NRNP 6675 FINAL EXAM LAST EXAM 2023

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NRNP 6675 FINAL EXAM LAST EXAM 2023

1.The 1/2 life of lithium is about ANS 24 hours 2.Fluoxetine is the SSRI with the WD risk ANS lowest due to long half life 3.What antipsychotics are good for pts who miss doses of their meds ANS

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 ANS LONG Half life--2-3 days persist up to 2 weeks following stopping 1 / 4

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5.What is the only TCA with a long half life ANS Protriptyline (Vivactil) 6.Most psychotropics have a medium range 1/2 life of approx ANS 24 hours 7.what does "steady state" mean in relation to 1/2 life ANS 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 ANS 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 ANS 5 half lives 2 / 4

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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 ANS 2 weeks 1/2 life take 2.5 months to achieve steady state 3 / 4

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11.Most psychotropic medications operate in this fashion ANS "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

short- ening it's half life: ANS 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 start- ing to take this med ANS 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 ANS 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

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