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32 Cards in this Set
- Front
- Back
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Cheri believes she may be pregnant. She goes to see her doctor who orders various tests, including TSH and FT4. Cheri is found to have a high TSH, low FT4 and is hCG+. She is prescribed a prenatal vitamin and levothyroxine. Choose the correct statements concerning the levothyroxine pregnancy category. Answer ALevothyroxine is pregnancy category A BLevothyroxine is pregnancy category B CLevothyroxine is pregnancy category C DLevothyroxine is pregnancy category D ELevothyroxine is pregnancy category X |
ALevothyroxine is pregnancy category A |
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Which of the following statements concerning thyroid function are correct? (Select ALL that apply.) Answer AIn a normally functioning system, thyroid-stimulating hormone (TSH) stimulates the secretion of thyroxine (T4) and, minimally, triiodothyronine (T3). BTotal daily T3 production results from the peripheral conversion of T4 to T3 (roughly 80%). CT3 is 3-4 times as potent as T4. DT4 is 3-4 times as potent as T3. EElevations in T4 inhibit the secretion of TSH, and a negative feedback loop is created. |
AIn a normally functioning system, thyroid-stimulating hormone (TSH) stimulates the secretion of thyroxine (T4) and, minimally, triiodothyronine (T3). BTotal daily T3 production results from the peripheral conversion of T4 to T3 (roughly 80%). CT3 is 3-4 times as potent as T4.
EElevations in T4 inhibit the secretion of TSH, and a negative feedback loop is created. |
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Which of the following statements concerning treatment of hyperthyroidism during pregnancy is correct? Answer AMethimazole is used in the first trimester of pregnancy. BPTU is used in the 2nd and 3rd trimesters. CHyperthyroidism should not be treated during pregnancy. DThe treatment of choice for hyperthyroidism in pregnancy is radioactive iodine. EWomen can commonly get hyperthyroidism during the reproductive years; most cases are in females in their 30's and 40's. |
EWomen can commonly get hyperthyroidism during the reproductive years; most cases are in females in their 30's and 40's. |
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A patient gave the pharmacist a prescription for Cytomel 25 micrograms once daily #30. Which of the following is an appropriate generic substitution for Cytomel? Answer AMethimazole BLevothyroxine CLiothyronine DThyroid USP EPropylthiouracil
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CLiothyronine |
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Chief Complaint: "I have a fever and I can't sleep"
History of Present Illness: JS is a 35 y/o male being treated for a severe MRSA skin infection. He presents to the clinic complaining of fever, nausea, increased insomnia, and "feeling like I'm going crazy". He appears very agitated and presents with hand tremor and moist skin. He recently picked up a second job, working 60 hours a week, and attributes his worsening insomnia to stress.
Past Medical History: Insomnia (x 3 years), atrial fibrillation, MRSA skin infection diagnosed 10 days ago
Medications: Melatonin 5 mg QHS, warfarin 5mg daily, Zyvox 600 mg PO BID, MVI daily
Pertinent Social History: Alcohol 2-3x/week to help him sleep
Vitals: Height: 5'10" Weight: 141 lbs BP: 140/96 mmHg HR: 105 BPM RR: 22 BPM Temp: 104ºF Pain: 2/10
Labs: Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.2 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 110 (100 - 125) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.3 (2.3 - 4.7) Ca (mg/dL) = 9.5 (8.5 - 10.5) TSH (mIU/L) = 0.1 (0.3-3.0) INR = 2.9 (2-3)
Question: What is JS experiencing? Answer ANew onset hypothyroidism BThyroid storm CPanic attack DMyxedema coma EHypertensive crisis |
BThyroid storm |
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Which of the following statements is correct regarding levothyroxine tablet colors? Answer AThe 25 mcg tablet is orange and the 50 mcg tablet is yellow BThe 100 mcg tablet is rose and the 88 mcg tablet is orange CThe 50 mcg tablet is white and the 75 mcg tablet is violet DThe 25 mcg tablet is green and the 100 mcg tablet is violet EThe 50 mcg tablet is blue and the 100 mcg tablet is white |
CThe 50 mcg tablet is white and the 75 mcg tablet is violet |
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What is the most common cause of hypothyroidism? Answer ALithium BAmiodarone CHashimoto's disease DGraves' disease ERadiation therapy |
CHashimoto's disease |
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Which of the following drugs can cause hyperthyroidism? (Select ALL that apply.) Answer AAmiodarone BPrednisone CIodide DLithium EThyroid hormone taken in excess |
AAmiodarone
CIodide
EThyroid hormone taken in excess |
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Select the correct pathway that describes thyroid function: Answer AThyroid-stimulating hormone (TSH) stimulates the secretion of thyroxine (T4). BThyroid-stimulating hormone (TSH) accounts for the majority of triiodothyronine (T3) production. CT3 is converted to T4. DThyroid-stimulating hormone (TSH) is stimulated by elevations of T4. EIn patients with hypothyroidism, T4 cannot be converted into T3. |
AThyroid-stimulating hormone (TSH) stimulates the secretion of thyroxine (T4). |
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Connie uses warfarin for atrial fibrillation. Connie has just left the hospital with several new medications: levothyroxine, diltiazem and amiodarone. Select the correct statement/s: (Select ALL that apply.) Answer AThe levothyroxine can make the INR become supratherapeutic. BThe diltiazem can make the levothyroxine subtherapeutic. CThe patient will be at increased risk for forming a deep vein thrombosis. DThe amiodarone can make the INR become supratherapeutic. EThe diltiazem can make the warfarin subtherapeutic. |
AThe levothyroxine can make the INR become supratherapeutic.
