NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR
(MINUS BOARDS) 181 QUESTIONS AND 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.
14. 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
15. '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--50 % 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
(MINUS BOARDS) 181 QUESTIONS AND 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.
14. 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
15. '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--50 % 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
