Georgette LMR Pharmacology Exam 2025

What 3 conditions can Depakote (Divalproex) cause? - -Spinabifida, hepatotoxicity, and pancreatitis A patient is complaining of pain in their URQ of their abdomen and they have brown urine and yellowing of the eyes. They are taking Depakote. What is your first intervention? - -Stop the Depakote and order LFTs, valproic acid levels, and ammonia levels What are normal AST and ALT levels? - -AST: 5-40 ALT: 5-35 What is the therapeutic range for Depakote (Divalproex)? What is a toxic level? - -50 125 Toxicity occurs 150 What can the supplement Kava kava, often used for anxiety and insomnia, cause? - Liver damage What are major interactions with Kava kava? - -Alcohol- increased risk of liver toxicity Benzodiazepines- increased drowsiness Which drug should not be used with paroxetine, fluoxetine, or bupropion due to risk of severe adverse effects like hypotension and bradycardia? - -Metoprolol Which supplements/vitamins can help with depressive symptoms? - -Vit B12 Vit B6 Folate Omega 3 fatty acids Which antipsychotics and antidepressants can cause QT prolongation? (4) - Ziprasidone (Geodon) Quetiapine (Seroquel) Haloperidol (Haldol) Citalopram (Celexa) What two SSRIs are the least sedating? - -Fluoxetine (Prozac) Escitalopram (Lexapro) Which two SSRIs are the safest for patients with heart conditions? - -Sertraline (Zoloft) Escitalopram (Lexapro) GEORGETTE GEORGETTE What is the most effective way to treat serotonin discontinuation syndrome? - -Taking the medication at the previously prescribed dose. Usually symptoms go away in 24 hrs. What is a possible serious side effect of Lamictal (Lamotrigine)? - -SJS Fever, body aches, rash, peeling skin, tongue and facial swelling Which mood stabilizer causes the least weight gain? - -Lamictal Which 3 antipsychotics cause the least weight gain? - -Aripiprazole (Abilify) Ziprasidone (Geodon) Lurasidone (Latuda) What is the BBW for Carbamazepine (Tegretol)? - -Agranulocytosis and Aplastic Anemia Carbamazepine (Tegretol) can induce what serious condition, often in the Asian population with a HLAB1502 allele? - -SJS Carbamazepine (Tegretol), Topiramate (Topamax), and Phenytoin (Dilantin) are in what drug class? - -Antiepileptics Carbamazepine (Tegretol), Topiramate (Topamax), and Phenytoin (Dilantin) can decrease the effectiveness of what common medication? - -Oral contraceptives Aside from Carbamazepine (Tegretol), which other antipsychotic drug can cause agranulocytosis? - -Clozapine (Clozaril) Carbamazepine or Clozapine should be discontinued if ANC or WBC is below what? - ANC 1000 d/t risk of neutropenia WBC d/t risk of agranulocytosis Clozapine can cause which two serious heart conditions? - -Myocarditis and cardiomyopathy What is the therapeutic range of Lithium? - -0.6-1.2 mEq/L At what level is Lithium toxic? - -1.5 mEq/L What should the NP do if a patient is taking lithium and has a serum level of 1.3-1.4 with NO signs of lithium toxicity? - -Continue to monitor the patient What should the NP do if a patient is taking lithium and has a serum level of 1.3-1.4 WITH signs of lithium toxicity (diarrhea, vomiting)? - -Stop Lithium GEORGETTE GEORGETTE What should the NP do if a patient is taking lithium and has a serum level of 1.5 with NO signs of lithium toxicity (diarrhea, vomiting)? - -Stop Lithium What is the only medication that reduces the risk of suicide in patients with schizophrenia? - -Clozapine True or false: Low sodium levels (hyponatremia) can reduce lithium clearance and cause lithium toxicity - -True If a patient has hypothyroidism after taking Lithium, what should the NP do? - -Refer to endocrinology Do not have to lower or stop Lithium Intersitial lung disease is a rare side effect of which drug class? - -SNRIs Which antidepressants can cause hyonatremia? - -Citalopram (Celexa) and Duloxetine (Cymbalta) Which medication is contraindicated in patients with a history of seizure disorders or have conditions that increase risk of seizure (bulimia, anorexia)? - -Wellbutrin (Bupropion) Urinary incontinence is a possible side effect of which drug class? - -Antipsychotics What is the calculation for switching oral Haloperidol (Haldol) to Haldol Decanoate (monthly injection)? - -10-15x the daily oral dose If they are on a high dose 20x the daily oral dose What is the max dose for injectable Haldol? - -100 mg The NP wants to switch a patient from oral Haldol to the injection. The patient takes 10 mg of Haldol orally daily. What dose should their injection be? - -100 mg (or 100 mg now + 50 mg in 5-7 days) How do inducers affect serum drug levels? - -Decreases serum drug levels Which CYP450 system does Clozapine get metabolized by? - -CYP1A2 Which CYP450 system does nicotine get metabolized by? - -CYP2A6 If a person starts smoking, should their medication that also uses the CYP2A6 pathway be increased or decreased? - -Increase Which drug class can cause mania, dep