Pharmacology- Endocrine -thyroid Treatment
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Questions and Answers
- 1.
Hypothyroidism usually requires a lifelong hormone replacement, what is the drug of choice for this condition?
- A.
Radioactive iodine
- B.
Levothyroxine
- C.
Thioamides
- D.
Iodides
Correct Answer
B. LevothyroxineExplanation
Levothyroxine is the drug of choice for hypothyroidism because it is a synthetic form of the thyroid hormone thyroxine. It is used to replace the deficient levels of thyroid hormone in the body and helps to regulate metabolism and energy levels. Unlike radioactive iodine, which is used to treat hyperthyroidism, levothyroxine is used to treat the opposite condition of hypothyroidism. Thioamides and iodides are not typically used as the first-line treatment for hypothyroidism.Rate this question:
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- 2.
What is Myxedema?
- A.
Irreversible mental retardation and dwarfism caused by congenital hypothyroidism
- B.
Severe hypothyroidism
- C.
Enlargement of the thyroid gland
- D.
Autoimmune disorder that results in hyperthyroidism
Correct Answer
B. Severe hypothyroidismExplanation
Cretinism- Irreversible mental retardation and dwarfism caused by congenital hypothyroidism
Myxedema- Severe hypothyroidism
Goiter- Enlargement of the thyroid gland
Graves’ disease- Autoimmune disorder that results in hyperthyroidismRate this question:
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- 3.
You as the NP is having a follow-up visit with a patient that you started on Levothyroxine approximately 1 month ago and you review the patients labs, the labs reveal elevated TSH. What could the elevated TSH indicate, what should you do FIRST?
- A.
Assess for malabsoprtion, diarrhea
- B.
Decrease dosage
- C.
Assess for Angina
- D.
Increase dosage
Correct Answer(s)
A. Assess for malabsoprtion, diarrhea
C. Assess for AnginaExplanation
An elevated TSH can indicate that the patient's thyroid hormone levels are still low, suggesting that the dosage of Levothyroxine may need to be increased. However, before adjusting the dosage, it is important to assess for other potential causes of the elevated TSH, such as malabsorption or diarrhea, which could be affecting the absorption of the medication. Additionally, assessing for angina is important as it could be a symptom of underlying cardiovascular disease that may need to be addressed before adjusting the medication dosage.Rate this question:
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- 4.
You know your patient understood the teaching about his medication Levothyroxine when the patient states...
- A.
"It's okay to switch brands, there is no difference in absorption"
- B.
"I should avoid taking my Iron and calcium supplements at the same time as I take my Levothyroxine"
- C.
"After one year of taking my Levothyroxine, my thyroid will be back to normal"
- D.
" I should take my medication on an empty stomach in the morning or at bedtime"
Correct Answer(s)
B. "I should avoid taking my Iron and calcium supplements at the same time as I take my Levothyroxine"
D. " I should take my medication on an empty stomach in the morning or at bedtime"Explanation
The correct answer is "I should avoid taking my Iron and calcium supplements at the same time as I take my Levothyroxine" and "I should take my medication on an empty stomach in the morning or at bedtime". These statements demonstrate understanding of the teaching about Levothyroxine medication. Taking iron and calcium supplements at the same time as Levothyroxine can interfere with its absorption, so it is important to avoid doing so. Additionally, taking Levothyroxine on an empty stomach in the morning or at bedtime helps ensure proper absorption of the medication.Rate this question:
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- 5.
What is the recommendation for Thyroid function monitoring with any changes in preparations?
- A.
4- 6 weeks
- B.
6-8 weeks
- C.
2-3 weeks
- D.
8-10 weeks
Correct Answer
A. 4- 6 weeksExplanation
The recommendation for Thyroid function monitoring with any changes in preparations is every 4-6 weeks. This frequency allows for regular monitoring and adjustment of medication dosage if necessary, ensuring that the thyroid function remains within the desired range. Monitoring at this interval allows for timely identification and management of any changes in thyroid function, helping to maintain optimal thyroid health.Rate this question:
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- 6.
What are some causes of Hypothyroidism with Goiter?
- A.
Peripheral resistance to thyroid hormone
- B.
Drugs like Lithium & amiodarone
- C.
Iodine elevated
- D.
Toxic adenoma
- E.
Hashimoto thyroiditis
- F.
Hepatitis C
- G.
Autoimmune disorder
Correct Answer(s)
A. Peripheral resistance to thyroid hormone
B. Drugs like Lithium & amiodarone
E. Hashimoto thyroiditis
F. Hepatitis CExplanation
Hypothyroidism with goiter can be caused by peripheral resistance to thyroid hormone, which means that the body is not able to effectively use the thyroid hormone. Certain drugs like Lithium and amiodarone can also cause hypothyroidism. Hashimoto thyroiditis, an autoimmune disorder where the immune system attacks the thyroid gland, is another cause. Additionally, Hepatitis C can lead to hypothyroidism.Rate this question:
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- 7.
