NURS 615 Exam II 2024
What blood values should be monitored with carbamazepine? - CORRECT ANSWER
Plasma carbamazepine levels should be monitored on a regular basis. The therapeutic
range is 4 to 12 mcg/L. Higher levels can lead to toxic symptoms consisting of initial
adverse effects and also hypertension, tachycardia, ECG changes, stupor, agitation,
nystagmus, urinary retention, respiratory depression, seizures, and coma. Children and
elderly patient may develop toxicity levels below 12.
CBC every 3 to 4 months
Affects RBC, WBC, Platelets
Agranulocytosis, Anemia
What is the pharmacodynamics of carbamazepine? - CORRECT ANSWER
Carbamazepine is metabolized in the liver and has the unique ability to induce its own
metabolism (autoinduction). Due to autoinduction, initial concentrations within
therapeutic range may later fall despite good compliance. It also induces the
metabolism of many CYP450 enzymes and other substances. Slowly but well absorbed
half life of about 30 hours, shortens to 15 hours when given repeatedly
The exact mechanism of action of carbamazepine is not known, but they are thought to
affect the sodium channels, slowing influx of sodium in the cortical neurons and slowing
the spread of abnormal activity. Carbamazepine exerts its effect by depressing
transmission in the nucleus ventralis anterior of the thalamus. This area is associated
with the spread of seizure discharge.
•Absorption and Distribution
Carbamazepine is absorbed through the stomach, the suspension being absorbed more
quickly than the tablet form. Absorption from the immediate-release tablets is slow and
erratic because of its slow water solubility. The drug is highly lipophilic, resulting in high
body tissue binding.
•Metabolism and Excretion
Excretion is through feces and urine.
Average blood levels of carbamazepine occur approximately 6 hours after
administration. Half-life can be as long as 65 hours with initial dosing, but is typically 12
to 17 hours as administration continues. It is noteworthy that the half-life after a single
dose is much longer than the half-life after long-term use. Steady state is attained in 2 to
4 days.
, What should families be taught regarding the monitoring of seizure activity? -
CORRECT ANSWER Patients should be monitored for seizure activity, severity, and
duration. Patient should carry medical identification for the seizure disorder. Patient
should report any mood changes or suicidal thoughts. Prevention of seizures. Do not
abruptly end medication increases risk of seizures
What electrolyte imbalance is noted with the administration of topiramate? - CORRECT
ANSWER Patients taking topiramate may have decreased concentrations of
bicarbonate due to inhibition of carbonic anhydrase and increased renal bicarbonate
loss, leading to hyperchloremic metabolic acidosis. Severe metabolic acidosis has been
reported in infants receiving a topiramate dose of 5mg/kg/day. Serum bicarbonate levels
should be monitored at baseline and periodically throughout therapy.
What is the pregnancy category for valproate? - CORRECT ANSWER Pregnancy
Category X.
What instructions will you provide to a woman who wants to get pregnant and has a
seizure disorder controlled with valproate? - CORRECT ANSWER Switch to another
antiseizure medication such as Keppra
Use of these drugs during the first trimester of pregnancy is associated with neural tube
defects including spina bifida. Their use should be restricted to cases in which a
woman's life would be endangered without them and then only beyond the first
trimester. They should be used with caution during lactation.
What are the precautions and contraindications for the tricyclic antidepressants? -
CORRECT ANSWER•Most significant risks are cardiac conduction disorder. At highest
risk are children and the elderly therefore, baseline ECG and periodic monitoring should
be performed. The most common cardiovascular effect is sinus tachycardia due to the
inhibition of norepinephrine reuptake and anticholinergic action. Contribute to the
slowing of depolarization of the cardiac muscle, contributing to prolongation of the QRS
complex and the PR/QT intervals.
Can be cardiotoxic in overdose.
•TCAs have a direct alpha-adrenergic blocking effect and quindine-like effect on the
myocardium, they are contraindicated for those with cardiovascular disorders.
•Due to their acetycholine blocking effect they should be used with caution in those who
have glaucoma, prostatic hypertrophy, or urinary incontinence.
•Should not be prescribed in combination with MAOIs or individuals who have
demonstrated hypersensitivity in this class.
