Chapter 2 Flashcards
(155 cards)
1
Q
What is the normal range for Aspartate aminotransferase (AST)?
A
0-40 units/L
2
Q
What does Aspartate aminotransferase (AST) measure?
A
Hepatocellular damage
3
Q
What is the normal range for Alanine aminotransferase (ALT)?
A
0-40 units/L
4
Q
What does Alanine aminotransferase (ALT) measure?
A
Hepatocellular damage
5
Q
What is the normal range for y-Glutamyl transferase (GGT)?
A
0-30 units/L
6
Q
What does y-Glutamyl transferase (GGT) indicate?
A
Cholestasis: Bile flow, either extrahepatic or intrahepatic
7
Q
What is the normal range for Alkaline phosphatase (ALP)?
A
30-120 international units/L
8
Q
What does Alkaline phosphatase (ALP) measure?
A
Cholestasis: Bile flow, either extrahepatic or intrahepatic
9
Q
What is the normal range for Creatine kinase (CK)?
A
<0-139 units/L
10
Q
What does Creatine kinase (CK) indicate?
A
Muscle injury: Found in heart, brain, skeletal muscle
11
Q
What is the normal range for Urea nitrogen (BUN)?
A
8-18 mg/dL (2.87-6.43 mmol/L)
12
Q
What does Urea nitrogen (BUN) assess?
A
Assessment of kidney function
13
Q
What is the normal range for Creatinine?
A
0.64-1.2 mg/dL (56.58-106.08 umol/L)
14
Q
What does Creatinine indicate regarding kidney function?
A
Glomerular filtration rate (GFR)
15
Q
What is the normal GFR value?
A
> 90 mL/min/1.73m2
16
Q
What factors can affect the normal range of Creatinine?
A
Age, gender, and ethnicity norms will vary
17
Q
True or False: Creatinine is a more sensitive and specific indicator of kidney disease than BUN.
A
True
18
Q
What can potentially elevate Creatinine levels?
A
Impaired kidney function, significant dehydration
19
Q
What is a common condition that can cause elevated levels of Creatine kinase (CK)?
A
Myocardial infarction (CK-MB specific to cardiac patients)
20
Q
Fill in the blank: Elderly patients often have normal creatinine but _______ reduced GFR because of reduced muscle mass.
A
30%
21
Q
When is there generally no dose adjustment or contraindications to use most psychotropics?
A
When GFR >60 mL/min/1.73m2
22
Q
What can potentially decrease Creatinine levels?
A
Chronic alcoholic liver disease
23
Q
What can cause elevated levels of y-Glutamyl transferase (GGT)?
A
Alcohol abuse, chronic alcoholic liver disease
24
Q
What can cause elevated Alkaline phosphatase (ALP) levels?
A
Gallbladder disease, liver disease
25
What might elevated Creatine kinase (CK) indicate?
Myositis, vigorous exercise, neuroleptic malignant syndrome
26
What laboratory testing is recommended for patients taking valproate?
Liver panel (ALT, AST, ALP, bilirubin, albumin, total protein), complete blood count with WBC differential, and platelet count
## Footnote
Monthly for the first several months, then every 6-24 months
27
What is the therapeutic level of valproate?
50-120 mcg/mL
## Footnote
Monitoring levels is crucial to ensure efficacy and safety.
28
What are the common hematologic complications associated with valproate?
Thrombocytopenia and neutropenia
## Footnote
Monitor closely and consider discontinuation of the drug if significant bone marrow depression occurs.
29
What should be done if AST/ALT elevations are >2-3x upper limit of normal while on valproate?
Discontinue valproate
## Footnote
Elevated transaminases can indicate liver dysfunction.
30
What is the incidence of Stevens-Johnson syndrome with carbamazepine?
5% incidence
## Footnote
Increased risk noted particularly in patients of Asian ancestry with the HLA-B*1502 allele.
31
What is recommended before starting carbamazepine in patients of Asian ancestry?
