NRNP 6675 FINAL EXAM LAST EXAM COMPLETE ‘A’ GRADE ASSURANCE

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) 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. 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: "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. 3 multiple choice options 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. _____ 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 transporte