NURS 615 Exam II UPDATED ACTUAL Questions and CORRECT
ANswers
1. What blood val- Plasma carbamazepine levels should be monitored on a regular basis. The ther-
ues should be apeutic range is 4 to 12 mcg/L. Higher levels can lead to toxic symptoms con-
monitored with sisting of initial adverse effects and also hypertension, tachycardia, ECG changes,
carbamazepine? 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
2. What is the phar- Carbamazepine is metabolized in the liver and has the unique ability to induce
macodynamics of its own metabolism (autoinduction). Due to autoinduction, initial concentrations
carbamazepine? 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
, NURS 615 Exam II UPDATED ACTUAL Questions and CORRECT
ANswers
Excretion is through feces and urine.
Average blood levels of carbamazepine occur approximately 6 hours after admin-
istration. 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.
3. What should fam- Patients should be monitored for seizure activity, severity, and duration. Patient
ilies be taught re- should carry medical identification for the seizure disorder. Patient should report
garding the mon- any mood changes or suicidal thoughts. Prevention of seizures. Do not abruptly
itoring of seizure end medication increases risk of seizures
activity?
4. What electrolyte Patients taking topiramate may have decreased concentrations of bicarbonate due
imbalance is not- to inhibition of carbonic anhydrase and increased renal bicarbonate loss, leading
ed with the ad- to hyperchloremic metabolic acidosis. Severe metabolic acidosis has been report-
ministration of ed in infants receiving a topiramate dose of 5mg/kg/day. Serum bicarbonate levels
topiramate? should be monitored at baseline and periodically throughout therapy.
5. What is the preg- Pregnancy Category X.
nancy category
for valproate?
6. What instructions Switch to another antiseizure medication such as Keppra
will you provide
to a woman who Use of these drugs during the first trimester of pregnancy is associated with neural
wants to get tube defects including spina bifida. Their use should be restricted to cases in which
pregnant and has a woman's life would be endangered without them and then only beyond the first
a seizure dis- trimester. They should be used with caution during lactation.
order controlled
with valproate?
ANswers
1. What blood val- Plasma carbamazepine levels should be monitored on a regular basis. The ther-
ues should be apeutic range is 4 to 12 mcg/L. Higher levels can lead to toxic symptoms con-
monitored with sisting of initial adverse effects and also hypertension, tachycardia, ECG changes,
carbamazepine? 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
2. What is the phar- Carbamazepine is metabolized in the liver and has the unique ability to induce
macodynamics of its own metabolism (autoinduction). Due to autoinduction, initial concentrations
carbamazepine? 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
, NURS 615 Exam II UPDATED ACTUAL Questions and CORRECT
ANswers
Excretion is through feces and urine.
Average blood levels of carbamazepine occur approximately 6 hours after admin-
istration. 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.
3. What should fam- Patients should be monitored for seizure activity, severity, and duration. Patient
ilies be taught re- should carry medical identification for the seizure disorder. Patient should report
garding the mon- any mood changes or suicidal thoughts. Prevention of seizures. Do not abruptly
itoring of seizure end medication increases risk of seizures
activity?
4. What electrolyte Patients taking topiramate may have decreased concentrations of bicarbonate due
imbalance is not- to inhibition of carbonic anhydrase and increased renal bicarbonate loss, leading
ed with the ad- to hyperchloremic metabolic acidosis. Severe metabolic acidosis has been report-
ministration of ed in infants receiving a topiramate dose of 5mg/kg/day. Serum bicarbonate levels
topiramate? should be monitored at baseline and periodically throughout therapy.
5. What is the preg- Pregnancy Category X.
nancy category
for valproate?
6. What instructions Switch to another antiseizure medication such as Keppra
will you provide
to a woman who Use of these drugs during the first trimester of pregnancy is associated with neural
wants to get tube defects including spina bifida. Their use should be restricted to cases in which
pregnant and has a woman's life would be endangered without them and then only beyond the first
a seizure dis- trimester. They should be used with caution during lactation.
order controlled
with valproate?
