NRNP 6675 WEEK 11 FINAL EXAM GRADED A+

NRNP 6675 WEEK 11 FINAL EXAM GRADED A+ The 1/2 life of lithium is about? 24 hours Fluoxetine is the SSRI with the ______ WD risk? lowest due to long half life What antipsychotics are good for pts who miss doses of their meds? Antipsychotics 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) Disulfiram's alcohol interactions persist for up to how long after the medication is stopped? LONG Half life--2-3 days persist up to 2 weeks following stopping What is the only TCA with a long half life? Protriptyline (Vivactil) Most psychotropics have a medium range 1/2 life of approx? 24 hours 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 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. 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 Fluoxetine has a half life of about? 2 weeks 1/2 life take 2.5 months to achieve steady state 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) _________induces it's own metabolism, hastening excretion and shortening 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. 3 multiple choice options 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. _____ 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 3 multiple choice options _______'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. Due to Gabapentin's serum pattern for dosage: @ 900 mg/day, how much is the patient absorbing? @ 0900mg/day---60% is absorbed. Due to Gabapentin's serum pattern for dosage: @ 1200 mg/day, how much is the patient absorbing? @ 1200 mg/day--50 % is absorbed. 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. Carbamazepine (Tegretol's) serum level drops after how long after stopping taking it? 1-2 months For Valproate (Depakote), ___ dose changes can have big effects once the level is beyond 50 mcg/mL? SMALL potency refers to a drug's> power per unit -or the amount of pharmacological activity per milligram. Delayed release= modified release "dont get absorbed until they have traveled to a specific site in the gut Intermediate release (IR) medications: dissolve rapidly in the GI tract and are absorbed in an hour or two the serum concentrations of IR medications spike quickly and then fall back down, leading to what? 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? can cause SE or efficacy problems. Bupropion can increase the risk of what? Seizures *IF the serum level peaks too high IR stimulants can lose ____ in the afternoon? efficacy due to IR effect The rise and fall of Haldol levels increases what? the likelihood of dystonic reactions in MODERATE RELEASE/DELAYED RELEASE dissolvable solutions or "dissolvable control", the medicine does what? slowly diffuses out of a semi-permeable membrane ex. Effexor ER capsules, Wellbutrin XL and Focalin XR in MODERATE RELEASE/DELAYED RELEASE is osmotic release pills, the medicine does what? is pushed out by a tiny pump that is powered by a osmotic flow of water across a semipermeable membrane ex. Concerta, Invega, and Effexor ER tablets Pros of Modified Release/Delayed Release meds? D. All of the above 3 multiple choice options Cons of Modified Release/Delayed Release meds? D. All of the above 3 multiple choice options Medicines that are preferred in IR? Benzos and stimulants Most ______ medications cannot be split or crushed without disrupting the integrity of the time-release mechanism? MR/delayed release Concerns when treating geriatric patients with psychotherapeutic drugs include all of the following EXCEPT? C. Elderly persons may metabolize psychotherapeutic drugs more rapidly 3 multiple choice options The treatment of others equitably and distribution of benefits/burdens fairly is known as which of the following? B. Justice a fair an equitable distribution of health resources 3 multiple choice options Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics of which of the following PD? C. Dependent PD 3 multiple choice options According to Sullivan, which of the following are consistent with a mentor/mentee relationship? C. Goals for the mentoring are set mutually 3 multiple choice options The need for NPs to practice to the full extent of their education and training is necessary for which of the following reasons? B, C & D 3 multiple choice options The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A. Diet 3 multiple choice options Trifluphenazine is also known as? Stelazine first generation antipsychotic Lillipucin hallucinations are what? "little people or kids" hallucinations What is a red flag that indicates Lewy Body? Lillipucin hallucinations hallucinations of little people or kids What is a key question to ask someone with dementia when performing an evaluation of mental status to show confabulation?