DThe amiodarone can make the INR become supratherapeutic. |
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Which of the following statements concerning treatment of hyperthyroidism are correct? (Select ALL that apply.) Answer ARadioactive iodine (RAI-131) is the treatment of choice in Grave's disease. BBeta blockers are often used initially to control symptoms such as palpitations and racing heart beat. CMethimazole is preferred in thyroid storm. DInitially, higher doses of drugs are used to control symptoms; afterwards the dose of the drugs is typically decreased to prevent over-treatment, and consequently, hypothyroidism. EBoth propylthiouracil and methimazole cause GI upset, including nausea, and can damage the liver. |
ARadioactive iodine (RAI-131) is the treatment of choice in Grave's disease. BBeta blockers are often used initially to control symptoms such as palpitations and racing heart beat.
DInitially, higher doses of drugs are used to control symptoms; afterwards the dose of the drugs is typically decreased to prevent over-treatment, and consequently, hypothyroidism. EBoth propylthiouracil and methimazole cause GI upset, including nausea, and can damage the liver. |
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A patient is admitted and was taking levothyroxine 100 mcg daily at home. She is NPO and provider would like the levothyroxine continued IV. What is the most appropriate dose for the pharmacist to dispense? Answer A112 mcg B50 mcg C200 mcg D100 mg E75 mcg |
E75 mcg |
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A patient with heartburn has been using OTC anti-gas and antacid products for many years. She has recently been diagnosed with hypothyroidism. Which of the following OTC medications will not interact with her thyroid medicine? Answer AMagnesium hydroxide BCalcium carbonate CAluminum hydroxide DFamotidine EPepcid Complete |
DFamotidine |
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A patient gave the pharmacist a prescription for Tapazole 5 mg TID #90. Which of the following is an appropriate generic substitution for Tapazole? Answer AMethimazole BLevothyroxine CLiothyronine DThyroid USP EPropylthiouracil
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AMethimazole |
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What is the most common cause of hyperthyroidism? Answer ALithium BAmiodarone CHashimoto's disease DGraves' disease ERadiation therapy
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DGraves' disease |
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The thyroid gland is the only organ which has the ability to absorb: Answer ATriiodothyronine (T3) BThyroxine (T4) CIodine DTSH ELevothyroxine |
CIodine |
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Chief Complaint: "I have a fever and I can't sleep"
History of Present Illness: JS is a 35 y/o male being treated for a severe MRSA skin infection. He presents to the clinic complaining of fever, nausea, increased insomnia, and "feeling like I'm going crazy". He appears very agitated and presents with hand tremor and moist skin. He recently picked up a second job, working 60 hours a week, and attributes his worsening insomnia to stress.
