NRNP 6675 Week 11 Final Exam Questions & Answers (2024-2025), Exams of Nursing

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NRNP 6675 WEEK 11 FINAL EXAM QUESTIONS WITH

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PASS LATEST VERSION 2024 - 2025

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:

1. Cariprazine(Vrylar): (2-4 days-active metabolites up to 3 weeks)
2. Abilify (3 days)
3. Brexipiprazole (4 days)

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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? 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?

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3 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).

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4 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? 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? 2 weeks 1/2 life take 2.5 months to achieve steady state Most psychotropic medications operate in this fashion:

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5 "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 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?

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6 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 _______'s serum level is the opposite of Valproic Acid: it rises quickly at first and then slows down? Gabapentin

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7 *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.

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8 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

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• 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 Intermediate release (IR) medications: dissolve rapidly in the GI tract and are absorbed in an hour or two 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.

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1 0 *the ups and downs in serum levels of IR medications can cause what? can cause SE or efficacy problems. Bupropion can increase the risk of what? Seizures *IF the serum level peaks too high IR stimulants can lose ____ in the afternoon? efficacy due to IR effect The rise and fall of Haldol levels increases what? the likelihood of dystonic reactions

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1 1 in MODERATE RELEASE/DELAYED RELEASE dissolvable solutions or "dissolvable control", the medicine does what? slowly diffuses out of a semi-permeable membrane e x. 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

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1 2 Cons of Modified Release/Delayed Release meds? D. All of the above 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

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1 3 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 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 According to Sullivan, which of the following are consistent with a mentor/mentee relationship?

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1 4 C. Goals for the mentoring are set mutually The need for NPs to practice to the full extent of their education and training is necessary for which of the following reasons? B, C & D The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A. Diet Trifluphenazine is also known as? Stelazine first generation antipsychotic Lillipucin hallucinations are what?

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1 5 "little people or kids" hallucinations 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?

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1 6 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

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1 7 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? meth

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1 8 Bugs, animals, snakes, spiders, creepy crawlies indicate what? A. NOT psychosis look into medication/medical options The smaller the dose of Geodon, the more? A. Activating *to sedate patients will need LARGE geodon doses Charles Bonat was no a psychiatrist- but believed that the brain creates things it wants that humans cannot see

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1 9 due to this it is important to assess hearing and sight prior to making a diagnosis of schizophrenia/ect for older adultsa Red flags for older adults to indicate infection? UTI, PNA, any infection Delirium, fatty liver Abilify in bipolar mania? NOT used, does not work well what antipsychotics are used at baby doses with older adults? C. A&B Seroquel in older adults? increases risk of falls and lowers BP--adding to increased falls

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2 0 *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

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2 1 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 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

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2 2 Parkinson like s/s--what meds should be avoided as they can cause increased stiffness? Haldol or risperidone ^makes patients stiff What antipsychotic is preferred in parkinson's disease? D All of the above

• Seroquel #1 choice
• then clozaril and zyprexa Older adults and risperidone? small doses of risperidone are used

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• available as liquid/ODT/ect other forms Older adults and Zyprexa? small doses of Zyprexa are used
• available as liquid/ODT/ect other forms Lisinopril can do what to Lithium levels? INCREASE *always check a lithium level dizziness, electric shock sensations, ear ringing, headache, fatigue, mood s/s and anxiety s/s?

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2 4 Serotonin Withdrawal from SSRIs and SNRIs 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 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

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2 5 _______ is ranked beside venlafaxine to have the most notorious WD problems? A) Paxil #1 ---ranked #1 due to half life of 24 hours Effexor #2 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: CYP2D6