NURS615 Study Guide Exam 2 - Exam review

What blood values should be monitored with carbamazepine? Plasma carbamazepine should be closely monitored. Therapeutic is 4-12 mcg/L Adverse Events: Hypersensitivity reaction Stevens Johnsons Syndrome & toxic epidermal necrolysis (POTENTIALLY LIFE-THREATENING!!!), N/V, dizziness, drowsy, dry mouth. Monitor thyroid function (TSH panel), CBC, liver function panel, carbamazepine blood lvls, renal function tests or CMP. Blood lvls should be checked before initializing treatment, during course, then q3-4 months. Monitor patient for seizure activity, Anticholinergic effects (glaucoma, constipation, etc), pregnancy category D, risk of arrhythmias 2. What are the pharmacodynamics of carbamazepine? Is metabolized by the liver, can be used to treat seizures and can be used to treat symptoms of trigeminal neuralgia. Slow influx of sodium channel ions reducing high frequency repetitive action potential in seizure activity as well as action on synaptic transmission. 3. What should families be taught regarding the monitoring of seizure activity? Monitor severity and duration of seizures, should carry medical identification for seizure activity, keep obstacles out of the way during seizure activity, do not abruptly stop seizure medications, may increase risk of seizure, report changes in behaviors while on medication. Help patient monitor for seizure activity, keep a log for triggers (certain foods, lack of sleep etc.), encourage patient to stay on medication (take regularly), watch for side effects of medications, patient should have medical alert systems (bracelet), family should learn how to treat seizures, how to keep patient safe, when to activate emergency medical system, drug interactions, alcohol should be avoided. 4. What electrolyte imbalance is noted with the administration of topiramate? Closely monitor bicarbonate levels, increased risk of metabolic acidosis. **Hyperchloremic Acidosis** 5. What are the pregnancy precautions for valproate?