Genetic testing for the HLA-B*1502 allele
## Footnote
This screening helps mitigate risk for Stevens-Johnson syndrome.
32
What are the signs and symptoms of liver dysfunction that patients on valproate should be educated to recognize?
Abdominal pain, nausea, vomiting, and jaundice
## Footnote
Patients should contact NP if these symptoms occur.
33
When do hepatic enzyme elevations occur most often in patients taking valproate?
In the first 6 months of therapy
## Footnote
More common in children.
34
What is the recommended frequency of laboratory testing for valproate during the first several months of therapy?
Monthly
## Footnote
Subsequently, testing occurs every 6-24 months.
35
What should patients on valproate be educated about regarding hematologic dysfunction?
Signs include easy bruising, bleeding that won't stop, slow healing wounds, high fever
## Footnote
Patients should report these symptoms to their NP.
36
What is the rare complication associated with valproate in children under 10 years of age?
Liver failure
## Footnote
Usually occurs in children with developmental disabilities and significant seizure disorders.
37
What initial laboratory tests are recommended for lithium therapy?
• Creatinine/BUN, GFR, TSH, serum electrolytes, CBC with WBC differential, serum hCG, urinalysis
## Footnote
Baseline EKG is also recommended.
38
How often should lithium serum levels be checked during initial therapy?
Every 4-5 days after 4 days on medication
## Footnote
Check serum lithium levels (12-hour post-dose [trough]).
39
What long-term laboratory tests are recommended for lithium therapy?
• Creatinine/BUN; GFR, TSH, UA, CBC, and 12-hour lithium level every 4-8 weeks to every 6-12 months
## Footnote
Depending on reliability of patient and kidney function.
40
What is the recommended acute treatment lithium level range?
0.8-1.2 mmol/L
## Footnote
Maintenance level is 0.6-1.0 mmol/L.
41
What is the effect of dehydration on lithium levels?
Increases lithium levels
## Footnote
1 sodium intake causes lithium reabsorption.
42
What are the symptoms of lithium toxicity?
• Lethargy, fatigue, clumsiness, weakness, muscle cramping, nausea, vomiting, severe tremor, blurred vision, confusion
## Footnote
Symptoms typically begin at a lithium level of 1.5 mmol/L.
43
What are the signs of lithium toxicity?
• Nystagmus, ataxia, increased deep tendon reflexes, altered mental status, cardiac arrhythmias
## Footnote
Worsening neurologic symptoms correspond to highest lithium levels.
44
True or False: Lithium is contraindicated in acute renal failure.
True
## Footnote
Also contraindicated in states of severe dehydration or sodium depletion.
45
What should patients be educated on regarding lithium therapy?
• Signs and symptoms of lithium toxicity
• Medications to avoid
• Necessity of regular blood monitoring
• Avoiding dehydration
## Footnote
Education is crucial for patient safety.
46
What is the absorption and excretion characteristic of lithium?
Rapidly absorbed in the GI tract; not metabolized, almost 100% excreted unchanged in urine
## Footnote
This highlights its narrow therapeutic index.
47
What is the recommended EKG monitoring frequency for patients over 50 years old on lithium?
Every 6-12 months
## Footnote
This is part of long-term monitoring.
48
What renal function value indicates a need to reduce lithium dose?
GFR <60 mL/min (<1.00 mL/s)
## Footnote
Monitoring closely is essential for patient safety.
49
What types of medications can increase lithium levels?
* ACE inhibitors (ACE)
* Angiotensin II receptor blockers (ARB)
* Nonsteroidal anti-inflammatories (NSAIDs)
* Tetracyclines
* Metronidazole
* Potassium-sparing diuretics
* Thiazide diuretics
## Footnote
These medications can lead to higher concentrations of lithium in the bloodstream, necessitating careful monitoring.
50
Which medications can decrease lithium levels?
* Theophylline
## Footnote
Theophylline is noted for its ability to lower lithium concentrations, which may affect treatment efficacy.
51
What medications have an unpredictable effect on lithium levels?
