NR 606 Week 2 Questions and
Answers
Valerio Acid – answer rValproic acid and its derivatives can cause leukopenia,
thrombocytopenia, and hepatotoxicity. Monitor CBC and LFTs every 3 months for 1 year
and then annually.
Lithium – answer Lithium has a narrow therapeutic index and should be monitored
carefully. Serum levels should be evaluated 5 days after any dosage change and
regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and
thyroid function should be evaluated every 6 months.
Carbamazepine (Tegretol) – answer Carbamazepine can cause blood dyscrasias,
hepatotoxicity, and renal failure. Oder a CBC, LFT, and renal function every 3 months
for 1 year and then annually.
Atypical antipsychotics – answer Atypical antipsychotics can cause increased blood
glucose and an increased risk of developing DM II. Measure HbA1C every 3 months for
1 year and then annually. Certain medications, such as Clozapine, may cause blood
dyscrasias and CBC should be monitored closely.
Lithium – answer Action - alters cation transport in the nerve and muscle
Indication - euphoric mania, rapid cycling, maintenance therapy
Adverse Effects - GI Effects, tremor, polyuria
Prescribing Pearls - Monitor plasma levels. Reduce dose in clients with renal failure.
Use caution with concurrent diuretics. Use to protect against suicide.
Lamotrigine (Lamictal) – answer Action - affects sodium channel ion transport and
enhances the activity of y-aminobutyric acid (GABA)
Indication - maintenance therapy, monotherapy for bipolar disorder
Adverse Effects - benign rash, GI effects, dizziness, headache
Prescribing Pearls - This drug is equal in efficacy to lithium.
Educate clients and assess for rash at each visit. Ten percent of rashes are benign.
There is a risk for rare Stevens-Johnson Syndrome rash and multi-organ failure. Take at
bedtime due to sedation side effect.
Valproic Acid – answer Action - affects ion transport and enhances the activity of y-
aminobutyric acid (GABA)
Indication - acute mania, mixed mood, comorbid substance use, multiple prior episodes
Adverse Effects - GI effects, weight gain
Prescribing Pearls - This drug is equal to lithium. Monitor plasma levels. If using with
lamotrigine decrease valproate levels by 50%.
Answers
Valerio Acid – answer rValproic acid and its derivatives can cause leukopenia,
thrombocytopenia, and hepatotoxicity. Monitor CBC and LFTs every 3 months for 1 year
and then annually.
Lithium – answer Lithium has a narrow therapeutic index and should be monitored
carefully. Serum levels should be evaluated 5 days after any dosage change and
regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and
thyroid function should be evaluated every 6 months.
Carbamazepine (Tegretol) – answer Carbamazepine can cause blood dyscrasias,
hepatotoxicity, and renal failure. Oder a CBC, LFT, and renal function every 3 months
for 1 year and then annually.
Atypical antipsychotics – answer Atypical antipsychotics can cause increased blood
glucose and an increased risk of developing DM II. Measure HbA1C every 3 months for
1 year and then annually. Certain medications, such as Clozapine, may cause blood
dyscrasias and CBC should be monitored closely.
Lithium – answer Action - alters cation transport in the nerve and muscle
Indication - euphoric mania, rapid cycling, maintenance therapy
Adverse Effects - GI Effects, tremor, polyuria
Prescribing Pearls - Monitor plasma levels. Reduce dose in clients with renal failure.
Use caution with concurrent diuretics. Use to protect against suicide.
Lamotrigine (Lamictal) – answer Action - affects sodium channel ion transport and
enhances the activity of y-aminobutyric acid (GABA)
Indication - maintenance therapy, monotherapy for bipolar disorder
Adverse Effects - benign rash, GI effects, dizziness, headache
Prescribing Pearls - This drug is equal in efficacy to lithium.
Educate clients and assess for rash at each visit. Ten percent of rashes are benign.
There is a risk for rare Stevens-Johnson Syndrome rash and multi-organ failure. Take at
bedtime due to sedation side effect.
Valproic Acid – answer Action - affects ion transport and enhances the activity of y-
aminobutyric acid (GABA)
Indication - acute mania, mixed mood, comorbid substance use, multiple prior episodes
Adverse Effects - GI effects, weight gain
Prescribing Pearls - This drug is equal to lithium. Monitor plasma levels. If using with
lamotrigine decrease valproate levels by 50%.
