NR565 FINAL TEST EXAM WITH CORRECT SOLUTIONS

NR565 FINAL TEST EXAM WITH CORRECT SOLUTIONS What labs are used to diagnose hypo/hyper thyroid? - CORRECT ANSWER-TSH, T3, and T4. High TSH = hypo and low TSH = hyper. Opposites. Timeframe for re-check of labs after starting levothyroxine - CORRECT ANSWER-6-8 weeks (long half-life). Yearly after stable. Signs and symptoms of hypothyroidism - CORRECT ANSWER-Dry hair, puffy face, goiter in the neck, slow heartbeat, weight gain, constipation, infertility, increased risk of miscarriages, irregular menstrual cycle, cold intolerance. Drug of choice for hypothyroidism - CORRECT ANSWER-Levothyroxine (Synthroid) § Signs and symptoms of hyperthyroidism - CORRECT ANSWER-Hair loss, bulging eyes, goiter, rapid heartbeat, weight loss, diarrhea, menstrual periods loss often or longer. Drug of choice for hyperthyroidism - CORRECT ANSWER-Methimazole (Tapazole) Treatment of thyroid storm - CORRECT ANSWER-high doses of potassium iodide or strong iodine solution are given to suppress thyroid hormone release. Methimazole is given to suppress thyroid hormone synthesis. Beta blocker given to reduce HR. additional measures include sedation, cooling, and giving glucocorticoids and IV fluids. Result of not treating hypothyroidism during pregnancy: - CORRECT ANSWERPermanent neuro-psychological deficits in the child. Decrease IQ/neuropsychological function. First trimester. Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself): - CORRECT ANSWER-Beta blockers (tachycardia) - propranolol/atenolol most popular.Non-radioactive iodine. ADJUNCTIVE THERAPY. Drug/Food/Supplement interactions with levothyroxine: - CORRECT ANSWER-Do not take antacids, Calcium or Iron, how to take it (morning 30-60 min b4 eat. How to confirm a diagnosis of DM prior to beginning treatment: - CORRECT ANSWERFasting plasma glucose above 126. A random plasma glucose of over 200 plus symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose of over 200, or a A1C higher than 6.5. A1c general goals - CORRECT ANSWER-7, patients that experience severe hypoglycemia/have a limited life expectancy may have an A1C goal of 8. A1c older adults - CORRECT ANSWER-8, those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals such as 8.0-8.5. When should insulin be considered? - CORRECT ANSWER-For treatment of persistent hyperglycemia starting at a threshold of 180. Early introduction of insulin should be considered if there is evidence of ongoing weight loss, if symptoms of hyperglycemia are present, or whenA1C levels 10% or BGS 300 At what time interval should A1c be re-checked? How often should an A1C be monitored when stable or when unstable? - CORRECT ANSWER-Every 2-3 months and max of 4 times a year. If 7, every 6 months. At least two times a year if meeting goals and quarterly if meds have changed or not meeting goals. Action of Insulin - CORRECT ANSWER-Anabolic, energy conservation, promotes cellular growth and division. Pioglitazone contraindications: - CORRECT ANSWER-Heart failure (severe = no, mild = caution) and bladder cancer. Causes fluid retention. GLP-1 (abbreviation and examples) - CORRECT ANSWER-Glucagonlike Peptide - Subcutaneous injections - Dulaglutide (Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza). SGLT2i (abbreviation and examples) - CORRECT ANSWER-Sodium Glucose Cotransporter 2 Inhibitors - Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance). DPP4-I (abbreviation and examples) - CORRECT ANSWER-Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin, Saxagliptin, Linagliptin, Alogliptin. TZD (abbreviation and examples) - CORRECT ANSWER-Thiazolidinediones - Rosiglitazone & Pioglitazone Which drug class should be considered for diabetes prior to insulin? - CORRECT ANSWER-It is recommended that a GLP-1 be considered before starting insulin. Metformin first always unless contraindicated. Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin - CORRECT ANSWER-Basal and bolus insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD) Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the basal insulin dose and the other 24 units is rapid-acting. How is total daily dose (TDD) of insulin calculated - CORRECT ANSWER-TDD is calculated by taking the total weight in kg and multiply by 0.6 units. Know the carbohydrate-to insulin ratio when calculating basal insulin - CORRECT ANSWER-Mealtime dose is calculated using the 450 rule for regular insulin and 500 rule for rapid acting insulin then divide by TDD. The answer (rounded) = the ratio of 1:the # answer. That means that if the meal is 60g of carbs, 60 divided by the # in answer = # of units of rapid-acting insulin. GLP-1 MOA - CORRECT ANSWER-slows gastric emptying, stimulates glucose dependent insulin release, and suppresses glucagon release and reduces appetite DPP-4i MOA - CORRECT ANSWER-Enhance the activity of incretins and thereby increase insulin release, reduce glucagon TZD MOA - CORRECT ANSWER-Decreases insulin resistance and increase glucose uptake by muscle and adipose tissue Sulfonylureas MOA - CORRECT ANSWER-promote insulin secretion by the pancreas. HYPOGLYCEMIA SGLT2i MOA - CORRECT ANSWER-Kidney tubules. Which diabetic medication(s) come with a concern of hypoglycemia? - CORRECT ANSWER-Insulin, meglitinides, sulfonylureas, amylin analogues Acute symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 200 mg/dL. *Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes are polyuria, polydipsia, and unexplained weight loss. · Diabetes mellitus · Pre-diabetes - CORRECT ANSWER-· Diabetes mellitus Fasting plasma glucose greater than or equal to 126 mg/dL. *Fasting is defined as no caloric intake for at least 8 hours. · Pre-diabetes · Diabetes mellitus - CORRECT ANSWER-· Diabetes mellitus 2 hour post-load plasma glucose in an oral glucose tolerance test greater than or equal to 200 mg/dL. The test uses a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.