* Loop diuretics
* Calcium channel blockers
## Footnote
These medications may either increase or decrease lithium levels, requiring close monitoring.
52
Is the use of medications that affect lithium levels contraindicated in patients on lithium?
No
## Footnote
While not contraindicated, close monitoring of lithium levels is recommended when these medications are used.
53
What is a common thyroid effect in patients taking lithium?
Thyroid hypofunction (elevated TSH) in up to 23% of people
## Footnote
This condition may lead to an increased incidence of goiter among those on lithium.
54
What are some potential cardiac effects of lithium?
Rare adverse cardiac events; conduction problems
## Footnote
These cardiac effects, while rare, may pose significant risks for some patients.
55
What renal side effects are associated with lithium use?
Polyuria, polydipsia
## Footnote
These effects are common and may require management strategies.
56
What is a common neurological side effect of lithium?
Fine hand tremor
## Footnote
This tremor can be distressing for patients and may affect their quality of life.
57
What general side effect is associated with lithium treatment?
Weight gain
## Footnote
Weight gain can be a significant concern for patients, affecting adherence to treatment.
58
Fill in the blank: Close monitoring of lithium level is recommended or consideration of a _______ in treatment regimen.
change
## Footnote
Adjustments to the treatment regimen may be necessary based on lithium levels and patient response.
59
What laboratory test is used exclusively for monitoring patients on Clozapine?
Absolute neutrophil count (ANC)
## Footnote
ANC is crucial for ensuring patient safety while on Clozapine due to its risk of agranulocytosis.
60
What is the minimum ANC required to initiate therapy with Clozapine?
ANC ≥1500/mm3
## Footnote
This threshold is critical for starting treatment to reduce risks associated with low neutrophil counts.
61
What action should be taken if a patient's ANC falls below 1000/mm3 while on Clozapine?
Interrupt treatment
## Footnote
This is necessary to prevent serious complications such as severe neutropenia.
62
What is the recommended monitoring schedule for ANC during the first year of Clozapine treatment?
Weekly for 6 months, then every 2 weeks for 6 months, then monthly if ANC ≥1500/mm3
## Footnote
This schedule helps in closely monitoring the patient’s neutrophil levels.
63
What is the significant risk associated with Clozapine treatment?
Agranulocytosis (1% to 2%)
## Footnote
Agranulocytosis is a potentially life-threatening condition that requires careful monitoring.
64
What is the Clozapine Risk Evaluation and Mitigation Strategy (REMS) Program?
A patient registry for Clozapine
## Footnote
This program aims to reduce the risk of severe neutropenia and is a centralized point of access for prescribers and pharmacies.
65
True or False: Clozapine is available through any pharmacy.
False
## Footnote
Clozapine can only be dispensed through pharmacies that are certified under the REMS Program.
66
What laboratory parameter is indicated for a diagnosis of microcytic anemia?
MCV <78 fL
## Footnote
Microcytic anemia is characterized by smaller than normal red blood cells, reflected in a low MCV.
67
What laboratory parameter indicates macrocytic anemia?
MCV >100 fL
## Footnote
Macrocytic anemia involves larger than normal red blood cells, leading to higher MCV values.
68
What is the normal range for hemoglobin in males?
13.5-18.0 g/dL (135-180 g/L)
## Footnote
Hemoglobin levels are used to assess anemia and overall blood health.
69
What condition is indicated by a platelet count of 70,000/mm3?
Thrombocytopenia
## Footnote
This condition refers to a lower than normal platelet count, which can lead to bleeding issues.
70
Fill in the blank: The normal range for hemoglobin in females is _______.
12.5-14.0 g/dL (125-140 g/L)
## Footnote
Hemoglobin levels can vary based on sex, and these ranges are essential for diagnosing anemia.
71
What are some symptoms of anemia?
* Fatigue
* Weakness
* Depression
## Footnote
Anemia can lead to various symptoms due to reduced oxygen delivery to tissues.
72
What could be a cause of macrocytic anemia?