Past Medical History: Insomnia (x 3 years), atrial fibrillation, MRSA skin infection diagnosed 10 days ago
Medications: Melatonin 5 mg QHS, warfarin 5mg daily, Zyvox 600 mg PO BID, MVI daily
Pertinent Social History: Alcohol 2-3x/week to help him sleep
Vitals: Height: 5'10" Weight: 141 lbs BP: 140/96 mmHg HR: 105 BPM RR: 22 BPM Temp: 104ºF Pain: 2/10
Labs: Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.2 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 110 (100 - 125) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.3 (2.3 - 4.7) Ca (mg/dL) = 9.5 (8.5 - 10.5) TSH (mIU/L) = 0.1 (0.3-3.0) INR = 2.9 (2-3)
Question: JS is sent to the hospital for treatment. An order for propylthiouracil (PTU) is written. Which of the following is correct regarding drug interactions with PTU and JS's current medications? Answer APTU may increase the anticoagulant effect of warfarin. BPTU may decrease the anticoagulant effect of warfarin. CPTU is contraindicated with Zyvox. DPTU should be separated from melatonin. EThere are no drug interactions present in the regimen. |
BPTU may decrease the anticoagulant effect of warfarin. |
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Alison has been prescribed propylthiouracil, which should be reserved for patients who cannot use other options due to the risk of this adverse reaction: Answer AFatal skin rash BLiver damage CTrouble breathing/laryngoedema DRenal failure ECardiotoxicity |
BLiver damage |
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Jane is a 78 year-old female with heart failure and history of MI. She has just been diagnosed with hypothyroidism. Jane is five feet tall and weighs 103 pounds. She is going to begin levothyroxine therapy. What is an appropriate starting dose in this patient? Answer A12.5-25 mcg/day B25-50 mcg/day C50-75 mcg/day D75-100 mcg/day E100-150 mcg/day
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A12.5-25 mcg/day |
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Select the correct statements concerning levothyroxine: (Select ALL that apply.) Answer AIt contains T3. BIt is the preferred agent for treating hypothyroidism. CIt is derived from dessicated porcine gland. DIt contains T4 EIt will lower the TSH |
BIt is the preferred agent for treating hypothyroidism.
DIt contains T4 EIt will lower the TSH |
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A patient gave the pharmacist a prescription for Armour Thyroid 60 mg once daily #30. Which of the following is a correct statement/s concerning Armour Thyroid? (Select ALL that apply.) Answer AIt contains both T3 and T4. BIt is not the preferred agent for treating hypothyroidism. CIt is not synthetic; it is derived from pork thyroid gland. DSome patients prefer it. EIt will raise the TSH. |
AIt contains both T3 and T4. BIt is not the preferred agent for treating hypothyroidism. CIt is not synthetic; it is derived from pork thyroid gland. DSome patients prefer it. |
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A 40 year-old, female patient has been prescribed levothyroxine 50 mcg once daily. Choose the correct counseling statement: Answer ATake this medicine with breakfast. BTake this medicine with lunch. CTake this medicine an hour before breakfast, on an empty stomach. DTake this medicine with dinner. ETake this medicine at bedtime, with a light snack. |
CTake this medicine an hour before breakfast, on an empty stomach.
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Alison has been prescribed propylthiouracil. What common side effect might she experience? Answer ABradycardia BGI upset CHypotension DDiarrhea EHyperglycemia
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BGI upset |
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Jessie, a 43 year-old patient, has been diagnosed with hypothyroidism. Which of the following are signs/symptoms of hypothyroidism that Jessie may have experienced? (Select ALL that apply.) Answer AAn increase in weight BLow TSH CDiarrhea and oily skin DDepression EFeeling more tired than usual |
AAn increase in weight
DDepression EFeeling more tired than usual |
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Chief Complaint: "I have no energy"
History of Present Illness: KB is a 32 y/o female who comes into the outpatient clinic complaining of low energy, recent weight gain of 15 pounds, foggy memory, and feeling cold even though it is sunny outside. She is diagnosed with hypothyroidism and started on levothyroxine.
Past Medical History: Allergic rhinitis, GERD, Hypothyroidism
Current Medications: Cetirizine 10 mg PRN, Mylanta 20 mL Q6H, Tylenol 325 mg Q4-6H PRN, Omega-3 fatty acid 1 gram daily, MVI daily
Vitals: Height: 5'7" Weight: 138 lbs BP: 129/80 mmHg HR: 85 BPM RR: 20 BPM Temp: 98.6ºF Pain: 1/10
3/10/14 Labs: Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.2 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 110 (100 - 125) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.4 (2.3 - 4.7) Ca (mg/dL) = 9.5 (8.5 - 10.5) TSH (mIU/L) = 32 (0.3-3.0) Free T4 (mg/dL) = 0.3 (0.9-2.3) hCG-
Plan: Hypothyroidism. Start levothyroxine 75 mcg daily. Follow-up visit on 4/14/14.
