NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR (minus boards)
1. The 1/2 life of lithium is about?: 24 hours
2. Fluoxetine is the SSRI with the ______ WD risk?: lowest due to long half life
3. 3. What antipsychotics are good for pts who miss doses of their meds?:
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)
4. Disulfiram's alcohol interactions persist for up to how long after the
medication is stopped?: LONG Half life--2-3 days
persist up to 2 weeks following stopping
5. What is the only TCA with a long half life?: Protriptyline (Vivactil)
6. Most psychotropics have a medium range 1/2 life of approx?: 24 hours
7. what does "steady state" mean in relation to 1/2 life?: steady state means
that you are eliminating the drug at the same overall rate that you are ingesting
it
8. Lithium reaches its 'steady state' when?: 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.
9. Due to the steady state of Lithium, when do we draw a blood level?: 5
half lives
if you check any earlier, the trough level will underestimate the actual level the pt
is on after achieving steady state
, NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR (minus boards)
10. Fluoxetine has a half life of about?: 2 weeks 1/2 life
take 2.5 months to achieve steady state
11. Most psychotropic medications operate in this fashion:: "when you double
the dose, the serum dose doubles."
*minus three SRIs and three anticonvulsants (Fluoxetine, fluvoxamine, paxil,
gabapentin, valproate and carbamazepine)
12. _________induces it's own metabolism, hastening excretion and
shortening it's half life: 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.
13. Carbamazepine (Tegretol) level should be checked how soon after
starting to take this med?: 1-2 months due to Tegretol inducing it's own
metabolism, hastening excretion and shortening it's half life.
14. _____ has trouble getting a "serum" level because it binds to proteins
that render it therapeutically inactive?: 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
15. _______'s serum level is the opposite of Valproic Acid: it rises quickly at
first and then slows down?: 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.
16. Due to Gabapentin's serum pattern for dosage:
@ 900 mg/day, how much is the patient absorbing?: @ 0900mg/day---60% is
absorbed.
17. Due to Gabapentin's serum pattern for dosage:
, NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR (minus boards)
@ 1200 mg/day, how much is the patient absorbing?: @ 1200 mg/day--50 %
is absorbed.
18. Due to Gabapentin's serum pattern for dosage:
@ 3000 mg/day, how much is the patient absorbing?: @3000 mg/day--30% of
the gabapentin is absorbed.
19. Carbamazepine (Tegretol's) serum level drops after how long after
stopping taking it?: 1-2 months
20. For Valproate (Depakote), ___ dose changes can have big effects once
the level is beyond 50 mcg/mL?: SMALL
21 potency refers to a drug's>: power per unit
-or the amount of pharmacological activity per milligram.
22. Delayed release=: modified release
"dont get absorbed until they have traveled to a specific site in the gut
23. Intermediate release (IR) medications:: dissolve rapidly in the GI tract and
are absorbed in an hour or two
24. the serum concentrations of IR medications spike quickly and then fall
back down, leading to what?: leading to low trough levels before the next
dose.
*These ups and downs in serum levels can cause SE or efficacy problems.
25. *the ups and downs in serum levels of IR medications can cause what?:
can cause SE or efficacy problems.
26. Bupropion can increase the risk of what?: Seizures
*IF the serum level peaks too high
27. IR stimulants can lose ____ in the afternoon?: efficacy due to IR effect
28. The rise and fall of Haldol levels increases what?: the likelihood of dystonic
reactions
29. in MODERATE RELEASE/DELAYED RELEASE dissolvable solutions or
"dissolvable control", the medicine does what?: slowly diffuses out of a
semi-permeable membrane
ex. Effexor ER capsules, Wellbutrin XL and Focalin XR
30. in MODERATE RELEASE/DELAYED RELEASE
1. The 1/2 life of lithium is about?: 24 hours
2. Fluoxetine is the SSRI with the ______ WD risk?: lowest due to long half life
3. 3. What antipsychotics are good for pts who miss doses of their meds?:
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)
4. Disulfiram's alcohol interactions persist for up to how long after the
medication is stopped?: LONG Half life--2-3 days
persist up to 2 weeks following stopping
5. What is the only TCA with a long half life?: Protriptyline (Vivactil)
6. Most psychotropics have a medium range 1/2 life of approx?: 24 hours
7. what does "steady state" mean in relation to 1/2 life?: steady state means
that you are eliminating the drug at the same overall rate that you are ingesting
it
8. Lithium reaches its 'steady state' when?: 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.
9. Due to the steady state of Lithium, when do we draw a blood level?: 5
half lives
if you check any earlier, the trough level will underestimate the actual level the pt
is on after achieving steady state
, NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR (minus boards)
10. Fluoxetine has a half life of about?: 2 weeks 1/2 life
take 2.5 months to achieve steady state
11. Most psychotropic medications operate in this fashion:: "when you double
the dose, the serum dose doubles."
*minus three SRIs and three anticonvulsants (Fluoxetine, fluvoxamine, paxil,
gabapentin, valproate and carbamazepine)
12. _________induces it's own metabolism, hastening excretion and
shortening it's half life: 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.
13. Carbamazepine (Tegretol) level should be checked how soon after
starting to take this med?: 1-2 months due to Tegretol inducing it's own
metabolism, hastening excretion and shortening it's half life.
14. _____ has trouble getting a "serum" level because it binds to proteins
that render it therapeutically inactive?: 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
15. _______'s serum level is the opposite of Valproic Acid: it rises quickly at
first and then slows down?: 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.
16. Due to Gabapentin's serum pattern for dosage:
@ 900 mg/day, how much is the patient absorbing?: @ 0900mg/day---60% is
absorbed.
17. Due to Gabapentin's serum pattern for dosage:
, NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR (minus boards)
@ 1200 mg/day, how much is the patient absorbing?: @ 1200 mg/day--50 %
is absorbed.
18. Due to Gabapentin's serum pattern for dosage:
@ 3000 mg/day, how much is the patient absorbing?: @3000 mg/day--30% of
the gabapentin is absorbed.
19. Carbamazepine (Tegretol's) serum level drops after how long after
stopping taking it?: 1-2 months
20. For Valproate (Depakote), ___ dose changes can have big effects once
the level is beyond 50 mcg/mL?: SMALL
21 potency refers to a drug's>: power per unit
-or the amount of pharmacological activity per milligram.
22. Delayed release=: modified release
"dont get absorbed until they have traveled to a specific site in the gut
23. Intermediate release (IR) medications:: dissolve rapidly in the GI tract and
are absorbed in an hour or two
24. the serum concentrations of IR medications spike quickly and then fall
back down, leading to what?: leading to low trough levels before the next
dose.
*These ups and downs in serum levels can cause SE or efficacy problems.
25. *the ups and downs in serum levels of IR medications can cause what?:
can cause SE or efficacy problems.
26. Bupropion can increase the risk of what?: Seizures
*IF the serum level peaks too high
27. IR stimulants can lose ____ in the afternoon?: efficacy due to IR effect
28. The rise and fall of Haldol levels increases what?: the likelihood of dystonic
reactions
29. in MODERATE RELEASE/DELAYED RELEASE dissolvable solutions or
"dissolvable control", the medicine does what?: slowly diffuses out of a
semi-permeable membrane
ex. Effexor ER capsules, Wellbutrin XL and Focalin XR
30. in MODERATE RELEASE/DELAYED RELEASE