* Vitamin B12 deficiency
* Folate deficiency
* Medications like valproate
* Interferon
## Footnote
These factors can disrupt normal red blood cell production, leading to larger cells.
73
For a patient receiving valproate therapy, regular monitoring is recommended for all of the following except:
C. TSH
## Footnote
Regular monitoring for ALT, AST, bilirubin, and platelet count is essential in valproate therapy.
74
What are the laboratory results for a 76-year-old woman with worsening fatigue and being treated with an SSRI?
* Hb = 9.3 g/dL (13-17) (93 g/L [130-170])
* MCV = 71 fL (80-96 fL)
## Footnote
These results indicate possible anemia.
75
The laboratory results of the 76-year-old woman most likely represent:
D. Iron-deficiency anemia
## Footnote
The low Hb and MCV suggest iron-deficiency anemia rather than other types of anemia.
76
A potential laboratory indicator for alcohol abuse is:
C. Elevated alkaline phosphatase
## Footnote
Elevated alkaline phosphatase can indicate liver issues related to alcohol use.
77
What is the most accurate laboratory measurement for kidney function?
Calculated glomerular filtration rate (GFR)
## Footnote
Other options include serum creatinine, blood urea nitrogen (BUN), and serum creatine kinase (CK), but GFR is the most accurate.
78
Which medication does not require initial laboratory testing before implementing therapy?
Lamotrigine
## Footnote
Carbamazepine, valproate, and lithium require initial laboratory testing.
79
Define a 'substrate' in the context of drug metabolism.
A medication or substance that is metabolized by an isoenzyme
## Footnote
It utilizes a specific enzymatic pathway to reach its drug site of action and/or be eliminated.
80
Name one clinical example of a CYP450 2D6 substrate.
Fluoxetine
## Footnote
Other examples include paroxetine, sertraline, venlafaxine, duloxetine, all tricyclic antidepressants (TCAs), haloperidol, risperidone, iloperidone, and aripiprazole.
81
List two medications that are CYP450 1A2 substrates.
* Duloxetine
* Mirtazapine
## Footnote
Other examples include clozapine, olanzapine, and asenapine.
82
Which CYP450 enzyme has about 50% of all prescription medications as substrates?
CYP450 3A4
## Footnote
This includes many common medications such as sildenafil, atorvastatin, simvastatin, venlafaxine, and alprazolam.
83
True or False: Blood urea nitrogen (BUN) is the most accurate measurement for kidney function.
False
## Footnote
The calculated glomerular filtration rate (GFR) is the most accurate measurement.
84
Fill in the blank: A medication or substance that utilizes a specific enzymatic pathway is called a _______.
substrate
## Footnote
This term is used in the context of drug metabolism.
85
What is the significance of CYP450 drug-metabolizing isoenzymes?
They are a potential source of drug-drug interactions
## Footnote
Understanding these isoenzymes helps in predicting how drugs will interact with each other.
86
What is the role of an inhibitor in drug metabolism?
Blocks a specific enzymatic pathway, keeps substrate from exiting, blocks the activity of the isoenzyme, limiting substrate excretion, allowing increase in substrate levels, and possible risk of substrate-induced toxicity
## Footnote
Inhibitors affect drug metabolism by preventing the normal breakdown of drugs, leading to increased concentrations in the body.
87
What is the function of an inducer in drug metabolism?
Accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway, leading to a reduction in substrate level
## Footnote
Inducers enhance drug metabolism, which can decrease the effectiveness of medications by reducing their levels in the body.
88
Which medications are considered CYP450 2D6 inhibitors?
* Fluoxetine
* Paroxetine
* Bupropion
* Duloxetine
## Footnote
These medications can increase substrate levels of CYP450 2D6 substrates, potentially leading to toxicity.
89
What is the consequence of using CYP450 2D6 inhibitors with their substrates?
Increase in substrate levels, potentially leading to substrate-induced toxicity
## Footnote
This interaction can result in serious side effects due to elevated drug concentrations.