4/14/14 Labs: Na (mEq/L) = 143 (135 - 145) K (mEq/L) = 4.1 (3.5 - 5) Cl (mEq/L) = 102 (95 - 103) HCO3 (mEq/L) = 26 (24 - 30) BUN (mg/dL) = 15 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 15 (100 - 125) Mg (mEq/L) = 1.8 (1.3 - 2.1) PO4 (mg/dL) = 4.1 (2.3 - 4.7) Ca (mg/dL) = 9.7 (8.5 - 10.5) TSH (mIU/L) = 4.7 (0.3-3.0) hCG+
Question: On KB's 4/14/14 visit, what changes should be made to her drug regimen? Answer AThe levothyroxine dose should be increased BThe levothyroxine dose should be decreased CThe levothyroxine should be changed to Thyrolar DThyroid replacement therapy should be discontinued ENo changes should be made |
AThe levothyroxine dose should be increased |
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A patient has been prescribed Synthroid. She wishes to use a generic. Choose the correct statement/s concerning generic options for levothyroxine brand formulations: (Select ALL that apply.) Answer AThe correct source to check for therapeutic (AB-rated) equivalents is the red book. BAll generics of levothyroxine are AB related to each of the available brand formulations. CIf a patient changes manufacturers, it is prudent to monitor for symptoms of hypo or hyperthyroidism as the dosage may vary slightly. DPatients should be told to use brand name only. ELevothyroxine has a narrow therapeutic index. |
CIf a patient changes manufacturers, it is prudent to monitor for symptoms of hypo or hyperthyroidism as the dosage may vary slightly.
ELevothyroxine has a narrow therapeutic index. |
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Chief Complaint: "I have no energy"
History of Present Illness: KB is a 32 y/o female who comes into the outpatient clinic complaining of low energy, recent weight gain of 15 pounds, foggy memory, and feeling cold even though it is sunny outside. She is diagnosed with hypothyroidism and started on levothyroxine.
Past Medical History: Allergic rhinitis, GERD, Hypothyroidism
Current Medications: Cetirizine 10 mg PRN, Mylanta 20 mL Q6H, Tylenol 325 mg Q4-6H PRN, Omega-3 fatty acid 1 gram daily, MVI daily
Vitals: Height: 5'7" Weight: 138 lbs BP: 129/80 mmHg HR: 85 BPM RR: 20 BPM Temp: 98.6ºF Pain: 1/10
3/10/14 Labs: Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.2 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 110 (100 - 125) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.4 (2.3 - 4.7) Ca (mg/dL) = 9.5 (8.5 - 10.5) TSH (mIU/L) = 32 (0.3-3.0) Free T4 (mg/dL) = 0.3 (0.9-2.3) hCG-
Plan: Hypothyroidism. Start levothyroxine 75 mcg daily. Follow-up visit on 4/14/14.
4/14/14 Labs: Na (mEq/L) = 143 (135 - 145) K (mEq/L) = 4.1 (3.5 - 5) Cl (mEq/L) = 102 (95 - 103) HCO3 (mEq/L) = 26 (24 - 30) BUN (mg/dL) = 15 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 15 (100 - 125) Mg (mEq/L) = 1.8 (1.3 - 2.1) PO4 (mg/dL) = 4.1 (2.3 - 4.7) Ca (mg/dL) = 9.7 (8.5 - 10.5) TSH (mIU/L) = 4.7 (0.3-3.0) hCG+
Question: Which drugs in KB’s medication profile will have a significant interaction with levothyroxine? Answer AMylanta and Tylenol BCetirizine and MVI COmega-3 fatty acid and Cetirizine DMVI and Mylanta EMylanta and Omega-3 fatty acid |
DMVI and Mylanta |
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Alison is a 33 year-old female who has been diagnosed with hyperthyroidism. She is waiting for an appointment to see an endocrinologist. In the meantime, she has been given a prescription for propylthiouracil and propranolol. Choose the correct statement/s: (Select ALL that apply.) Answer AThe propylthiouracil increases the production of T3. BThe propranolol will help reduce hyperthyroid symptoms. CThe propylthiouracil increases the production of T4. DThe propylthiouracil inhibits thyroid hormone synthesis. EThe propranolol increases the production of TSH. |
BThe propranolol will help reduce hyperthyroid symptoms.
