NURS nurs 615Exam 2 Transcript Strathmann

1. What blood values should be monitored with carbamazepine? a. You should check a CBC every three to four months. In the US, the label for carbamazepine contains warnings on the effects of the body's production of red blood cells, white blood cells, and platelets. Rarely there are major effects of aplastic anemia and agranulocytosis reported. More commonly there are minor changes such as decrease white blood cell count or platelet counts that generally do not progress to more serious problems. 2. What is the pharmacodynamics of carbamazepine? a. Carbamazepine auto-induces metabolism leading to lower levels in spite of good compliance. Carbamazepine is relatively is relatively slowly, but well absorbed after oral administration. Its plasma half-life is about 30 hours when it is given as a single dose, but it is a strong inducer of hepatic enzymes and the plasma half-life shortens to about 15 hours when it is given repeatedly. 3. What should families be taught regarding the monitoring of seizure activity? a. Patient and family education focuses on prevention seizures, patient safety, and quality of life issues. The clinician and patient must establish mutually acceptable goals regarding treatment. The patient should not abruptly discontinue their medication do the increased risk of seizures 4. What electrolyte imbalance is noted with the administration of topiramate? a. Decrease in serum bicarbonate due to inhibition of carbonic anhydrase and increase renal bicarbonate- leading to hypercholemic metabolic acidosis. (He skipped this question) 5. What is the pregnancy category for valproate? a. Recently within the past few weeks the FDA has stopped using the categories for pregnancy safety, but when they were using them before valproate was a category X, which is a because valproate is a known teratogen. It may be taken after the first trimester if necessary and this use is very popular in Europe. 6. What instructions will you provide to a woman who wants to get pregnant and has a seizure disorder controlled with valproate? a. I would recommend switching to another anticonvulsant. Keppra is good, then restart valproate in the second trimester, but this is best monitored by a high-risk obstetrician or an NFM 7. What are the precautions and contraindications for the tricyclic antidepressants? a. Most common side effects include dry mouth, sedation, constipation, and increased appetite, blurred vision, tinnitus, euphoria, and mania. These are all consistent with some anticholinergic activity. Caution in patients with cardiac disease tricyclics can behave like class 1 antiarrhythmics and as such they could theoretically terminate ventricular fibrillation, decrease cardiac contractility, and increase collateral blood circulation to ischemic my heart muscles