90
List some CYP450 1A2 inhibitors.
* Fluvoxamine
* Fluoxetine
* Paroxetine
* Sertraline
* Cimetidine
* Fluoroquinolones
## Footnote
These drugs can cause increased substrate levels of CYP450 1A2, leading to toxicity.
91
What effect do CYP450 3A4 inhibitors have on substrate levels?
Result in an increase in substrate levels, potentially leading to substrate-induced toxicity
## Footnote
Examples of CYP450 3A4 inhibitors include erythromycin and clarithromycin.
92
What is the effect of St. John's wort as a CYP450 3A4 inducer?
Can lead to reduced target drug levels and diminished therapeutic effect, possible treatment failure
## Footnote
This is particularly concerning for medications like antiretrovirals and oral contraceptives.
93
Fill in the blank: Erythromycin and clarithromycin are examples of CYP450 _______ inhibitors.
3A4
## Footnote
These antibiotics can significantly affect the metabolism of drugs processed by this enzyme.
94
What is the impact of carbamazepine on CYP450 enzymes?
CYP1A2, CYP2C19, CYP3A4/5 inducer
## Footnote
Carbamazepine can induce multiple cytochrome P450 enzymes, affecting the metabolism of numerous drugs.
95
True or False: The concomitant use of fluoxetine and a CYP450 2D6 substrate can lead to decreased substrate levels.
False
## Footnote
Fluoxetine increases substrate levels, which can lead to toxicity.
96
Identify a potential risk associated with using CYP450 inducers.
Reduced target drug levels and diminished therapeutic effect
## Footnote
This can lead to treatment failures, especially in critical medication regimens.
97
Which CYP pathway is olanzapine an inhibitor of?
CYP1A2 pathway
## Footnote
This interaction could be relevant to understanding the effects of ciprofloxacin.
98
What is the role of ciprofloxacin in relation to the CYP pathways?
Inhibiting of the CYP3A4 pathway
## Footnote
This could lead to increased levels of other medications metabolized by this pathway.
99
What is the earliest marker to become positive post-HBV exposure?
HBV core IgM ab
## Footnote
Denotes acute infection
100
What does HBsAg indicate?
Always growing, surrogate marker for HBV
## Footnote
Indicates active HBV infection
101
What does HBeAg signify?
A time when HBV is extra contagious, extra growing
## Footnote
Indicates high viral replication
102
What level of hepatic enzymes is considered elevated?
≥10 x ULN
## Footnote
Indicates possible acute infection or liver damage
103
What are the characteristics of chronic disease markers in patients?
Patient without symptoms, NL or slightly elevated hepatic enzymes
## Footnote
NL = Normal Level
104
What does the presence of HBsAg indicate?
Only present if HBV on board
## Footnote
Surrogate marker for HBV
105
What does HBsAb (Anti-HBs) indicate?
A protective antibody, unable to get HBV in the future
## Footnote
Indicates immunity to HBV
106
What does 'B=Bye' refer to in the context of HBV?
No HBV on board
## Footnote
Indicates recovery or vaccination
107
What is the significance of normalized hepatic enzymes?
Indicates resolution of liver inflammation or damage
## Footnote
Suggests recovery from HBV infection
108
Which of the following medications does not require initial laboratory testing before implementing therapy?
Lamotragine
109
For a patient receiving valproate therapy, regular monitoring for all of the following is recommended except:
TSH
110
A 76 year old woman presents with worsening fatigue during the past 6 months. She is currently being treated with an SSRI for major depressive disorder. Her lab results are as follows: Hb: 9.3, MCV=71. This most likely represents:
Iron deficiency anemia
111
Patient on Olanzapine and taking cipro. She's been very sleepy, and this is possibly due to the cipro:
Inhibiting of the CYP1A2 pathway
112
After you realize that the cipro is inhibiting the olanzapine, what is next course of action?
Reassurance of increased symptoms and schedule follow up in 3 days.
113
Which of the following meds should an alternative to oral contraceptive pills be used as a method of contraception?
