Nr 545 Exam Questions with Verified
Solutions
Lithium - ANSWER-Action: alters cation transport in the nerve and muscle
indication: euphoric mania, rapid cycling, maintenance therapy CKD,
AE: GI effects, tremor, polyuria
Pearls: monitor plasma levels, reduce dose w/renal failure, use caution w/ concurrent
diuretics, use to protect against suicide
Lamotrigine (Lamictal) - ANSWER-Action: affects sodium channel ion transport and
enhances the effect of GABA
indications: maintenance, monotherapy for bipolar disorder
AE: benign rash, GI effects, dizziness, HA, SJS!!!
Pearls: equal in efficacy to lithium, assess for rash, risk for SJS and multi organ failure,
take at bedtime
Valporic acid( depakene) - ANSWER-Action: affects ion transport and enhances the
activity of GABA
indications: acute mania, mixed mood, comomorbid substance abuse, multiple prior
episodes
AE: weight gain, GI effects
2nd generation antipsychotics - ANSWER-Risperidone
Quetiapine
Aripriprazole
cariprazine
lurasidone
quetapine
actions: DA, NE, 5HT receptor antagonists
Indications: acute bipolar depression, acute manic or mixed episodes, bipolar
maintenance/adjunct
AE: wt gain, sedation, GI effects
Pearls: eps, XR May improve adherence, monthly injection may improve adherence,
select 2nd gen antipsychotics first to decrease risk of SE and long term adverse effects
Nicotine Replacement Therapy (NRT) - ANSWER-Use for patients that smoke > 20
cigarettes/day
otc
gum is pregnancy cat C
patch is pregnancy d
, immeduaty after MI and stroke
nicotine gum - ANSWER-Improved cessation success
buccal absorption
follow directions or nicotine will release too quickly increasing AE
> 25 cig a day- 4 mg
< 25 cig a day -2 mg qhour
weans dose after 2-3 months
Nicotine Lozenge - ANSWER-Dissolves slowly in mouth
1 every 1-2 hour4 mg if pt smokes within 30 min of waking
dN eat or drink while it is in mouth
wean after 6 weeks
nicotine patch - ANSWER-Transdermal absorption
16 and 24 hour
slow onset, steady state once at peak
dose decreased gradually
cannot Smoke w/patch on
monitor for nicotine toxicity
dispose of safely
Nicotine Nasal Spray - ANSWER-Rapid onset and peak
potential for abuse
nicotine inhaler - ANSWER-Puffs on inhaler for 20 min
dose weaned gradually over 12 weeks
adrs - cough, mouth irritation, dyspepsia
Zyban (bupropion) - ANSWER-Dopamine/Norepinephrine Reuptake inhibitor, used for
smoking cessation
start 1-2 weeks before quit date
150 mg for 3 days, then increase to 150mg bid, on to use nicotine replacement,
continue therapy for 7-12 weeks
DN give with seizure do, anorexia or bulemia
reduce dose in renal dysfunction
avoid in pregnancy
AE: insomnia, dizziness, dry mouth
Varenicline (Chantix) - ANSWER-- start 1 week before quit date
BW
- Serious neuropsychiatric events including depression, etc.
Warning
- Angioedema, hypersensitivty rxns, seizures, increase intoxicating effect of alcohol, and
serious skin reactions have occured.
Solutions
Lithium - ANSWER-Action: alters cation transport in the nerve and muscle
indication: euphoric mania, rapid cycling, maintenance therapy CKD,
AE: GI effects, tremor, polyuria
Pearls: monitor plasma levels, reduce dose w/renal failure, use caution w/ concurrent
diuretics, use to protect against suicide
Lamotrigine (Lamictal) - ANSWER-Action: affects sodium channel ion transport and
enhances the effect of GABA
indications: maintenance, monotherapy for bipolar disorder
AE: benign rash, GI effects, dizziness, HA, SJS!!!
Pearls: equal in efficacy to lithium, assess for rash, risk for SJS and multi organ failure,
take at bedtime
Valporic acid( depakene) - ANSWER-Action: affects ion transport and enhances the
activity of GABA
indications: acute mania, mixed mood, comomorbid substance abuse, multiple prior
episodes
AE: weight gain, GI effects
2nd generation antipsychotics - ANSWER-Risperidone
Quetiapine
Aripriprazole
cariprazine
lurasidone
quetapine
actions: DA, NE, 5HT receptor antagonists
Indications: acute bipolar depression, acute manic or mixed episodes, bipolar
maintenance/adjunct
AE: wt gain, sedation, GI effects
Pearls: eps, XR May improve adherence, monthly injection may improve adherence,
select 2nd gen antipsychotics first to decrease risk of SE and long term adverse effects
Nicotine Replacement Therapy (NRT) - ANSWER-Use for patients that smoke > 20
cigarettes/day
otc
gum is pregnancy cat C
patch is pregnancy d
, immeduaty after MI and stroke
nicotine gum - ANSWER-Improved cessation success
buccal absorption
follow directions or nicotine will release too quickly increasing AE
> 25 cig a day- 4 mg
< 25 cig a day -2 mg qhour
weans dose after 2-3 months
Nicotine Lozenge - ANSWER-Dissolves slowly in mouth
1 every 1-2 hour4 mg if pt smokes within 30 min of waking
dN eat or drink while it is in mouth
wean after 6 weeks
nicotine patch - ANSWER-Transdermal absorption
16 and 24 hour
slow onset, steady state once at peak
dose decreased gradually
cannot Smoke w/patch on
monitor for nicotine toxicity
dispose of safely
Nicotine Nasal Spray - ANSWER-Rapid onset and peak
potential for abuse
nicotine inhaler - ANSWER-Puffs on inhaler for 20 min
dose weaned gradually over 12 weeks
adrs - cough, mouth irritation, dyspepsia
Zyban (bupropion) - ANSWER-Dopamine/Norepinephrine Reuptake inhibitor, used for
smoking cessation
start 1-2 weeks before quit date
150 mg for 3 days, then increase to 150mg bid, on to use nicotine replacement,
continue therapy for 7-12 weeks
DN give with seizure do, anorexia or bulemia
reduce dose in renal dysfunction
avoid in pregnancy
AE: insomnia, dizziness, dry mouth
Varenicline (Chantix) - ANSWER-- start 1 week before quit date
BW
- Serious neuropsychiatric events including depression, etc.
Warning
- Angioedema, hypersensitivty rxns, seizures, increase intoxicating effect of alcohol, and
serious skin reactions have occured.
