PHARM FINAL EXAM QUESTIONS WITH ANSWERS, Exams of Pharmacy

Download PHARM FINAL EXAM QUESTIONS WITH ANSWERS and more Exams Pharmacy in PDF only on Docsity!

PHARM FINAL EXAM QUESTIONS WITH ANSWERS

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. What antipsychotics are good for pts who miss doses of their meds?: An- tipsychotics 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 med- ication 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 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 shorten- ing 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.
13. 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
14. '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: @ 1200 mg/day, how much is the patient absorbing?: @ 1200 mg/day-- % 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 stop- ping 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 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 31.Pros of Modified Release/Delayed Release meds?: D. All of the above 32.Cons of Modified Release/Delayed Release meds?: D. All of the above 33.Medicines that are preferred in IR?: Benzos and stimulants 34.Most medications cannot be split or crushed without disrupting the integrity of the time-release mechanism?: MR/delayed release

35.Concerns when treating geriatric patients with psychotherapeutic drugs include all of the following EXCEPT?: C. Elderly persons may metabolize psy- chotherapeutic drugs more rapidly

36.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 37.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 38.According to Sullivan, which of the following are consistent with a men- tor/mentee relationship?: C. Goals for the mentoring are set mutually 39.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 40.The ARNP assessing lifestyle as a social determinant of health would ask about which of the following?: A. Diet 41.Trifluphenazine is also known as?: Stelazine

first generation antipsychotic 42.Lillipucin hallucinations are what?: "little people or kids" hallucinations 43.What is a red flag that indicates Lewy Body?: Lillipucin hallucinations hallucinations of little people or kids 44.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 45.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 46.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

47.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 48.1st 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 49.What are the preferred tx of antipsychotics in lewy body?: Seroquel, Clozaril and Zyprexa **they don't make you stiff 50.Possible indications of lewy body dementia?: increased falls, delirium, pneu- monia/recent infections 51.What hallucination indicates paranoia?: bugs 52.scratching/itching/picking, talking about bugs in their skin?: meth 53.Bugs, animals, snakes, spiders, creepy crawlies indicate what?: A. NOT psychosis look into medication/medical options

54.The smaller the dose of Geodon, the more?: A. Activating *to sedate patients will need LARGE geodon doses 55.Charles Bonat: was no a psychiatrist- but believed that the brain creates things it wants that humans cannot see due to this it is important to assess hearing and sight prior to making a diagnosis of schizophrenia/ect for older adultsa 56.Red flags for older adults to indicate infection?: UTI, PNA, any infection Delirium, fatty liver 57.Abilify in bipolar mania?: NOT used, does not work well 58.what antipsychotics are used at baby doses with older adults?: C. A&B 59.Seroquel in older adults?: increases risk of falls and lowers BP-- adding to increased falls *be cautious with all older adults 60.Topamax is also known as?: Dopamax--- increased brain fog/foggy/makes you feel stupid

61. is known to reduce appetite in individuals with weight gain

related to antipsychotics?: Topamax

62.what is the gold standard/preferred treatment of bipolar?: always start with an anticonvulsant for bipolar disorders-- preferred option for mood disorder

63. What anticonvulsant medications increase the risk of hyponatremia?: - Tegretol and Trileptal high association with increased risk of 64.Smaller doses of antipsychotics and anticonvulsants should be used with what population(s)?: Young and elderly 65.Chosen favorite anticonvulsants to combine to treat a mood disorder?: A. Lithium and depakote 66.How often do you need a creatinine clearance done if on Lithium and/or depakote?: yearly 67.What antipsychotic is used to treat psychosis?: A&B 68.Parkinson like s/s--what meds should be avoided as they can cause in- creased stiffness?: Haldol or risperidone ^makes patients stiff 69.What antipsychotic is preferred in parkinson's disease?: D All of the

above -Seroquel #1 choice -then clozaril and zyprexa 70.Older adults and risperidone?: small doses of risperidone are used -available as liquid/ODT/ect other forms 71.Older adults and Zyprexa?: small doses of Zyprexa are used -available as liquid/ODT/ect other forms 72.Lisinopril can do what to Lithium levels?: INCREASE *always check a lithium level 73.dizziness, electric shock sensations, ear ringing, headache, fatigue, mood s/s and anxiety s/s?: Serotonin Withdrawal from SSRIs and SNRIs 74.Mood and anxiety related symptoms may make it look like?: the patient is relapsing on their depression /anxiety ect 75.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

