatment.
• >The ngeneralngoal nforntreatment nofndiabetes nis ntonmaintainnblood nsu
garnlevels nwithin nthe nnormal nrange.
• >Fornoldernadults,nthengoalnmaynbenslightlyndifferentnduentonthenincrea
sed nrisknofncomplications nfrom ndiabetes.
• >Insulin nshould nbenconsiderednwhennblood nsugarnlevelsnarennotnrespondi
ng nto nothernforms nofntreatment.
• >The nA1Cntest nshould nbe nre-
checkedneveryn3 nton6 nmonthsnto nmonitornfornchangesninnbloodnsugarnl
evels.
• >Insulin nis na nhormone nthat nhelps nto nregulate nblood nsugarnlevels.
• >Pioglitazonenisna nmedication nthatnis nusedntontreatndiabetes.nIt nis nnotn
recommendednfornusenin npregnantnwomennornwomen nwhonarenplanning
nto
become npregnant.
• >The nabbreviations nfornthe ndiabetic ndrug nclassifications nare nas nfollows:
• GLP-1 n=nglucagon-like npeptide-1
• TZDn=nthiazolidinedione
• DPP4-In=ndipeptidyl npeptidase-4 ninhibitor
• SGLT2i n=nsodium-glucose ncotransporter-2 ninhibitor
• >GLP-1 nand nDPP4-Inshould nbe nconsidered nforndiabetes npriornto ninsulin.
• >1:10
• 1 nunit nofnrapid-acting ninsulin nwill ncovern10 ngrams nofncarbohydrates.
about:blank 4/42
e
NR565nFinal nStudynGuide
Benfamiliar nwith ntheninteractivenactivitiesnthroughoutncoursenmodules.n Youncoul
d n seenvariationsnofnthosensamenquestionsnon nyour nexams.
Weekn5
• Thyroid
o Diagnosisn&nEvaluation
▪ Whatnlabsnarenusedntondiagnose?
▪ Timeframenfor nre-checknofnlabs nafter nstarti ng nlev othyr oxine
▪ Signsnandnsymptomsnofnhy pon andnhy perthyroidism
o Treatment
▪ Treatmentnofnthyroidnstorm
▪ Resultnofnnot ntreati ng nhy pothyr oidi sm nduri ng npregnancy
▪ Medicationntontreat nsym ptomsnof nhyperthyroi dism n(notic enthisnisntreating
symptomsnandnnotnthenhy perthyr oidism nitself)
▪ Drug/Food/Supplementn interactionsn withn lev othyroxine
• Diabetes
o How ntonconfirm nandiagnosisnprior ntonbeginni ng ntreatment
o A1C
▪ General n goals
▪ Older nAdultn goal
▪ Whennshouldninsulinn benconsidered?
▪ Atnwhatntimeninterval nshoul dnitnbenre-c heck ed?
o ActionnofnInsulin
o Pioglitazonen contraindications
o Benfamiliar nwithnabbr eviations nofndiabeticndrug ncl assi ficationsn( GLP-
1,nTZD,n DPP4-I,nSGLT 2i)
o Whichndrug nclassnshouldnbenc onsiderednfor ndi abetesnpri or ntonins ulin?
• Rationofnbasal ninsulinntonrapi d-ac ting nins ulinninntotal ndailyndosen(TDD) nofnins ulin
• Know nthencar bohy drate- to nins ulin nrationw hennc alcul ati ng nbas al ni nsulin
o Simplencalculationn(Noncalc ulatorsn arenall owednandnwill nnotnbenneeded)
• Mechanism n ofnAction
o GLP-1
o TZD
o DPP-4i
o Sulfonylureas
o SGLT2i
• Whichndiabeticnmedi cation(s) ncom enwithnanconc ernnofnhypoglycemia?
• Thyroid
o Diagnosisn&nEvaluation
▪ Whatnlabsnarenusedntondiagnose?
