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Questions and Answers
What is the anticipated initial dose of levothyroxine for an adult?
What is the anticipated initial dose of levothyroxine for an adult?
Which medication can induce thyroid dysfunction?
Which medication can induce thyroid dysfunction?
What is a symptom of hypothyroidism?
What is a symptom of hypothyroidism?
What condition may occur postpartum and is characterized by a severe increase in thyroid hormone levels?
What condition may occur postpartum and is characterized by a severe increase in thyroid hormone levels?
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What is the recommended testing interval post-adjustment for levothyroxine dosage changes?
What is the recommended testing interval post-adjustment for levothyroxine dosage changes?
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Which of the following can reduce levothyroxine absorption?
Which of the following can reduce levothyroxine absorption?
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Why is T3 supplementation usually unnecessary in most patients taking levothyroxine?
Why is T3 supplementation usually unnecessary in most patients taking levothyroxine?
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What dosage adjustment is generally recommended for elderly patients starting levothyroxine?
What dosage adjustment is generally recommended for elderly patients starting levothyroxine?
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What is the recommended first-line treatment for hypothyroidism during pregnancy?
What is the recommended first-line treatment for hypothyroidism during pregnancy?
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What should be monitored regularly in pregnant women taking thyroid hormone replacement therapy?
What should be monitored regularly in pregnant women taking thyroid hormone replacement therapy?
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What common complication can arise if hypothyroidism is left untreated during pregnancy?
What common complication can arise if hypothyroidism is left untreated during pregnancy?
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Which of the following statements regarding propylthiouracil (PTU) is accurate?
Which of the following statements regarding propylthiouracil (PTU) is accurate?
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Which symptom is commonly associated with untreated hyperthyroidism during pregnancy?
Which symptom is commonly associated with untreated hyperthyroidism during pregnancy?
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What is the relationship between testosterone deficiency and age in the male population?
What is the relationship between testosterone deficiency and age in the male population?
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What is a potential fetal effect of hypothyroidism during early pregnancy?
What is a potential fetal effect of hypothyroidism during early pregnancy?
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What distinguishes primary testosterone deficiency from secondary deficiency?
What distinguishes primary testosterone deficiency from secondary deficiency?
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What might be necessary when starting levothyroxine therapy in a patient taking warfarin?
What might be necessary when starting levothyroxine therapy in a patient taking warfarin?
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Which symptom is NOT associated with thyroid hormone over-replacement?
Which symptom is NOT associated with thyroid hormone over-replacement?
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What is a significant concern when using triiodothyronine (T3) as a replacement therapy?
What is a significant concern when using triiodothyronine (T3) as a replacement therapy?
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During which trimester is the fetus solely dependent on maternal thyroid hormones?
During which trimester is the fetus solely dependent on maternal thyroid hormones?
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Why might patients on levothyroxine experience increased insulin requirements?
Why might patients on levothyroxine experience increased insulin requirements?
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Which factor can lead to elevated thyroid hormone levels during pregnancy?
Which factor can lead to elevated thyroid hormone levels during pregnancy?
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What is the primary reason for only prescribing T4 in most cases of hypothyroidism?
What is the primary reason for only prescribing T4 in most cases of hypothyroidism?
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What is the risk associated with using thyroid hormones for weight loss?
What is the risk associated with using thyroid hormones for weight loss?
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Study Notes
Diabetic Medications
- Two main types: Type 1 and Type 2
- Type 1: Autoimmune destruction of insulin-producing beta cells; requires lifelong insulin therapy.
- Type 1 symptoms: Involuntary weight loss, polyuria, polydipsia, polyphagia, diabetic ketoacidosis (dehydration, abdominal pain, vomiting, decreased consciousness).
- Type 2: Genetic predisposition plus environmental factors (genetics loads the gun, environment pulls the trigger); insulin resistance and eventual beta cell impairment.
- Type 2 treatment: Healthy diet, regular exercise, and stress management; eventually insulin therapy might be necessary.
Insulin
- Protein, must be injected/infused.
- Subcutaneous (SC) injection or intravenous infusion, rotation and consistency of sites is important.
- Abdomen is most common injection site; other options include back of arms, thighs, and buttocks.