What blood values should be monitored with carbamazepine? - CORRECT ANSWER
Plasma carbamazepine levels should be monitored on a regular basis. The therapeutic
range is 4 to 12 mcg/L. Higher levels can lead to toxic symptoms consisting of initial
adverse effects and also hypertension, tachycardia, ECG changes, stupor, agitation,
nystagmus, urinary retention, respiratory depression, seizures, and coma. Children and
elderly patient may develop toxicity levels below 12.
CBC every 3 to 4 months
Affects RBC, WBC, Platelets
Agranulocytosis, Anemia
What is the pharmacodynamics of carbamazepine? - CORRECT ANSWER
Carbamazepine is metabolized in the liver and has the unique ability to induce its own
metabolism (autoinduction). Due to autoinduction, initial concentrations within
therapeutic range may later fall despite good compliance. It also induces the
metabolism of many CYP450 enzymes and other substances. Slowly but well absorbed
half life of about 30 hours, shortens to 15 hours when given repeatedly
The exact mechanism of action of carbamazepine is not known, but they are thought to
affect the sodium channels, slowing influx of sodium in the cortical neurons and slowing
the spread of abnormal activity. Carbamazepine exerts its effect by depressing
transmission in the nucleus ventralis anterior of the thalamus. This area is associated
with the spread of seizure discharge.
•Absorption and Distribution
Carbamazepine is absorbed through the stomach, the suspension being absorbed more
quickly than the tablet form. Absorption from the immediate-release tablets is slow and
erratic because of its slow water solubility. The drug is highly lipophilic, resulting in high
body tissue binding.
•Metabolism and Excretion
Excretion is through feces and urine.
Average blood levels of carbamazepine occur approximately 6 hours after
administration. Half-life can be as long as 65 hours with initial dosing, but is typically 12
to 17 hours as administration continues. It is noteworthy that the half-life after a single
dose is much longer than the half-life after long-term use. Steady state is attained in 2 to
4 days.
, What should families be taught regarding the monitoring of seizure activity? -
CORRECT ANSWER Patients should be monitored for seizure activity, severity, and
duration. Patient should carry medical identification for the seizure disorder. Patient
should report any mood changes or suicidal thoughts. Prevention of seizures. Do not
abruptly end medication increases risk of seizures
What electrolyte imbalance is noted with the administration of topiramate? - CORRECT
ANSWER Patients taking topiramate may have decreased concentrations of
bicarbonate due to inhibition of carbonic anhydrase and increased renal bicarbonate
loss, leading to hyperchloremic metabolic acidosis. Severe metabolic acidosis has been
reported in infants receiving a topiramate dose of 5mg/kg/day. Serum bicarbonate levels
should be monitored at baseline and periodically throughout therapy.
What is the pregnancy category for valproate? - CORRECT ANSWER Pregnancy
Category X.
What instructions will you provide to a woman who wants to get pregnant and has a
seizure disorder controlled with valproate? - CORRECT ANSWER Switch to another
antiseizure medication such as Keppra
Use of these drugs during the first trimester of pregnancy is associated with neural tube
defects including spina bifida. Their use should be restricted to cases in which a
woman's life would be endangered without them and then only beyond the first
trimester. They should be used with caution during lactation.
What are the precautions and contraindications for the tricyclic antidepressants? -
CORRECT ANSWER•Most significant risks are cardiac conduction disorder. At highest
risk are children and the elderly therefore, baseline ECG and periodic monitoring should
be performed. The most common cardiovascular effect is sinus tachycardia due to the
inhibition of norepinephrine reuptake and anticholinergic action. Contribute to the
slowing of depolarization of the cardiac muscle, contributing to prolongation of the QRS
complex and the PR/QT intervals.
Can be cardiotoxic in overdose.
•TCAs have a direct alpha-adrenergic blocking effect and quindine-like effect on the
myocardium, they are contraindicated for those with cardiovascular disorders.
•Due to their acetycholine blocking effect they should be used with caution in those who
have glaucoma, prostatic hypertrophy, or urinary incontinence.
•Should not be prescribed in combination with MAOIs or individuals who have
demonstrated hypersensitivity in this class.
