NRNP 6675 Final Exam
The 1/2 life of lithium is about? - ANSWER 24 hours
Fluoxetine is the SSRI with the ______ WD risk? - ANSWER lowest due to long
half life
What antipsychotics are good for pts who miss doses of their meds? - ANSWER
Antipsychotics with long half-lives:
1. Cariprazine(Vrylar): (2-4 days-active metabolites up to 3 weeks)
2. Abilify (3 days)
3. Brexipiprazole (4 days)
4. Pimozide (4-5 days)
5. Pimavanserin (2 days, active metabolites 8 days)
Disulfiram's alcohol interactions persist for up to how long after the medication is
stopped? - ANSWER LONG Half life--2-3 days
persist up to 2 weeks following stopping
What is the only TCA with a long half life? - ANSWER Protriptyline (Vivactil)
Most psychotropics have a medium range 1/2 life of approx? - ANSWER 24 hours
what does "steady state" mean in relation to 1/2 life? - ANSWER steady state
means that you are eliminating the drug at the same overall rate that you are
ingesting it
Lithium reaches its 'steady state' when? - ANSWER 5 half lives
example:
Day 1: Start pt on Lithium 600 mg daily
Day 2: (24 hours later) the amount left in his body is 300 mg (day 2 min) because 24
hours has passed--one 1/2 life--therefore the pt has excreted 1/2 of the initial
amount.
THEN the pt takes his 2nd dose of 600 mg on DAY 2-resulting in a max dose of 900
(300 mg left in body + 600 mg of 2nd dose).
DAY 3: starts off with 450 mg (1/2 of the 900 mg in pt's system) and after taking the
day 3 600 mg dose, the pt now has a total of 1050 mg.
Due to the steady state of Lithium, when do we draw a blood level? - ANSWER 5
half lives
, if you check any earlier, the trough level will underestimate the actual level the pt is
on after achieving steady state
Fluoxetine has a half life of about? - ANSWER 2 weeks 1/2 life
take 2.5 months to achieve steady state
Most psychotropic medications operate in this fashion: - ANSWER "when you
double the dose, the serum dose doubles."
*minus three SRIs and three anticonvulsants (Fluoxetine, fluvoxamine, paxil,
gabapentin, valproate and carbamazepine)
_________induces it's own metabolism, hastening excretion and shortening it's half
life - ANSWER A. Carbamazepine (Tegretol)
*this effect begins to "rev up" after 2-4 weeks--which is why a carbamazepine level is
so important on obtaining 1-2 months after starting Tegretol.
Carbamazepine (Tegretol) level should be checked how soon after starting to take
this med? - ANSWER 1-2 months due to Tegretol inducing it's own metabolism,
hastening excretion and shortening it's half life.
_____ has trouble getting a "serum" level because it binds to proteins that render it
therapeutically inactive? - ANSWER A. Valproate Acid (Depakote)
-this is particularly true at the lower levels (eg. <50 mcg/mL), so you can expect dose
changes to make a more dramatic difference when the pt's depakote level is in the
higher range
_______'s serum level is the opposite of Valproic Acid: it rises quickly at first and
then slows down? - ANSWER Gabapentin
*gabapentin saturates the transporters that absorb it in the small intestine, causing
its levels to rise at a snails pace when the dosage goes above a certain saturation
point (around 900 mg/day).
-from there, the saturation trickles down; @ 900 mg/day--60% is absorbed. @ 1200
mg/day--50 % is absorbed. @3000 mg/day--30% of the gabapentin is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 900 mg/day, how much is the patient absorbing? - ANSWER @ 0900mg/day---
60% is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 1200 mg/day, how much is the patient absorbing? - ANSWER @ 1200
mg/day--50 % is absorbed.
Due to Gabapentin's serum pattern for dosage:
The 1/2 life of lithium is about? - ANSWER 24 hours
Fluoxetine is the SSRI with the ______ WD risk? - ANSWER lowest due to long
half life
What antipsychotics are good for pts who miss doses of their meds? - ANSWER
Antipsychotics with long half-lives:
1. Cariprazine(Vrylar): (2-4 days-active metabolites up to 3 weeks)
2. Abilify (3 days)
3. Brexipiprazole (4 days)
4. Pimozide (4-5 days)
5. Pimavanserin (2 days, active metabolites 8 days)
Disulfiram's alcohol interactions persist for up to how long after the medication is
stopped? - ANSWER LONG Half life--2-3 days
persist up to 2 weeks following stopping
What is the only TCA with a long half life? - ANSWER Protriptyline (Vivactil)
Most psychotropics have a medium range 1/2 life of approx? - ANSWER 24 hours
what does "steady state" mean in relation to 1/2 life? - ANSWER steady state
means that you are eliminating the drug at the same overall rate that you are
ingesting it
Lithium reaches its 'steady state' when? - ANSWER 5 half lives
example:
Day 1: Start pt on Lithium 600 mg daily
Day 2: (24 hours later) the amount left in his body is 300 mg (day 2 min) because 24
hours has passed--one 1/2 life--therefore the pt has excreted 1/2 of the initial
amount.
THEN the pt takes his 2nd dose of 600 mg on DAY 2-resulting in a max dose of 900
(300 mg left in body + 600 mg of 2nd dose).
DAY 3: starts off with 450 mg (1/2 of the 900 mg in pt's system) and after taking the
day 3 600 mg dose, the pt now has a total of 1050 mg.
Due to the steady state of Lithium, when do we draw a blood level? - ANSWER 5
half lives
, if you check any earlier, the trough level will underestimate the actual level the pt is
on after achieving steady state
Fluoxetine has a half life of about? - ANSWER 2 weeks 1/2 life
take 2.5 months to achieve steady state
Most psychotropic medications operate in this fashion: - ANSWER "when you
double the dose, the serum dose doubles."
*minus three SRIs and three anticonvulsants (Fluoxetine, fluvoxamine, paxil,
gabapentin, valproate and carbamazepine)
_________induces it's own metabolism, hastening excretion and shortening it's half
life - ANSWER A. Carbamazepine (Tegretol)
*this effect begins to "rev up" after 2-4 weeks--which is why a carbamazepine level is
so important on obtaining 1-2 months after starting Tegretol.
Carbamazepine (Tegretol) level should be checked how soon after starting to take
this med? - ANSWER 1-2 months due to Tegretol inducing it's own metabolism,
hastening excretion and shortening it's half life.
_____ has trouble getting a "serum" level because it binds to proteins that render it
therapeutically inactive? - ANSWER A. Valproate Acid (Depakote)
-this is particularly true at the lower levels (eg. <50 mcg/mL), so you can expect dose
changes to make a more dramatic difference when the pt's depakote level is in the
higher range
_______'s serum level is the opposite of Valproic Acid: it rises quickly at first and
then slows down? - ANSWER Gabapentin
*gabapentin saturates the transporters that absorb it in the small intestine, causing
its levels to rise at a snails pace when the dosage goes above a certain saturation
point (around 900 mg/day).
-from there, the saturation trickles down; @ 900 mg/day--60% is absorbed. @ 1200
mg/day--50 % is absorbed. @3000 mg/day--30% of the gabapentin is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 900 mg/day, how much is the patient absorbing? - ANSWER @ 0900mg/day---
60% is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 1200 mg/day, how much is the patient absorbing? - ANSWER @ 1200
mg/day--50 % is absorbed.
Due to Gabapentin's serum pattern for dosage:
