50 Questions
What solution can the nurse use for IV administration of Depakote?
0.9% sodium chloride
How long is IV infusion of Depakote recommended to occur over?
1 hour
For how long is IV administration permissible for Depakote?
14 days
How should Depakote ER be administered to children?
Sprinkled on applesauce or pudding
What is indicative that the therapeutic effects of valproate have been attained?
Presence of simple and complex absent seizures
What should the nurse assess the patient for signs and symptoms of?
Pancreatitis
What should the nurse routinely assess the patient’s liver function tests for?
Hepatitis
Which herb decreases the effect of Depakote?
Ginkgo biloba
Which medication's serum levels may increase when combined with valproate?
Phenobarbital
What is a contraindication to valproate?
Hepatic impairment
What is the half-life of carbamazepine?
12 to 17 hours
How is carbamazepine primarily excreted from the body?
Feces
What effect does carbamazepine have on liver enzymes?
Induces liver enzymes
How does carbamazepine affect sodium channels within the cortical neurons?
Inhibits sodium influx
What is the onset of action for the regular oral preparation of carbamazepine?
4 to 5 hours
How does carbamazepine's antiepileptic activity relate to polysynaptic responses?
Inhibits polysynaptic responses
What is the primary route of administration for carbamazepine?
Oral
What is the mechanism of action of carbamazepine?
Inhibits action potential
What effect does carbamazepine have on posttetanic potentiation?
Inhibits posttetanic potentiation
How does carbamazepine's onset of action in the oral suspension compare to the regular oral preparation?
Faster onset in oral suspension
What is the onset of action for regular oral preparation of carbamazepine?
4 to 5 hours
How is carbamazepine metabolized in the body?
Metabolized by the liver and excreted in the feces and urine
What does carbamazepine induce in the body?
Liver enzymes to increase metabolism
What is the half-life of carbamazepine?
12 to 17 hours
How does carbamazepine affect sodium channels within the cortical neurons?
It affects sodium channels similar to tricyclic antidepressants
What is the mechanism of action of carbamazepine believed to be related to?
Inhibition of polysynaptic responses
What is the variability of the half-life of carbamazepine related to?
Autoinduction
Where is carbamazepine excreted in the body?
Feces and urine
What is the peak time for the oral suspension preparation of carbamazepine?
1.5 hours
How does carbamazepine decrease the action potential of the cell?
By inhibiting the influx of sodium into the cell
Which adverse effect is associated with carbamazepine use?
Aplastic anemia
What is a contraindication for carbamazepine use?
Hypersensitivity reactions
What is a life-threatening adverse effect of valproate?
Pancreatitis
Which condition warrants caution when administering valproate?
Renal impairment
What should be monitored in older adults taking carbamazepine?
Sedation and confusion
Which medication may interact with carbamazepine, affecting its effects?
Warfarin
What is a BLACK BOX WARNING for valproate?
Discontinuation at signs of pancreatitis
What should be included in patient teaching for carbamazepine?
Taking the medication with food
What is synthesized from valeric acid found in the herb valerian?
Valproate
What should be adjusted slowly in the elderly when administering valproate?
Dosage
Which medication is used to prevent partial seizures with complex symptoms, generalized tonic–clonic and mixed seizures, and uncontrolled seizures or CNS depression on other AEDs?
Carbamazepine
What is a serious adverse effect of carbamazepine?
Aplastic anemia
Which medication has BLACK BOX WARNINGS for discontinuation at signs of pancreatitis, teratogenicity, and checking for signs of bleeding or bruising?
Valproate
What is a cautionary consideration when administering valproate?
Renal impairment
Which adverse effect is associated with carbamazepine use in older adults?
Increased sedation and confusion
What are the contraindications for carbamazepine?
Hypersensitivity reactions and use of monoamine oxidase inhibitors
Which medication interacts with warfarin and Ginkgo biloba, affecting its effects?
Carbamazepine
What is an adverse effect of valproate related to bleeding?
Altered bleeding time
What is a significant adverse effect of valproate related to the liver?
Hepatic failure
What should be considered when administering valproate to the elderly?
Dosage should be adjusted slowly
Study Notes
Antiepileptic Drugs: Carbamazepine and Valproate
- Carbamazepine is used to prevent partial seizures with complex symptoms, generalized tonic–clonic and mixed seizures, and uncontrolled seizures or CNS depression on other AEDs
- It may result in increased sedation and confusion in older adults
- Caution is necessary in patients with renal or hepatic impairment due to potential adverse effects, including hepatic cellular necrosis
- Serious adverse effects of carbamazepine include aplastic anemia, agranulocytosis, heart block, Stevens-Johnson syndrome, respiratory depression, hepatitis, and suicidal ideation
- Contraindications for carbamazepine include hypersensitivity reactions, use of monoamine oxidase inhibitors, and history of certain conditions
- Some medications interact with carbamazepine, affecting its effects, such as warfarin and Ginkgo biloba
- Administration guidelines for carbamazepine include precautions with monoamine oxidase inhibitors, extended-release tablets, and suspension, and monitoring for therapeutic and adverse effects
- Patient teaching for carbamazepine includes taking the medication with food, avoiding abrupt discontinuation, and reporting symptoms of concern
- Valproate is synthesized from valeric acid found in the herb valerian and is used for simple and complex absence seizures, as well as seizures related to Lennox-Gastaut syndrome
- Caution is necessary in renal or hepatic impairment when administering valproate, and the dosage should be adjusted slowly in the elderly
- Life-threatening adverse effects of valproate include pancreatitis and hepatic failure, with other significant adverse effects including altered bleeding time, thrombocytopenia, and CNS effects
- FDA has issued BLACK BOX WARNINGS for valproate, including discontinuation at signs of pancreatitis, teratogenicity, and checking for signs of bleeding or bruising
Test your knowledge of iminostilbenes, such as the prototype carbamazepine (Tegretol), with this pharmacokinetics quiz. Explore topics like absorption, onset of action, and administration of iminostilbenes.
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