Select all that apply: As a NP, you know the the clinical signs of Hypothyroidism are
- A.
Bradycardia
- B.
Nervousness, irritability,
- C.
Palpably enlarged thyroid (goiter)
- D.
Skin pallor or yellowing (carotenemia)
- E.
Peripheral edema, puffy face and eyelids
- F.
Tremor, hyperreflexia
- G.
Dry, pale skin
Correct Answer(s)
A. Bradycardia
C. Palpably enlarged thyroid (goiter)
D. Skin pallor or yellowing (carotenemia)
E. Peripheral edema, puffy face and eyelids
G. Dry, pale skinExplanation
The clinical signs of Hypothyroidism include bradycardia, palpably enlarged thyroid (goiter), skin pallor or yellowing (carotenemia), peripheral edema, puffy face and eyelids, and dry, pale skin. These are all symptoms that can be observed in patients with Hypothyroidism.Rate this question:
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- 8.
What lab values would be consistent with the diagnosis of HYPOthyroidism?
- A.
T4- Low T3- Low TSH- High
- B.
T4- High T3- High TSH- Low
- C.
T4- Low T3- High TSH- Normal
Correct Answer
A. T4- Low T3- Low TSH- HighExplanation
The lab values consistent with the diagnosis of HYPOthyroidism would be low levels of T4 and T3, and high levels of TSH. This is because hypothyroidism is characterized by an underactive thyroid gland, which leads to a decrease in the production of thyroid hormones (T4 and T3). In response to the low levels of thyroid hormones, the pituitary gland releases more TSH to stimulate the thyroid gland to produce more hormones, resulting in high levels of TSH.Rate this question:
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- 9.
What are some causes of HYPERthyroidism?
- A.
Hashimoto thyroiditis
- B.
Toxic diffuse goiter (Graves disease)
- C.
Toxic adenoma
- D.
Peripheral resistance to thyroid hormone
- E.
Genetic thyroid enzyme defects
Correct Answer(s)
B. Toxic diffuse goiter (Graves disease)
C. Toxic adenomaExplanation
Some causes of HYPERthyroidism include toxic diffuse goiter (Graves disease) and toxic adenoma. Graves disease is an autoimmune disorder that leads to the overproduction of thyroid hormones, causing hyperthyroidism. Toxic adenoma refers to the presence of a single, overactive nodule in the thyroid gland, which also results in excessive production of thyroid hormones.Rate this question:
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- 10.
True or False: Hyperthyroidism is a hypermetabolic state resulting from excess thyroid hormone and affects 2% of women and 0.2% of men in their lifetimes.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Hyperthyroidism is a condition characterized by an overactive thyroid gland, which leads to an excess production of thyroid hormones. This condition causes a hypermetabolic state in the body, leading to symptoms such as weight loss, increased heart rate, and anxiety. It is more commonly seen in women, with a prevalence rate of 2% throughout their lifetimes, compared to a lower prevalence rate of 0.2% in men. Therefore, the statement provided in the answer is correct.Rate this question:
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- 11.
What are some clinical features in Thyrotoxicosis (hyperthyroidism)?
- A.
Nervousness, irritability
- B.
Cool dry skin
- C.
Tachycardia, arrhythmias
- D.
Heat intolerance, increased perspiration
- E.
Decreased appetite
- F.
Goiter
Correct Answer(s)
A. Nervousness, irritability
C. Tachycardia, arrhythmias
D. Heat intolerance, increased perspirationExplanation
Thyrotoxicosis, or hyperthyroidism, is a condition characterized by an overactive thyroid gland, leading to excessive production of thyroid hormones. The clinical features mentioned in the answer are commonly seen in individuals with hyperthyroidism. Nervousness and irritability are common symptoms due to increased stimulation of the nervous system. Tachycardia and arrhythmias occur as a result of increased heart rate and abnormal heart rhythm. Heat intolerance and increased perspiration are also common due to increased metabolic rate. These symptoms help in the diagnosis of hyperthyroidism.Rate this question:
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- 12.
What would the lab values look like in Hyperthyroidism?
- A.
Suppressed TSH and elevated T3 & T4
- B.
Elevated TSH and suppressed T3 & T4
Correct Answer
A. Suppressed TSH and elevated T3 & T4Explanation
In hyperthyroidism, the thyroid gland produces excessive amounts of thyroid hormones. This leads to a negative feedback mechanism, where the elevated levels of T3 and T4 suppress the production of thyroid-stimulating hormone (TSH) by the pituitary gland. Therefore, in hyperthyroidism, the lab values would show suppressed TSH levels and elevated T3 and T4 levels.Rate this question:
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- 13.
Select all: What medications are used in a patient with HYPERthyroidism?
- A.
Thioamides
- B.
Levothyroxine
- C.
Somostatin Analogs
- D.
Iodides
- E.
