NRNP 6675 FINAL EXAM
QUESTIONS AND ANSWERS
2025-2026 update
The 1/2 life of lithium is about?-ANS>>24 hours
Fluoxetine is the SSRI with the ______ WD risk?-ANS>>lowest due to long half life
What antipsychotics are good for pts who miss doses of their meds?-ANS>>Antipsychotics with lon
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?-ANS>>LON
Half life--2-3 days
persist up to 2 weeks following stopping
What is the only TCA with a long half life?-ANS>>Protriptyline (Vivactil)
Most psychotropics have a medium range 1/2 life of approx?-ANS>>24 hours
what does "steady state" mean in relation to 1/2 life?-ANS>>steady state means that you are eliminatin
the drug at the same overall rate that you are ingesting it
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.
Due to the steady state of Lithium, when do we draw a blood level?-ANS>>5 half lives
if you check any earlier, the trough level will underestimate the actual level the pt is on after achievin
steady state
Fluoxetine has a half life of about?-ANS>>2 weeks 1/2 life
take 2.5 months to achieve steady state
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 an
carbamazepine)
_________induces it's own metabolism, hastening excretion and shortening 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 o
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?-ANS>>1-
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 therapeuticall
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
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?
ANS>>Gabapentin
*gabapentin saturates the transporters that absorb it in the small intestine, causing its levels to rise at
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 % i
absorbed. @3000 mg/day--30% of the gabapentin is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 900 mg/day, how much is the patient absorbing?-ANS>>@ 0900mg/day---60% is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 1200 mg/day, how much is the patient absorbing?-ANS>>@ 1200 mg/day--50 % is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 3000 mg/day, how much is the patient absorbing?-ANS>>@3000 mg/day--30% of the gabapentin i
absorbed.
Carbamazepine (Tegretol's) serum level drops after how long after stopping taking it?-ANS>>1-2 month
For Valproate (Depakote), ___ dose changes can have big effects once the level is beyond 50 mcg/mL?
ANS>>SMALL
potency refers to a drug's>-ANS>>power per unit
-or the amount of pharmacological activity per milligram.
Delayed release=-ANS>>modified release
"dont get absorbed until they have traveled to a specific site in the gut
Intermediate release (IR) medications:-ANS>>dissolve rapidly in the GI tract and are absorbed in an hou
or two
the serum concentrations of IR medications spike quickly and then fall back down, leading to what?
ANS>>leading to low trough levels before the next dose.
*These ups and downs in serum levels can cause SE or efficacy problems.
*the ups and downs in serum levels of IR medications can cause what?-ANS>>can cause SE or efficac
problems.
Bupropion can increase the risk of what?-ANS>>Seizures
*IF the serum level peaks too high
IR stimulants can lose ____ in the afternoon?-ANS>>efficacy due to IR effect
QUESTIONS AND ANSWERS
2025-2026 update
The 1/2 life of lithium is about?-ANS>>24 hours
Fluoxetine is the SSRI with the ______ WD risk?-ANS>>lowest due to long half life
What antipsychotics are good for pts who miss doses of their meds?-ANS>>Antipsychotics with lon
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?-ANS>>LON
Half life--2-3 days
persist up to 2 weeks following stopping
What is the only TCA with a long half life?-ANS>>Protriptyline (Vivactil)
Most psychotropics have a medium range 1/2 life of approx?-ANS>>24 hours
what does "steady state" mean in relation to 1/2 life?-ANS>>steady state means that you are eliminatin
the drug at the same overall rate that you are ingesting it
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.
Due to the steady state of Lithium, when do we draw a blood level?-ANS>>5 half lives
if you check any earlier, the trough level will underestimate the actual level the pt is on after achievin
steady state
Fluoxetine has a half life of about?-ANS>>2 weeks 1/2 life
take 2.5 months to achieve steady state
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 an
carbamazepine)
_________induces it's own metabolism, hastening excretion and shortening 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 o
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?-ANS>>1-
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 therapeuticall
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
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?
ANS>>Gabapentin
*gabapentin saturates the transporters that absorb it in the small intestine, causing its levels to rise at
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 % i
absorbed. @3000 mg/day--30% of the gabapentin is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 900 mg/day, how much is the patient absorbing?-ANS>>@ 0900mg/day---60% is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 1200 mg/day, how much is the patient absorbing?-ANS>>@ 1200 mg/day--50 % is absorbed.
Due to Gabapentin's serum pattern for dosage:
@ 3000 mg/day, how much is the patient absorbing?-ANS>>@3000 mg/day--30% of the gabapentin i
absorbed.
Carbamazepine (Tegretol's) serum level drops after how long after stopping taking it?-ANS>>1-2 month
For Valproate (Depakote), ___ dose changes can have big effects once the level is beyond 50 mcg/mL?
ANS>>SMALL
potency refers to a drug's>-ANS>>power per unit
-or the amount of pharmacological activity per milligram.
Delayed release=-ANS>>modified release
"dont get absorbed until they have traveled to a specific site in the gut
Intermediate release (IR) medications:-ANS>>dissolve rapidly in the GI tract and are absorbed in an hou
or two
the serum concentrations of IR medications spike quickly and then fall back down, leading to what?
ANS>>leading to low trough levels before the next dose.
*These ups and downs in serum levels can cause SE or efficacy problems.
*the ups and downs in serum levels of IR medications can cause what?-ANS>>can cause SE or efficac
problems.
Bupropion can increase the risk of what?-ANS>>Seizures
*IF the serum level peaks too high
IR stimulants can lose ____ in the afternoon?-ANS>>efficacy due to IR effect