DThe propylthiouracil inhibits thyroid hormone synthesis. |
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Chief Complaint: "I have a fever and I can't sleep"
History of Present Illness: JS is a 35 y/o male being treated for a severe MRSA skin infection. He presents to the clinic complaining of fever, nausea, increased insomnia, and "feeling like I'm going crazy". He appears very agitated and presents with hand tremor and moist skin. He recently picked up a second job, working 60 hours a week, and attributes his worsening insomnia to stress.
Past Medical History: Insomnia (x 3 years), atrial fibrillation, MRSA skin infection diagnosed 10 days ago
Medications: Melatonin 5 mg QHS, warfarin 5mg daily, Zyvox 600 mg PO BID, MVI daily
Pertinent Social History: Alcohol 2-3x/week to help him sleep
Vitals: Height: 5'10" Weight: 141 lbs BP: 140/96 mmHg HR: 105 BPM RR: 22 BPM Temp: 104ºF Pain: 2/10
Labs: Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.2 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 110 (100 - 125) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.3 (2.3 - 4.7) Ca (mg/dL) = 9.5 (8.5 - 10.5) TSH (mIU/L) = 0.1 (0.3-3.0) INR = 2.9 (2-3)
Question: JS is sent to the hospital for treatment. An order for propylthiouracil is written. What other medications should be initiated? Answer APotassium chloride, acetaminophen, propranolol and dexamethasone BSSKI, propranolol, dexamethasone and acetaminophen CLevothyroxine, SSKI, magnesium and aspirin DLiotrix, acetaminophen, Lugol’s solution and dexamethasone EPotassium chloride, ThyroShield, and metoprolol |
BSSKI, propranolol, dexamethasone and acetaminophen |
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Propylthiouracil can have this effect on blood cells: Answer ALow white blood cells (leukopenia) BHigh white blood cells (leukocytosis) CIncreased platelets (thrombocytosis) DDecreased red blood cells EDecreased platelets |
ALow white blood cells (leukopenia) |
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A patient has been diagnosed with hyperthyroidism. The following signs and symptoms would be expected to be present: (Select ALL that apply.) Answer AHigh TSH BLow FT4 CAgitation, irritability and tachycardia DDiarrhea EDepression |
CAgitation, irritability and tachycardia DDiarrhea |
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Chief Complaint: "I have no energy"
History of Present Illness: KB is a 32 y/o female who comes into the outpatient clinic complaining of low energy, recent weight gain of 15 pounds, foggy memory, and feeling cold even though it is sunny outside. She is diagnosed with hypothyroidism and started on levothyroxine.
Past Medical History: Allergic rhinitis, GERD, Hypothyroidism
Current Medications: Cetirizine 10 mg PRN, Mylanta 20 mL Q6H, Tylenol 325 mg Q4-6H PRN, Omega-3 fatty acid 1 gram daily, MVI daily
Vitals: Height: 5'7" Weight: 138 lbs BP: 129/80 mmHg HR: 85 BPM RR: 20 BPM Temp: 98.6ºF Pain: 1/10
3/10/14 Labs: Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.2 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 110 (100 - 125) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.4 (2.3 - 4.7) Ca (mg/dL) = 9.5 (8.5 - 10.5) TSH (mIU/L) = 32 (0.3-3.0) Free T4 (mg/dL) = 0.3 (0.9-2.3) hCG-
Plan: Hypothyroidism. Start levothyroxine 75 mcg daily. Follow-up visit on 4/14/14.
4/14/14 Labs: Na (mEq/L) = 143 (135 - 145) K (mEq/L) = 4.1 (3.5 - 5) Cl (mEq/L) = 102 (95 - 103) HCO3 (mEq/L) = 26 (24 - 30) BUN (mg/dL) = 15 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 15 (100 - 125) Mg (mEq/L) = 1.8 (1.3 - 2.1) PO4 (mg/dL) = 4.1 (2.3 - 4.7) Ca (mg/dL) = 9.7 (8.5 - 10.5) TSH (mIU/L) = 4.7 (0.3-3.0) hCG+
Question: Was KB’s initial levothyroxine dose a full replacement dose based on her ideal body weight? Answer AYes, it was a full replacement dose. BNo, the dose should have been 50 mcg daily CNo, the dose should have been 100 mcg daily DNo, the dose should have been 112 mcg daily ENo, the dose should have been 125 mcg daily
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CNo, the dose should have been 100 mcg daily |
