NURS 615 – Exam II Review with Practice Questions and Correct
answers for Advanced Pathophysiology
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
answers for Advanced Pathophysiology
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