Oxcarbazepine
114
There is a potential drug interaction between oxcarbazepine and oral contraceptives because oxcarbazepine is an:
Inducer of CYP3A4
115
True or false: Hep B is transmitted via sexual fluids
True
116
True or false: the most efficient route of transmission for hep c virus is sexual activity
False
117
True or false: vertical transmission ( mom to baby) of hep C is quite common
False
118
A 45 year old man with schizophrenia and alcohol dependence presents with the following lab results:
Anti-HCV with HCV RNA
HBsAB: Positive
Anti-HAV:Negative
You offer immunization against:
Hepatitis A
119
A 44 year old with possible bipolar disorder has the following laboratory data:
HBsAg: Present
AST: 56
ALT: 98
These findings are most consistent with:
Chronic hepatitis B
120
The cranial nerve responsible for facial expressions and secretions of tears and saliva is:
VII
121
The cranial nerve responsible for chewing is:
V
122
What meds can commonly cause hypothyroidism?
Lithium, amiodarone, interferon
123
Is lid retraction oa symptom of hyperthyroidism or hypothyroidism or both?
Hyperthyroidism
124
You're following a patient for anxiety and depression, which have been stable for many years on sertraline. She is 2 months postpartum and relates diff with sleep, irritability, fatigue, return on anxiety. She says, " I'm doing fine with breastfeeding, and he is a good baby." You respond:
I'd like to get a TSH to check your thyroid. ( assessment data).
125
What are the components of Metabolic Syndrome?
* Large waistline
* Hypercholesterolemia
* Low HDL-cholesterol
* High blood pressure
* High glucose
## Footnote
These components are used to diagnose Metabolic Syndrome and indicate increased health risks.
126
What causes Metabolic Syndrome?
* Overweight and obesity
* Inactive lifestyle
* Insulin resistance
* Older age
* Genetics
## Footnote
These factors contribute to the development of Metabolic Syndrome and its associated health risks.
127
What are the risks associated with Metabolic Syndrome?
* Heart disease
* Diabetes
* Renal dysfunction
* Stroke
## Footnote
Metabolic Syndrome significantly increases the risk of these serious health conditions.
128
What lifestyle changes are recommended for treating Metabolic Syndrome?
* Healthy diet
* Increasing physical activity
* Smoking cessation
## Footnote
These lifestyle modifications are crucial for weight loss and overall health improvement.
129
What is the goal of treating each component of Metabolic Syndrome?
Treat each component to goal as determined by nationally recognized guidelines.
## Footnote
This ensures a standardized approach to managing the syndrome and its risk factors.
130
How can LDL-cholesterol be reduced in Metabolic Syndrome?
With statins.
## Footnote
Statins are commonly prescribed to lower LDL-cholesterol levels in patients.
131
What are some agents used to reduce high blood pressure in Metabolic Syndrome?
* Diuretics
* ACE inhibitors
* ARBs
* CCBs
## Footnote
These medications help manage hypertension effectively.
132
What role does Metformin play in patients on second-generation antipsychotics?
Indicated for treatment of impaired glucose tolerance to slow or impede the development of Type 2 diabetes.
## Footnote
Metformin is particularly beneficial in managing metabolic side effects of atypical antipsychotics.
133
What are the effects of Metformin?
* Suppresses glucose production in the liver
* Stabilizes blood sugar levels
* Reduces hunger
* Promotes fat loss
* Stops or reverses weight gain associated with atypical antipsychotics
## Footnote
These effects make Metformin an important medication for weight management in certain patients.
134
What is the most common adverse effect of Metformin?
GI intolerability.
## Footnote
Although it is the most common side effect, it rarely leads to discontinuation of the medication.
135
What is the dosing strategy for Metformin?
Tapered dosing up to 2000 mg/day in divided doses.
## Footnote
This approach helps minimize side effects and ensures effective management.
136
What is a contraindication for Metformin use?
GFR <30 mL/min/1.73m2.
## Footnote
This contraindication is crucial for patient safety, as impaired kidney function can lead to serious complications.