Propanolol
Correct Answer(s)
A. Thioamides
D. Iodides
E. PropanololExplanation
Thioamides, iodides, and propanolol are medications used in a patient with HYPERthyroidism. Thioamides, such as methimazole or propylthiouracil, work by inhibiting the production of thyroid hormones. Iodides, such as potassium iodide or sodium iodide, can temporarily reduce the release of thyroid hormones. Propanolol, a beta-blocker, helps manage symptoms such as rapid heart rate and tremors associated with hyperthyroidism. Levothyroxine, on the other hand, is used in HYPOthyroidism to supplement the low levels of thyroid hormones. Somostatin analogs are not typically used in the treatment of hyperthyroidism.Rate this question:
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- 14.
True or false: Methimazole is the first-line Rx in children, adolescents, and pregnancy with HYPERthyroidism.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Methimazole is indeed the first-line treatment for hyperthyroidism in children, adolescents, and pregnant women. Methimazole is preferred because it is effective at controlling hyperthyroidism and has a lower risk of liver toxicity compared to propylthiouracil (PTU). However, in the first trimester of pregnancy, PTU is sometimes preferred due to a lower risk of birth defects associated with methimazole. After the first trimester, methimazole is typically resumed for the remainder of the pregnancy.
Therefore, the statement is True.Rate this question:
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- 15.
What is the MOA of Thioamides (Methimazole and PTU)?
- A.
Inhibits iodine organification & hormone release
- B.
Inhibit cell-mediated immunologic functions
- C.
Inhibit thyroid peroxidase reactions, iodine organification, and peripheral conversion of T4 to T3 (prevent hormone synthesis)
Correct Answer
C. Inhibit thyroid peroxidase reactions, iodine organification, and peripheral conversion of T4 to T3 (prevent hormone synthesis)Explanation
Thioamides such as Methimazole and PTU inhibit thyroid peroxidase reactions, iodine organification, and peripheral conversion of T4 to T3. This prevents the synthesis of thyroid hormones.Rate this question:
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- 16.
Select all: What are some ADE's of Thioamides (Methimazole & PTU)?
- A.
GI symptoms, Nausea,
- B.
Rash
- C.
Agranulocytosis
- D.
Hypothyroidism
- E.
Edema
- F.
Hepatitis
Correct Answer(s)
A. GI symptoms, Nausea,
B. Rash
C. Agranulocytosis
D. Hypothyroidism
F. HepatitisExplanation
Thioamides, such as Methimazole and PTU, are medications used to treat hyperthyroidism. The possible adverse drug effects (ADEs) of these medications include gastrointestinal (GI) symptoms such as nausea, rash, agranulocytosis (a condition characterized by a low level of white blood cells), hypothyroidism (underactive thyroid), and hepatitis (inflammation of the liver). These ADEs can occur as a result of taking thioamides.Rate this question:
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- 17.
What medication class is used in hyperthyroidism as a supportive therapy?
- A.
Ace inhibitors
- B.
Beta blockers
- C.
Calcium channel blockers
- D.
Alpha Blockers
Correct Answer
B. Beta blockersExplanation
• β-blockers
• Provide symptom relief- helps to control adrenergic manifestations
• Propranolol inhibits peripheral conversion of T4 to T3
• Propranolol- drug of choice
• Can use others… Atenolol, metoprolol
• Caution with CHF, asthmaRate this question:
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- 18.
Your patient is in the first trimester of her pregnancy, what treatment is best for her to start for HYPERthyroidism?
- A.
Methimazole
- B.
Radioiodine
- C.
Propylthiouracil (PTU)
- D.
Subtotal thyroidectomy
Correct Answer
C. Propylthiouracil (PTU)Explanation
Hyperthyroidism
• Almost solely caused by Graves’ disease
• Preferred Rx - treatment with 131I prior to pregnancy
• PTU during 1st trimester, (MMI assoc w/ fetal abn)
• Subtotal thyroidectomy in 2nd trimester is an optionRate this question:
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- 19.
This Thioamide is the drug of choice during thyroid storm
- A.
Propylthiouracil (PTU)
- B.
Methimazole
- C.
Propanolol
- D.
Iodine
Correct Answer
A. Propylthiouracil (PTU)Explanation
Propylthiouracil (PTU) is the drug of choice during thyroid storm because it inhibits the production of thyroid hormones by blocking the enzyme responsible for the conversion of T4 to T3. It also inhibits the peripheral conversion of T4 to T3. This helps to reduce the levels of thyroid hormones in the body and control the symptoms of thyroid storm. Methimazole is another antithyroid medication, but PTU is preferred in thyroid storm due to its additional peripheral action. Propanolol is a beta-blocker that can be used to manage the cardiovascular symptoms of thyroid storm. Iodine is not the drug of choice for thyroid storm but may be used in combination with PTU or methimazole to inhibit the release of thyroid hormones.Rate this question:
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