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Exam (elaborations)

NURS 615 Practice Exam 2025

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NURS 615 Practice Exam 2025 What blood values should be monitored with carbamazepine? 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? 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? 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

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NURS 615 Practice Exam 2025


What blood values should be monitored with carbamazepine?

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.

CBCheveryh3htoh4hmonths

AffectshRBC,hWBC,hPlatelets

Agranulocytosis,hAnemia



Whathishthehpharmacodynamicshofhcarbamazepine?h-
hANSWERhCarbamazepinehishmetabolizedhinhthehliverhandhhashthehuniquehabilityhtohinducehitshownh
metabolismh(autoinduction).hDuehtohautoinduction,hinitialhconcentrationshwithinhtherapeutichrangehm
ayhlaterhfallhdespitehgoodhcompliance.hIthalsohinduceshthehmetabolismhofhmanyhCYP450henzymeshand
hotherhsubstances.hSlowlyhbuthwellhabsorbedhhalfhlifehofhabouth30hhours,hshortenshtoh15hhourshwhe
nhgivenhrepeatedly



Thehexacthmechanismhofhactionhofhcarbamazepinehishnothknown,hbuththeyharehthoughthtohaffecththeh
sodiumhchannels,hslowinghinfluxhofhsodiumhinhthehcorticalhneuronshandhslowinghthehspreadhofhabnor
malhactivity.hCarbamazepinehexertshitsheffecthbyhdepressinghtransmissionhinhthehnucleushventralishant
eriorhofhthehthalamus.hThishareahishassociatedhwithhthehspreadhofhseizurehdischarge.h




•AbsorptionhandhDistribution

Carbamazepinehishabsorbedhthroughhthehstomach,hthehsuspensionhbeinghabsorbedhmorehquicklyhthan
hthehtablethform.hAbsorptionhfromhthehimmediate-
releasehtabletshishslowhandherratichbecausehofhitshslowhwaterhsolubility.hThehdrughishhighlyhlipophilic,
hresultinghinhhighhbodyhtissuehbinding.h

, •MetabolismhandhExcretionh




Excretionhishthroughhfeceshandhurine.h



Averagehbloodhlevelshofhcarbamazepinehoccurhapproximatelyh6hhourshafterhadministration.hHalf-
lifehcanhbehashlonghash65hhourshwithhinitialhdosing,hbuthishtypicallyh12htoh17hhourshashadministrationh
continues.hIthishnoteworthyhthaththehhalf-lifehafterhahsinglehdosehishmuchhlongerhthanhthehhalf-
lifehafterhlong-termhuse.hSteadyhstatehishattainedhinh2htoh4hdays.



Whathshouldhfamilieshbehtaughthregardinghthehmonitoringhofhseizurehactivity?h-
hANSWERhPatientshshouldhbehmonitoredhforhseizurehactivity,hseverity,handhduration.hPatienthshouldhc
arryhmedicalhidentificationhforhthehseizurehdisorder.hPatienthshouldhreporthanyhmoodhchangeshorhsuic
idalhthoughts.hPreventionhofhseizures.hDohnothabruptlyhendhmedicationhincreaseshriskhofhseizures



Whathelectrolytehimbalancehishnotedhwithhthehadministrationhofhtopiramate?h-
hANSWERhPatientshtakinghtopiramatehmayhhavehdecreasedhconcentrationshofhbicarbonatehduehtohinhi
bitionhofhcarbonichanhydrasehandhincreasedhrenalhbicarbonatehloss,hleadinghtohhyperchloremichmetab
olichacidosis.hSeverehmetabolichacidosishhashbeenhreportedhinhinfantshreceivinghahtopiramatehdosehof
h5mg/kg/
day.hSerumhbicarbonatehlevelshshouldhbehmonitoredhathbaselinehandhperiodicallyhthroughouththerapy
.



Whathishthehpregnancyhcategoryhforhvalproate?h-hANSWERhPregnancyhCategoryhX.



Whathinstructionshwillhyouhprovidehtohahwomanhwhohwantshtohgethpregnanthandhhashahseizurehdisor
derhcontrolledhwithhvalproate?h-hANSWERhSwitchhtohanotherhantiseizurehmedicationhsuchhashKeppra

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