Nokea
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.
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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.
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 has given medication instructions to a patient receiving phenytoin. Which statement by the patient indicates that the patient has an adequate understanding of the instructions?
- A. I will need to take extra care of my teeth and gums while on this medication.
- B. I can go out for a beer while on this medication.
- C. I can skip doses if the side effects bother me.
- D. I will be able to stop taking this drug once the seizures stop.
Correct Answer: A
Rationale: Good dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.
During a routine appointment, a patient with a history of seizures is found to have a phenytoin level of 18 mg/mL. What concern will the nurse have, if any?
- A. The patient is at risk for seizures because the drug level is not at a therapeutic level.
- B. The patient's seizures should be under control because this is a therapeutic drug level.
- C. The patient's seizures should be under control if she is also taking a second antiepileptic drug.
- D. The drug level is at a toxic level, and the dosage needs to be reduced.
Correct Answer: B
Rationale: Therapeutic drug levels for phenytoin are usually 10 to 20 mg/mL. The other options are incorrect.
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.