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Semelhante a Depakote (valproic acid)
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Depakote (valproic acid)
- 1. The Use of Depakote as Treatment for Bipolar Disorder Baleigh Brown Lamar University
- 2. Depakote (Valproic Acid) • An anticonvulsant • Administered for treatment for Bipolar Disorder (BD)
- 3. Bipolar Disorder (BD) Mental disorder Characterized by constantly changing moods (mania, hypomania, major depression) Psychosis occasionally occurs with mood swings Suicidal ideations, homicidal ideations, paranoia, hallucinations, delusions, excessive spending, insomnia, poor judgement- all types of behaviors associated with BD Actual cause is unknown May stem from genetics, neurochemical transmitters, or environmental factors
- 4. Intended Drug Response Remission from mood swings and/or paranoia Response to symptoms Maintenance of therapeutic serum drug levels (50-100 mcg/ml)
- 5. Potential Interactions Lamotrigine-Depakote doubles it’s half life, increases risk of Steven Johnson’s Syndrome and toxic epidermal necrolysis Topiramate-mixture increases risk for hyperammonemia and encephalopathy Risperidone-mixture may cause toxic affects may be enhanced as well as cause generalized edema Some mixtures may increase or decrease serum concentration of Depakote which leads to nontherapeutic levels Depakote may cause an increase or decrease in other medications’ serum concentration leading to adverse affects
- 6. Adverse Drug Reactions Hepatotoxicity (life threatening)- monitor serum liver function tests and ammonia levels, monitor LOC, encourage patients to report symptoms of malaise, weakness, lethargy, facial edema, anorexia, and vomiting Pancreatitis (life threatening)- encourage patients to report abdominal pain, persistent nausea, vomiting, and anorexia Hyperammonemia- watch for unexplained lethargy, vomiting or mental status changes; monitor liver function tests and ammonia levels (especially in patients that frequently drink alcohol)
- 7. Side Effects 1% - 25% occurrence: dizziness, insomnia, nervousness, alopecia, drowsiness, headache, abdominal pain, dyspepsia, diarrhea, vomiting, weakness, thrombocytopenia (dose related), and diplopia Dyspepsia (indigestion) is one I see most often. Most of my patients are prescribed an antacid or protein pump inhibitor in addition to Depakote Nausea has a 3% - 48% incidence occurrence 1% - 5% occurrence: chest pain, edema, palpitations, tachycardia, anxiety, vertigo, ecchymosis, pruritus, amenorrhea, weight gain, weight loss, constipation
- 8. Phamacokinetics Dissociates to the valproate ion in the GI tract Highly protein bound, concentration dependent Protein binding is reduced in elderly patients, patients with chronic hepatic disease, renal impairment, and when mixed with ASA Almost entirely metabolized by the liver Excreted through urine
- 9. Drug Binding Issues Aspirin (metabolically converted to salicyclic acid) Able to inhibit metabolism of Depakote Protein binding displacement may result in increased unbound drug concentration
- 10. Improving Communication and Patient Safety Monitoring patient labs Allowing pharmacy to receive a copy to assist in monitoring labs Draw Depakote levels 3-5 days after initiation of treatment or upon admission if patient is currently prescribed Depakote Draw labs every 3-5 days after changes are made to dose and until more than one therapeutic level is accomplished Meet all criteria on MUE (Medication Use Evaluation)-discuss this with multidisciplinary team at least twice a week
- 11. Application to the Practice Setting Review labs with each chart check Make sure all labs are scheduled to be drawn Place lab results on chart and notify practitioner if results warrant it Assess level of consciousness and orientation level Inquire about any side effects or difficulty with urination Educate other healthcare members and nurses about findings Assist with MUE criteria