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NURO 504 - Exam 1 Latest Update
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NURO 504 - Exam 1Latest Update
1. What labs will you test before initiating antithyroid medication? - Answer Baseline
CBC and
LFTs
(Dunphy Chapter 57) this is to make sure that someone is healthy before starting
medication. Rare but serious side effects of antithyroid medications include
agranulocytosis and liver damage.
What diet would you recommend to a patient who has been diagnosed with
hyperthyroidism? - Answer Patients who have experienced significant weight loss would
benefit from
a high-carbohydrate, high calorie diet.
Once treatment is initiated and the patient is euthyroid, caloric needs decrease but the
patient may still have an increased appetite, a sensible diet low in fat and sugar with
adequate protein may avoid significant unwanted weight gain during this timeframe.
(Dunphy chapter 57)
What is the goal of thyroid hormone replacement therapy? What could happen with over
treatment? - Answer The goal is to normalize, not suppress TSH.
Treat with Levothyroxine (L4) to TSH target of 0.5-3.5 or 4 mIU/L.
Suppressed TSH, particularly in post-menopausal women or individuals with
levothyroxine over-replacement, causes decreased bone mineral density after several
years, leading to osteoporosis (Dunphy chapter 57)
What are the hallmark features of hypothyroidism? - Answer Fatigue, weight gain,
hoarseness, hyperlipidemia, constipation, bradycardia. (Brucker and King Pharm book
page 532)
What should you educate your patient about regarding Levothyroxine (LT4)
administration? - Answer Take this medication in the morning on an empty stomach, and
do not eat anything for 30-60 minutes after taking the medication as this can decrease
absorption of Levothyroxine.
Also important to consistently take the same brand or generic formulation, do not switch
,these (pharm book)
What is the diagnostic criteria for diabetes? - Answer a. HbA1C 6.5 or higher
b. Symptoms of diabetes (polyuria, polydipsia, weight loss) AND a random BG level of
200 mg/dl or higher
c. Fasting (at least 8hr since last meal) BG of 126 mg/dl or higher
d. 2 hour BG of 200 mg/dl or higher during oral glucose tolerance test with 75g glucose
load
e. Any ONE of the previous are diagnostic criteria type 1
f. Any TWO are criteria for type 2
(Dunphy Chapter 58)
How should you counsel a patient who has Type 1 DM and wishes to exercise more but
is scared about how it will influence their diabetes? - Answer a. People with DM1 can
perform all levels of exercise as long as glycemic control is achieved and there are no
other risks for complications
b. Guidelines:
i. Check BG before, q30-60 minutes during, and after exercise
ii. Avoid exercise if fasting glucose is >250 mg/dL and ketosis is present OR BG
>300mg/dL
iii. Consume additional carbs is BG <100mg/dL to avoid hypoglycemia
iv. Identify when changes in insulin dose or food intake are necessary.
c. This is also true for a Type 2 diabetic, incorporating exercise is an important part of
the treatment plan however education about their medications should be provided to
prevent the risk of hypoglycemia.
Additionally, before starting an exercise program the patient should be screened for
presence of macrovascular and microvascular complications that can be worsened with
exercise (CAD, PVD, retinopathy, nephropathy, and peripheral or autonomic
neuropathy)
(Chapter 58 Dunphy)
What are the risk factors for Diabetes Mellitus Type 2 - Answer a. Family history (first
degree relative)
b. BMI >25 (lower for Asian Americans)
c. Age >45
, d. Impaired fasting glucose or A1C >5.7
e. History of gestational diabetes
f. Hypertension (>140/90 mm Hg or on antihypertensive therapy)
g. Hyperlipidemia (high density lipoprotein <35 mg/dL, triglycerides >250 mg/dL
h. Women with PCOS
i. Race/ Ethnicity: African American, Latino, Native American, Asian American, Pacific
Islander
(Dunphy Chapter 58)
In addition to diagnostic testing, what are some additional routine tests that should be
completed at time of diagnosis of T2DM and yearly after? - Answer Fasting lipid profile,
serum creatinine, eGFR, liver function, spot urinary (UACR) and C-peptide.
(Dunphy chapter 58)
What is the first line treatment during pregnancy for a patient with a diagnosis of Type 2
Diabetes?
a. Insulin
b. Metformin
c. Sulfonylurea
d. Alpha-Glucosidase inhibitors - Answer a. Insulin
rationale: to reduce risk of fetal malformation and maternal and fetal
complications, pregnancy in pts with T2DM should be planned in advance. Insulin is
first-line treatment of diabetes in pregnancy. Tight glucose control and monitoring.
Maintain A1C <6% during pregnancy to prevent adverse fetal outcomes but this goal
increases chance of hypoglycemia.
What is the first line treatment in a non-pregnant patient that was recently diagnosed
with T2DM and has non other co-morbidities with a low risk of weight gain and
hypoglycemia?
a. Biguanides (Glucophage)
b. Second gen sulfonylurea (Glipizide)
c. Insulin
d. Meglitinides (Mitiglinide) - Answer a. Biguanides (Glucophage)
What oral anti-diabetic agent/s can be used in conjunction with insulin in a patient with
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