- Several types, classified by duration of action:
- Rapid-acting (lispro, aspart): Immediate treatment of blood glucose, often in insulin pumps.
- Short-acting (Regular): Short-acting insulin
- Intermediate-acting(NPH): Intermediate-acting insulin
- Long-acting (basal) (glargine, detemir): Coverage for 24 hours; not to be mixed with other insulins in the same syringe.
- Premixed combinations: Mixtures of different types of insulin (e.g., Novolog Mix 70/30).
- Insulin Pumps: Continuous delivery of insulin, useful for type 1 diabetes.
- Insulin inhaler: Powdered form inhaled into lungs; risk of acute bronchospasm in asthma/COPD patients.
Type 2 Diabetes Medications
- Sulfonylureas: Stimulate insulin secretion, enhance tissue sensitivity, require some insulin production. Longer-acting versions can result in risks of hypoglycemia.
- Biguanides (e.g., metformin): Preferred initial treatment; inhibits liver glucose production, reduces gut glucose absorption, improves insulin receptor sensitivity; does not cause weight gain or hypoglycemia; important to check for potential lactic acidosis reactions.
- Meglitinides: Stimulate insulin release, often used with erratic meal schedules.
- Alpha-glucosidase inhibitors: Delay carbohydrate digestion.
- Thiazolidinediones: Increase insulin sensitivity in skeletal muscle.
- Gliptins (DPP-4 inhibitors): Increase insulin release, reduce glucagon levels, and decrease hepatic glucose production.
- SGLT2 inhibitors: Prevent kidneys from re-absorbing glucose and increase urinary glucose excretion (newest class). Reduces risk of major cardiovascular events and protect kidneys. Risk of lower limb amputations and diabetic ketoacidosis.
- GLP-1 receptor agonists (incretin mimetics): Mimic incretin hormones, slow gastric emptying, and decrease food intake; often used for weight management as well as diabetes.
Thyroid Disorders
- Hyperthyroidism: Overactive thyroid gland, can be Grave's Disease (caused by autoimmune antibodies) or Toxic Nodular Goiter(hyperfunctioning nodule). Symptoms: Tremors, tachycardia, tachypnea, heat intolerance, exophthalmos, and pretibial edema.
- Hypothyroidism: Underactive thyroid gland, most common cause is Hashimoto's thyroiditis (autoimmune). Symptoms: Lethargy, fatigue, weight gain, cold sensitivity, constipation, hyperlipidemia, and bradycardia.
Benign Prostatic Hyperplasia (BPH)
- Alpha-blockers: Relax bladder and prostate muscles for easier urination.
- 5-alpha-reductase inhibitors: Shrink prostate, increase urine flow.
- Lifestyle modifications, surgery are additional treatments.
Osteoporosis
- Disease characterized by low bone density and increased risk of fractures.
- Bisphosphonates: Inhibit osteoclast activity, preventing bone loss.
- Parathyroid Hormone Analogs (teriparatide): Stimulate bone formation.
- Selective Estrogen Receptor Modulators (SERMs): Reduce bone resorption, potentially lower breast cancer risk.
- Hormone Replacement Therapy (HRT): May reduce fracture risk, but with increased cardiovascular risks and other side effects.
- Lifestyle modifications are often foundational treatments.
Rheumatoid Arthritis
- Chronic, autoimmune disease, causing inflammation in joints and potentially other parts of the body.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Symptom relief, many side effects
- Glucocorticoids (corticosteroids): Powerful anti-inflammatory, but many potential long-term adverse effects.
- Disease-modifying antirheumatic drugs (DMARDs): Suppress immune response, some examples: methotrexate, infliximab, leflunomide, and hydroxychloroquine.
Obesity
- Chronic condition of excess body fat, measured by BMI.
- Diet, exercise, and behavioral modification are fundamental treatments.
- Medications (e.g., naltrexone/bupropion, lorcaserin, phentermine/topiramate) can augment lifestyle changes.
- Bariatric surgery may be an option for severe cases.
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Description
This quiz covers the essential aspects of diabetic medications, focusing on Type 1 and Type 2 diabetes. It discusses the importance of insulin therapy, including the methods of administration and the various types of insulin available. Test your knowledge on symptoms, treatments, and management strategies for diabetes.
