Divalproex Sodium Med Template

ACTIVE LEARNING TEMPLATE: Medication STUDENT NAME _____________________________________ divalproex sodium MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________ Therapeutic: anticonvulsants, vascular headache suppressants CATEGORY CLASS ______________________________________________________________________ PURPOSE OF MEDICATION Expected Pharmacological Action Increases levels of GABA, an inhibitory neurotransmitter in the CNS. Therapeutic Use Suppression of seizure activity. Decreased manic episodes. Decreased frequency of migraine headaches. Complications Monotherapy and adjunctive therapy for simple and complex absence seizures. Monotherapy and adjunctive therapy for complex partial seizures. Adjunctive therapy for patients with multiple seizure types, including absence seizures. Divalproex sodium only. Manic episodes associated with bipolar disorder. Prevention of migraine headache. Medication Administration Regular-release and delayed-release formulations usually given in 2–4 divided doses daily; extended-release formulation (Depakote ER) usually given once daily. Contraindications/Precautions Contraindicated in: Hypersensitivity; Hepatic impairment; Known/suspected urea cycle disorders (may result in fatal hyperammonemic encephalopathy); Mitochondrial disorders caused by mutations in mitochondrial DNA Nursing Interventions hepatotoxicity); OB: Pregnancy (for migraines only). disease; Organic brain disease; Bone marrow depression; Renal impairment; Women of childbearing potential; Consider discontinuing nursing when valproates are administered to the nursing mother. Interactions with other CNS depressants, including alcohol, antihistamines, antidepressants, opioid analgesics, MAO inhibitors, and sedative/hypnotics. MAO inhibitors and other antidepressants lamotrigine, phenobarbital, phenytoin, rufinamide, topiramate, or zidovudine Evaluation of Medication Effectiveness Decreased seizure activity. Decreased incidence of manic episodes in patients with bipolar disorders. Decreased frequency of migraine headaches. Geri: Assess geriatric patients for excessive somnolence. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. Monitor for signs and symptoms of pancreatitis (abdominal pain, nausea, vomiting, anorexia). If pancreatitis occurs, valproates should be discontinued and alternate therapy initiated. Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis, eosinophilia). If symptoms occur and DRESS is confirmed, discontinue valproate and do not restart. Client Education Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.