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NRNP 6675 FINAL EXAM LAST EXAM
EVERRRRR (minus boards)
The 1/2 life of lithium is about? 24 hours Fluoxetine is the SSRI with the ______ WD risk? lowest due to long half life What antipsychotics are good for pts who miss doses of their meds? Antipsychotics with long half-lives:
- Cariprazine(Vrylar): (2-4 days-active metabolites up to 3 weeks)
- Abilify (3 days)
- Brexipiprazole (4 days)
- Pimozide (4-5 days)
- Pimavanserin (2 days, active metabolites 8 days) 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 What is the only TCA with a long half life?
Protriptyline (Vivactil) Most psychotropics have a medium range 1/2 life of approx? 24 hours 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 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.
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? 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 3 multiple choice options _______'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. Due to Gabapentin's serum pattern for dosage: @ 900 mg/day, how much is the patient absorbing? @ 0900mg/day---60% is absorbed. Due to Gabapentin's serum pattern for dosage: @ 1200 mg/day, how much is the patient absorbing?
@ 1200 mg/day--50 % is absorbed. 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. Carbamazepine (Tegretol's) serum level drops after how long after stopping taking it? 1-2 months For Valproate (Depakote), ___ dose changes can have big effects once the level is beyond 50 mcg/mL? SMALL potency refers to a drug's> power per unit -or the amount of pharmacological activity per milligram. Delayed release= modified release "dont get absorbed until they have traveled to a specific site in the gut
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 in MODERATE RELEASE/DELAYED RELEASE is osmotic release pills, the medicine does what? is pushed out by a tiny pump that is powered by a osmotic flow of water across a semipermeable membrane ex. Concerta, Invega, and Effexor ER tablets Pros of Modified Release/Delayed Release meds? D. All of the above 3 multiple choice options Cons of Modified Release/Delayed Release meds? D. All of the above 3 multiple choice options
Medicines that are preferred in IR? Benzos and stimulants Most ______ medications cannot be split or crushed without disrupting the integrity of the time-release mechanism? MR/delayed release Concerns when treating geriatric patients with psychotherapeutic drugs include all of the following EXCEPT? C. Elderly persons may metabolize psychotherapeutic drugs more rapidly 3 multiple choice options The treatment of others equitably and distribution of benefits/burdens fairly is known as which of the following? B. Justice a fair an equitable distribution of health resources 3 multiple choice options Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics of which of the following PD? C. Dependent PD 3 multiple choice options
What is a red flag that indicates Lewy Body? Lillipucin hallucinations hallucinations of little people or kids What is a key question to ask someone with dementia when performing an evaluation of mental status to show confabulation? "You look familiar, didn't we meet before?" will show confabulation How to test for lewy body dementia? (question to ask?) Q: how do you think they are getting in the house? Q: where in the home are they hiding? *Individuals are typically paranoid What is not used in tx of lewy body dementia for antispcyhotics? D. Risperidone and haldol WHY? -Individuals with lewy body dementia have increased sensitivity to antipsychotics -increased risk of EPS, confusion, sedation and falls
-typical or traditional antipsychotics should be avoided Why is haldol contraindicated in lewy body? first generation antipsychotic meds should not be used to tx lewy body due to increased confusion, severe parkinsonism/EPS, sedation and even death 1st gen antipsychotics should be prescribed ______ term for older adults with lewy body dementia? SHORT TERM at a lose dose but only if the benefits outweigh the risks What are the preferred tx of antipsychotics in lewy body? Seroquel, Clozaril and Zyprexa **they don't make you stiff Possible indications of lewy body dementia? increased falls, delirium, pneumonia/recent infections What hallucination indicates paranoia? bugs scratching/itching/picking, talking about bugs in their skin?
Abilify in bipolar mania? NOT used, does not work well what antipsychotics are used at baby doses with older adults? C. A&B 3 multiple choice options Seroquel in older adults? increases risk of falls and lowers BP--adding to increased falls *be cautious with all older adults Topamax is also known as? Dopamax--- increased brain fog/foggy/makes you feel stupid _________ is known to reduce appetite in individuals with weight gain related to antipsychotics? Topamax what is the gold standard/preferred treatment of bipolar? always start with an anticonvulsant for bipolar disorders-- preferred option for mood disorder
What anticonvulsant medications increase the risk of hyponatremia? Tegretol and Trileptal high association with increased risk of Smaller doses of antipsychotics and anticonvulsants should be used with what population(s)? Young and elderly Chosen favorite anticonvulsants to combine to treat a mood disorder? A. Lithium and depakote 3 multiple choice options How often do you need a creatinine clearance done if on Lithium and/or depakote? yearly What antipsychotic is used to treat psychosis? A&B 3 multiple choice options Parkinson like s/s--what meds should be avoided as they can cause increased stiffness? Haldol or risperidone ^makes patients stiff
Mood and anxiety related symptoms may make it look like? the patient is relapsing on their depression /anxiety ect Serotonin withdrawal when severe can cause? A. increased risk of falls in relation to 1/ 2 life *ONLY EXCEPTION = Paxil due to long half life 2 multiple choice options What is the only exception to severe serotonin withdrawal with a SSRI/SNRI? Paxil due to long half life Paxil's half life is _____ longer than effexor? 3-4x longer _______ is ranked beside venlafaxine to have the most notorious WD problems? A) Paxil #1 ---ranked #1 due to half life of 24 hours Effexor # 3 multiple choice options
How long is venlafaxine's half life? 5 hours How does WD syndrome affect Paxil due to it's long metabolism of 24 hours? Paxil slows down it's own metabolism by inhibiting the enzyme that metabolizes it: CYP2D -this hastens the withdrawal due to enzyme effectively shortening the 1/2 life How does Paxil hasten it's WD syndrome? it hastens the withdrawal due to the enzyme effectively shortening the 1/2 life (CYPD26) How many half life's need to pass in order to avoid drug interactions prior to starting a MAOI from a SSRI/SNRI? FIVE half life's of the drug how long do you have to wait when taking fluoxetine and switching to a MAOI? A. wait 6 weeks 3 multiple choice options how long do you have to wait when taking Vortioxetine and switching to a MAOI? A. Wait 2 weeks 3 multiple choice options
How do you manage a modified release (MR & IR) medication withdrawal syndrome? A. You cannot prevent withdrawal, you can only change the rate of absorption (not excretion) With modified release meds, is the half life longer? MR/IR do not actually lengthen the half life Risk with short 1/2 life drugs? Cause withdrawal symptoms as they quickly exit the body The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A. Diet 3 multiple choice options In educating the patient beginning to take lithium, the ARNP explains which of the following related to diet and fluid intake? D. All of the above 3 multiple choice options the goal of psychotropic tx is to eliminate all manifestations of a disorder to below the syndromal threshold i defined as which of the following? B. Remission 3 multiple choice options
The NP can impact health policy and healthcare by doing which of the following? D. All of the above 3 multiple choice options A term used to describe individuals and familie who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following? D. A&B 3 multiple choice options Which of the following is consistent with current literature regarding the epidemiology dependent personality disorder? C. Persons with chronic physical illness in childhood may be more susceptible to this disorder. 3 multiple choice options patients who injure themselves by SIB but who usually do not wish to die are said to have which of the following? C. Parasuicidal behavior 3 multiple choice options The NP preceptor should have which of the following? D. All of the above 3 multiple choice options Tx choice for patients with histrionic personality disorder inlcudes?
