NR565 Final Exam Study Guide Week 5

NR565 Final Exam Study Guide
Week 5
Key Points
ï‚· The first-line medication for type 2 DM is metformin.
ï‚· ADA and other professional guidelines inform prescribing decisions.
ï‚· Combination injectable therapy should be considered for immediate implementation in patients
with an A1C of 10% or higher.
ï‚· TZDs, like Actos, can precipitate CHF and should be avoided in patients with heart failure.
ï‚· Older adults should be started on lower doses of levothyroxine.
ï‚· Radioactive iodine treatment results in lifelong hypothyroidism.
ï‚· When treating hypothyroidism, TSH levels should be monitored every 6-8 weeks until the patient
achieves a euthyroid state.
- Signs and symptoms of hypothyroidism and hyperthyroidism (pp. 418-419)
Hypothyroidism: The face is pale, puffy, & expressionless. The skin is cold & dry. The hair is brittle, & hair
loss occurs. Heart rate & temperature are lowered. The patient may c/o lethargy, fatigue, & cold
intolerance. Mentation may be impaired. Thyroid enlargement may occur if reduced levels of T3 & T4
promote excessive release of TSH.
Hyperthyroidism: Heartbeat is rapid & strong, & dysrhythmias & angina may develop. The CNS is
stimulated, resulting in nervousness, insomnia, rapid thought flow, & rapid speech. Skeletal muscles may
weaken & atrophy. Metabolic rate is raised, resulting in increased heat production, increased body
temperature, intolerance to heat, & skin that is warm & moist. Increased appetite, but weight loss may
occur if caloric intake fails to match the increase in metabolic rate. (Exophthalmos w/Graves’ disease).
- What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than
thyroid specific medications? Know drug classes and examples of those drug classes. (pp. 419, 423)
Beta-blockers & nonradioactive iodine may be used as adjunctive therapy for hyperthyroidism.
Beta-blockers: Suppress tachycardia by blocking beta-receptors on the heart. (“-lol”)
Nonradioactive iodine: Inhibits synthesis & release of thyroid hormones. (Lugol Solution = mixture
containing 5% elemental iodine & 10% potassium iodine).
- Monitoring needs and intervals for thyroid medications. (pp. 421, 423)
Hypothyroidism: Levothyroxine (T4) (Brand-name: Levoxyl, Synthroid)
Therapeutic Goal: Resolution of signs & symptoms of hypothyroidism & restoration of normal lab values for
serum TSH & free T4.
Baseline Data: Obtain serum levels of TSH & free T