NURS 615 Exam II Already Graded A+
1. What blood values should be monitored with carbamazepine? - Plasma carbamazepine levels should be monitored regularly to maintain therapeutic efficacy. The
target therapeutic range is typically 4 to 12 mcg/L. Higher levels can lead to toxicity, which manife...
NURS 615 Exam II Already Graded A+
1. What blood values should be monitored with carbamazepine?
- Plasma carbamazepine levels should be monitored regularly to maintain therapeutic efficacy. The
target therapeutic range is typically 4 to 12 mcg/L. Higher levels can lead to toxicity, which manifests
with symptoms like hypertension, tachycardia, ECG changes, stupor, agitation, and others. Monitoring
CBC every 3 to 4 months is recommended due to its potential effects on red blood cells (RBCs), white
blood cells (WBCs), and platelets, which can result in conditions like agranulocytosis and anemia.
2. What is the pharmacodynamics of carbamazepine?
- Carbamazepine is metabolized in the liver and uniquely induces its own metabolism over time
(autoinduction). This can result in decreased drug concentrations despite adherence to therapy. It also
induces several CYP450 enzymes and affects other substances. Carbamazepine is well absorbed, with an
initial half-life of about 30 hours that shortens to approximately 15 hours with repeated dosing. Its
mechanism of action is not fully understood, but it is believed to modulate sodium channels, slowing
sodium influx into cortical neurons and thereby reducing abnormal neuronal activity. Specifically, it
depresses transmission in the nucleus ventralis anterior of the thalamus, implicated in the propagation
of seizure activity.
- Carbamazepine absorption is faster with oral suspensions compared to tablets, although tablets can
show slow and erratic absorption due to limited water solubility. The drug is highly lipophilic, leading to
extensive tissue binding throughout the body. Excretion occurs primarily through feces and urine. Blood
levels peak around 6 hours post-administration, with a half-life ranging from 12 to 65 hours depending
on initial dosing and duration of therapy. Steady-state concentrations are typically achieved within 2 to
4 days of consistent dosing.
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
What electrolyte imbalance is noted with the administration of topiramate? ✔️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? ✔️Pregnancy Category X.
, What instructions will you provide to a woman who wants to get pregnant and has a seizure disorder
controlled with valproate? ✔️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? ✔️•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.
•Pregnancy category C and are excreted in low doses in breast milk. Safety of use in pregnancy is
unclear.
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