76.What is the only exception to severe serotonin withdrawal with a SSRI/SNRI?: Paxil due to long half life 77.Paxil's half life is longer than effexor?: 3-4x longer

78. is ranked beside venlafaxine to have the most notorious WD problems?: A) Paxil #1 ---ranked #1 due to half life of 24 hours Effexor # 79.How long is venlafaxine's half life?: 5 hours 80.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 me- tabolizes it: CYP2D -this hastens the withdrawal due to enzyme effectively shortening the 1/2 life 81.How does Paxil hasten it's WD syndrome?: it hastens the withdrawal due to the enzyme effectively shortening the 1/2 life (CYPD26) 82.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 83.how long do you have to wait when taking fluoxetine and switching to

a MAOI?: A. wait 6 weeks 84.how long do you have to wait when taking Vortioxetine and switching to a MAOI?: A. Wait 2 weeks

85. how long do you have to wait when taking "most other antidepres- sants"(outside of Prozac and Trintellix) and switching to a MAOI?: normally 3-5 days 86.How do you manage withdrawal symptoms with? (two options): -option 1: taper slowly over a couple of months -option 2: switch to a longer half life drug, such as Prozac 87.How do you manage withdrawal symptoms with SSRIs?: A. Switch to a drug with a longer half-life ex. Fluoxetine 88.How do you manage withdrawal syndrome with Benzodiazepines?: A. Switch to a drug with a longer half life ex. diazepam *Important to remember that you may still need to taper off the old med as you add

in the longer 1/2 life alternative due to the new med not binding with the receptors in the same way* 89.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) 90.With modified release meds, is the half life longer?: MR/IR do not actually lengthen the half life 91.Risk with short 1/2 life drugs?: Cause withdrawal symptoms as they quickly exit the body 92.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 93.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 94.The NP can impact health policy and healthcare by doing which of the following?: D. All of the above 95.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

96.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. 97.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 98.The NP preceptor should have which of the following?: D. All of the above 99.Tx choice for patients with histrionic personality disorder includes?: D. A&B

100. Antipsychotics which are most likely to cause neuroleptic induced parkinsonism are which of the following effects?: C. High potency drugs with high levels of anticholinergic activity
101. Tx aimed at reducing intimate partner violence and domestic violence includes which of the following?: D. A&B only
102. A patient presents with a formal tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, pre- occupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights reluctant to confide in the ARNP; what PD?: B. Paranoid PD

103. Which of the following is consistent with current perspectives on NP competencies?: A. The national organization of NP faculties have developed a list

of core competencies that all students should have upon graduation from a master's program

104. Which of the following core competencies are quality competencies?: D. A&C
105. Which of the following are criteria for a particular suicide to be considered inevitable?: D. All of the above
106. The misuse of the charge's funds for personal gain is known as which of the following?: C. Financial abuse/exploitation
107. According to Freud, passive and dependent personality traits are associ- ated with which stage of development?: A. Oral stage
108. the incidence of suicide is higher for what population?: D. Older African American men
109. Assumes complex and advanced leadership roles to initiate and guide change is a NP core competency for what area?: C. Leadership competencies
110. At a minimum, a psychiatric eval in an emergency should include which of the following? Select all that apply: A, B & C
111. Stage of the cycle of DV that is characterized by the abuser subconscious- ly implementing defense mechanisms and cognitive

distortions to alleviate the ego dystonic implication of the abuse?: D. Defensive phase

112. An ARNP takes a position in which the ARNP is guaranteed a set salary but can make additional salary if he or she generates practice income over some set amount. This is known as what type of pay structure?: C. Base salary plus percentage
113. A pt is prescribed Haldol and has a hx of schizophrenia. she appears in the ED with hyperthermia muscle rigidity, autonomic instability, and elevated phosphokinase. The ARNP recognizes these symptoms are consistent with which of the following psychiatric emergencies?: D. NMS
114. Pt with extreme sensitivity to rejection who are socially withdrawn be- cause they consider themselves socially inept, although are not asocial, but show a great desire for companionship are demonstrating symptoms most consistent with which of the following PD?: B. Avoidance PD feel uncomfortable in social situations and often feel socially inept. Despite this self-awareness, comments by others about your shyness or nervousness in a social setting may come off as criticism or rejection*
115. Non pharmacologic tx for abuse includes all of the following