137
What potential long-term effect does Metformin have on vitamin levels?
B12 loss.
## Footnote
Long-term use of Metformin may lead to vitamin B12 deficiency, requiring monitoring and possible supplementation.
138
True or False: Metformin use is robustly supported for preventive use in antipsychotic-naive patients.
False.
## Footnote
Evidence for preventive use in these patients is less robust compared to those already on antipsychotics.
139
Which of the following second generation antipsychotics should be avoided in an overweight patient at risk for diabetes?
Olanzapine
140
Melvin is a 45 year old man with obsessive compulsive disorder, schozoid personality disorder, HTN, HLD, and type 2 DM. Which of the following medications are indicated?
Moderate intensity statin therapy
141
What is no longer recommended for treating atherosclerotic coronary vascular disease (ASCVD)?
Treating to LDL targets is no longer recommended
## Footnote
Current guidelines suggest focusing on patient risk categories instead.
142
What are the four categories for statin therapy recommendations based on patient risk?
* ASCVD
* Age <75 years
* Age >75 years
* LDL ≥190 mg/dL (4.9 mmol/L)
* Diabetes
* LDL 70-189 mg/dL (1.8-4.9 mmol/L)
## Footnote
These categories guide the dosing of statins.
143
What is the statin therapy recommendation for patients with ASCVD aged <75 years?
High-dose statin
## Footnote
This recommendation is based on the patient’s risk factors.
144
What is the statin therapy recommendation for patients aged >75 years with LDL ≥190 mg/dL?
High-dose statin
## Footnote
This is part of the risk-based approach to statin therapy.
145
What is the statin therapy recommendation for patients with diabetes and LDL 70-189 mg/dL?
Moderate- or high-dose statin
## Footnote
The recommendation may vary depending on additional risk factors.
146
What is the LDL-C reduction approximate for high-dose statin therapy?
LDL-C reduction approx. ≥50%
## Footnote
This indicates a significant impact on lowering LDL cholesterol.
147
What is the LDL-C reduction approximate for moderate-dose statin therapy?
LDL-C reduction approx. 30-49%
## Footnote
Moderate-dose statins provide a lesser reduction compared to high-dose.
148
List three examples of high-dose statins.
* Atorvastatin 40-80 mg
* Rosuvastatin 20-40 mg
* Simvastatin 20-40 mg
## Footnote
These doses are considered high for effective treatment.
149
List two examples of moderate-dose statins.
* Atorvastatin 10-20 mg
* Rosuvastatin 5-10 mg
* Pravastatin 40-80 mg
## Footnote
Moderate doses are used for patients with lower risk profiles.
150
Fill in the blank: Statin doses are recommended based on patient risk and are based on where the patient falls in _______.
[one of four categories]
## Footnote
This categorization is essential for appropriate statin therapy.
151
True or False: Moderate- or high-dose statin therapy is recommended for patients with diabetes and LDL 70-189 mg/dL plus a 10-year CVD risk ≥7.5%.
True
## Footnote
This recommendation emphasizes the importance of considering both LDL levels and CVD risk.
152
Melvin who has ocd, schizoid personality disorder, htn, hld, type 2 dm develops psychotic symptoms requiring medication treatment. Based on his metabolic profile, which medication would be most appropriate for Melvin?
Ziprasidone because it has the lowest metabolic profile
153
Lab testing for a 34 year old male who has been receiving valproate therapy for the past 2 months for bipolar disorder reveals AST=240 and ALT=132. The PMHNP considers:
Discontinuing valproate therapy
154
A 54 year old man presents to the ED with symptoms of lethargy, weakness, blurred vision, and confusion. His medical history includes manic depression, dyslipidemia, and htn. He is currently being treated with lithium, a statin, and an anti hypertension medication that was started in the past week. Suspecting lithium toxicity, which of the following is least likely to contribute to his current symptoms?
A beta blocker
155
When considering clozapine. Regular monitoring of what is required?
ANC
