Midterm Exam: NR668/ NR 668 (Latest 2024/ 2025 Update) Psychiatric-Mental Health Capstone Practicum & Intensive Complete Review (Weeks 1-4) Questions and Verified Answers| 100% Correct | Grade A – Chamberlain

Midterm Exam: NR668/ NR 668 (Latest 2024/ 2025 Update) Psychiatric-Mental Health Capstone Practicum & Intensive Complete Review (Weeks 1-4) Questions and Verified Answers| 100% Correct | Grade A – Chamberlain Q: Drugs that are highly protein bound and have a narrow therapeutic index can be dangerous because: Answer: margin of error between therapeutic and toxic is narrow Q: Metabolism Answer: -Mostly in the liver -Biotransformation or change it to inactive form or make it more water soluble to facilitate excretion • transformed substance is called the metabolite. Q: The rate of metabolism is affected by: Answer: -age, liver & drug tolerance • Body may produce more enzymes & the liver becomes faster at breaking that particular drug down Q: half life Answer: this is the time it takes the peak level to fall by ½ Q: Steady state of a drug: Answer: -When the rate of drug administration & elimination are equal -can be achieved in 4 - 5 half lives Q: Phase I reactions: Answer: Transforms drug, CYP450 Oxidases. Make it available for the body to use Q: Phase II reactions: Answer: Conjugation reactions or attach drug with something. End products tend to be less active than their substrates Q: Excretion: Answer: -Kidneys are the main excretory gland. -Other modes include feces, bile, respiration, milk, perspiration and tears Q: Glomerular Filtration: Answer: Removes drugs or metabolites not bound to proteins present in the blood plasma. -Metabolite excreted in the urine Q: inducers Answer: speeds up metabolism Q: inhibitors Answer: slow down metabolism Q: Cytochrome P450 metabolizing enzymes Answer: -Cytochrome P450: Alters just how the body metabolizes many drugs -Nomenclature: Example CYP2D6: CYP (cytochrome P450 enzyme)2 (Family) D (Subfamily) 6 (Individual enzyme) -Pharmacogenetic testing • determines CYP450 differences • Predicts High vs. Low Substrates of 2D6, 2C19, 3A4 -Prodrug: Liver metabolism activates the drug. • Example: Codeine • Converted to morphine via CYP2D6 Q: CYP 1A2 Answer: -CYP 1A2 Substrates: • Caffeine, Theophylline, some TCA's (Amitriptyline, clomipramine, imipramine), Haloperidol, Olanzapine & others. -CYP1A2 Inhibitors: • Ciprofloxacin, Verapamil, Fluvoxamine -CYP1A2 Inducers: • Omeprazole, Charbroiled foods, Phenobarbital, Tobacco smoking • Tobacco smoking will induce the metabolism of Olanzapine (Zyprexa) & Haloperidol (Haldol) Q: CYP 2D6 Answer: Greatly affected by polymorphism -CYP 2D6 Substrates: • Venlafaxine, Duloxetine, Fluoxetine, Paroxetine, Fluvoxamine, several antipsychotics, Beta Blockers, Stimulants, Opioids -CYP2D6 Inhibitors: • Fluoxetine, Paroxetine, Bupropion & (Sertraline moderate inhibitor) -CYP2D6 Inducers: • No strong inducers Q: CYP 3A4: -CYP 3A4 Substrates: • Alprazolam, Buspirone, Statins, Chemo drugs, Calcium Channel blockers, Macrolides, Celexa, Sertraline, Methadone, Sex hormones & hormonal contraceptives.