▪ Timeframenfor nre-checknofnlabs nafter nstarti ng nlev othyr oxine
▪ Signsnandnsymptomsnofnhy pon andnhy perthyroidism
about:blank 1/42
,12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
o Treatment
▪ Treatmentnofnthyroidnstorm
▪ Resultnofnnot ntreati ng nhy pothyr oidi sm nduri ng npregnancy
▪ Medicationntontreat nsym ptomsnof nhyperthyroi dism n(notic enthisnisntreating
symptomsnandnnotnthenhy perthyr oidism nitself)
▪ Drug/Food/Supplementn interactionsn withn lev othyroxine
• Diabetes
o How ntonconfirm nandiagnosisnprior ntonbeginni ng ntreatment
o A1C
▪ General n goals
▪ Older nAdultn goal
▪ Whennshouldninsulinn benconsidered?
▪ Atnwhatntimeninterval nshoul dnitnbenre-c heck ed?
o ActionnofnInsulin
o Pioglitazonen contraindications
o Benfamiliar nwithnabbr eviations nofndiabeticndrug ncl assi ficationsn( GLP-
1,nTZD,n DPP4-I,nSGLT 2i)
o Whichndrug nclassnshouldnbenc onsiderednfor ndi abetesnpri or ntonins ulin?
• Rationofnbasal ninsulinntonrapi d-ac ting nins ulinninntotal ndailyndosen(TDD) nofnins ulin
• Know nthencar bohy drate- to nins ulin nrationw hennc alcul ati ng nbas al ni nsulin
o Simplencalculationn(Noncalc ulatorsn arenall owednandnwill nnotnbenneeded)
• Mechanism n ofnAction
o GLP-1
o TZD
o DPP-4i
o Sulfonylureas
o SGLT2i
• Whichndiabeticnmedi cation(s) ncom enwithnanconc ernnofnhypoglycemia?
>The nmostncommon nlab ntestsnused nto ndiagnosenthyroid nconditionsnarent
hyroid-
stimulatingnhormonen(TSH)nandnfreenthyroxinen(FT4).nTSHnlevelsnarentypic
allynhigh ninnhypothyroidismnandnlowninnhyperthyroidism.nFT4 nlevelsnare nt
ypicallynlownin nhypothyroidism nand nhigh nin nhyperthyroidism.
• >Labs nshould nbe nrechecked n4-6 nweeks nafternstarting nlevothyroxine.
• >Signs nand nsymptoms nofnhypothyroidism ninclude nfatigue,nweight ngain,
constipation,ndrynskin,nand ncoldnintolerance.nSigns nandnsymptomsnofn
hyperthyroidismnincludenweightnloss,nanxiety,ntremors,npalpitations,nan
d nheat nintolerance.
• Treatment;
• >Treatmentnofnthyroid nstorm nincludes naggressivensupportive ncarenand nbe
ta nblockers.
• Ifn left nuntreated,nhypothyroidismnduring npregnancyncan nlead n
to nmiscarriage,npreterm ndelivery,nornlownbirth nweight.
• >Medicationsnused ntontreatnsymptomsnofnhyperthyroidismnincludenbe
ta nblockers nand nanti-thyroid nmedications.
about:blank 2/42
,12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
• >Levothyroxine ncanninteract nwithna nnumbernofndrugs,nfoods,nandnsuppl
ements,nsonit nisnimportantnto ndiscuss nall npotential ninteractions nwith na
healthcare nprovidernbefore nstarting nthis nmedication.
Thyroid:nThyroid ndisorders narentypicallyndiagnosed nbased non nclinicalnsigns nand
nsymptoms,nin ncombination nwith nlaboratoryntesting.
1. Thyroid ndisorders narentypicallyndiagnosed nbasednonnclinicalnsigns na
nd nsymptoms,nin ncombination nwith nlaboratoryntesting.
2. The nmost ncommon nlaboratoryntestsnused ntondiagnosenthyroid ndisorders ninclu
de nthe nfollowing:
-Thyroid-stimulating nhormone n(TSH)
-Free nthyroxine n(FT4)
-Free ntriiodothyronine n(FT3)
-Thyroid nperoxidase n(TPO)nantibodies
-Thyroglobulin nantibodies
3. The ntimeframe nfornre-
checkingnlabsnafternstarting nlevothyroxine nvariesndepending non nthenind
ividual's nresponse nto ntherapy.
