NR565 Final Exam Study Guide
Week 5
Key Points
 The first-line medication for type 2 DM is metformin.
 ADA and other professional guidelines inform prescribing decisions.
 Combination injectable therapy should be considered for immediate implementation in patients
with an A1C of 10% or higher.
 TZDs, like Actos, can precipitate CHF and should be avoided in patients with heart failure.
 Older adults should be started on lower doses of levothyroxine.
 Radioactive iodine treatment results in lifelong hypothyroidism.
 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