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The nurse is monitoring a patient who has been taking carbamazepine for 2 months. Which effects would indicate that autoinduction has started to occur?
- A. The drug levels for carbamazepine are higher than expected.
- B. The drug levels for carbamazepine are lower than expected.
- C. The patient is experiencing fewer seizures.
- D. The patient is experiencing toxic effects from the drug.
Correct Answer: B
Rationale: With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.
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Phenytoin has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
- A. The safe and the toxic plasma levels of the drug are very close to each other.
- B. The phenytoin has a low chance of being effective.
- C. There is no difference between safe and toxic plasma levels.
- D. A very small dosage can result in the desired therapeutic effect.
Correct Answer: A
Rationale: Having a narrow therapeutic index means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
- A. Levetiracetam
- B. Phenobarbital
- C. Valproic acid
- D. Gabapentin
Correct Answer: B
Rationale: Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options; therefore, it allows for once-a-day dosing.
The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate?
- A. AED therapy can be stopped when seizures are stopped.
- B. AED therapy is usually lifelong.
- C. Consistent dosing is the key to controlling seizures.
- D. A dose may be skipped if the patient is experiencing adverse effects.
- E. Abruptly stopping AEDs may cause rebound seizure activity.
Correct Answer: B,C,E
Rationale: Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity.
When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
- A. Driving is allowed after 2 weeks of therapy.
- B. If seizures recur, take a double dose of the medication.
- C. Antacids can be taken with the AED to reduce gastrointestinal adverse effects.
- D. Take the drug at the same time every day.
Correct Answer: D
Rationale: Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. The other options are not correct statements.
A 9-year-old child will be receiving carbamazepine suspension, 200 mg twice daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient for each dose.
Correct Answer: 10 mL
Rationale: 100 mg : 5 mL :: 200 mg : x mL; (100 * x) = (5 * 200); 100x = 1000; x = 10 mL/dose.