4. The nsigns nand nsymptoms nofnhypothyroidism ninclude nfatigue,nweight ngain,
constipation,ncoldnintolerance,nand nmusclencramps.nThe nsigns nand nsymptoms no
fnhyperthyroidismnincludenweightnloss,nanxiety,nirritability,nheatnintolerance,na
nd npalpitations.
Treatment
1. Treatmentnofnthyroid nstormnincludes naggressive nsupportivencare nand ni
mmediate ntreatment nofnthenunderlying ncause.nTreatmentsnmaynincludenbet
a nblockers,nsteroids,nand ncooling nmeasures.
2. Ifnhypothyroidism nis nnot ntreated nduring npregnancy,nit ncan nlead nto npreterm
labor,npreeclampsia,nlownbirth nweight,nand ncongenital nanomalies.
3. Medicationsnused ntontreat nsymptoms nofnhyperthyroidismninclude nbetanblocke
rs,nantithyroid ndrugs,nand nradioactive niodine.
4. Levothyroxine ncan ninteractnwithna nnumbernofndrugs,nfoods,nandnsupplement
s.nSome nofnthese ninteractions ncan nincreasenthenrisknofnsideneffects,nwhile nothe
rs ncan ndecrease nthe neffectiveness nofnlevothyroxine.
about:blank 3/42
, 12/1/23,n6:55nAM 565nFinal nExamnStudy nGuid
e
NR565nFinal nStudynGuide
• Diabetes
o How ntonconfirm nandiagnosisnprior ntonbeginni ng ntreatment
o A1C
▪ General n goals
▪ Older nAdultn goal
▪ Whennshouldninsulinn benconsidered?
▪ Atnwhatntimeninterval nshoul dnitnbenre-c heck ed?
o ActionnofnInsulin
o Pioglitazonen contraindications
o Benfamiliar nwithnabbr eviations nofndiabeticndrug ncl assi ficationsn( GLP-
1,nTZD,n DPP4-I,nSGLT 2i)
o Whichndrug nclassnshouldnbenc onsiderednfor ndi abetesnpri or ntonins ulin?
• Rationofnbasal ninsulinntonrapi d-ac ting nins ulinninntotal ndailyndosen(TDD) nofnins ulin
• Know nthencar bohy drate- to nins ulin nrationw hennc alcul ati ng nbas al ni nsulin
o Simplencalculationn(Noncalc ulatorsn arenall owednandnwill nnotnbenneeded)
• Mechanism n ofnAction
o GLP-1
o TZD
o DPP-4i
o Sulfonylureas
o SGLT2i
• Whichndiabeticnmedi cation(s) ncom enwithnanconc ernnofnhypoglycemia?
Diabetes;
• >The nA1Cntest nis nusednto nconfirmnandiagnosis nofndiabetes nprior
nto nbeginning ntreatment.
• >The ngeneralngoal nforntreatment nofndiabetes nis ntonmaintainnblood nsu
garnlevels nwithin nthe nnormal nrange.
• >Fornoldernadults,nthengoalnmaynbenslightlyndifferentnduentonthenincrea
sed nrisknofncomplications nfrom ndiabetes.
• >Insulin nshould nbenconsiderednwhennblood nsugarnlevelsnarennotnrespondi
ng nto nothernforms nofntreatment.
• >The nA1Cntest nshould nbe nre-
checkedneveryn3 nton6 nmonthsnto nmonitornfornchangesninnbloodnsugarnl
evels.
• >Insulin nis na nhormone nthat nhelps nto nregulate nblood nsugarnlevels.
• >Pioglitazonenisna nmedication nthatnis nusedntontreatndiabetes.nIt nis nnotn
recommendednfornusenin npregnantnwomennornwomen nwhonarenplanning
nto
become npregnant.
• >The nabbreviations nfornthe ndiabetic ndrug nclassifications nare nas nfollows:
• GLP-1 n=nglucagon-like npeptide-1
• TZDn=nthiazolidinedione
• DPP4-In=ndipeptidyl npeptidase-4 ninhibitor
• SGLT2i n=nsodium-glucose ncotransporter-2 ninhibitor
• >GLP-1 nand nDPP4-Inshould nbe nconsidered nforndiabetes npriornto ninsulin.
• >1:10
• 1 nunit nofnrapid-acting ninsulin nwill ncovern10 ngrams nofncarbohydrates.
about:blank 4/42
