A patient who is taking oral contraceptives begins taking ...

[wrbasek0]

A patient who is taking oral contraceptives begins taking valproic acid (Depakote) for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?
 
  a. Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.
  b. Contact the provider to request an order for a blood ammonia level, because hyperammonemia can occur with valproic acid therapy.
  c. Suggest that the patient perform a home pregnancy test, because valproic acid can reduce the efficacy of oral contraceptives.
  d. Suspect that hepatotoxicity has occurred, because this is a common adverse effect of valproic acid.

Question 2

A patient is to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?
 
  a. She may need to increase her dose of phenytoin while taking oral contraceptives.
  b. She should consider a different form of birth control while taking phenytoin.
  c. She should remain on oral contraceptives, because phenytoin causes birth defects.
  d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.

[yeungji]

Answer to Question 1

ANS: A
Gastrointestinal effects, including nausea, vomiting, and indigestion, are common with valproic acid and can be minimized by taking the drug with food or using an enteric-coated product. Hyperammonemia can occur when valproic acid is combined with topiramate. Signs of pregnancy usually do not occur within a week, so this is less likely. Hepatotoxicity is a rare adverse effect.

Answer to Question 2

ANS: B
Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral contraceptives or use an alternative method of birth control. Increasing the patient's dose of phenytoin is not necessary; OCPs do not affect phenytoin levels. Phenytoin is linked to birth defects; OCPs have decreased effectiveness in patients treated with phenytoin, and the patient should be advised to increase the OCP dose or to use an alternative form of birth control. OCPs do not alter the effects of phenytoin.

[wrbasek0]

Both answers were spot on, thank you once again

[yeungji]

Great! Please up vote