A patient with bipolar disorder takes lamotrigine (Lamictal). ...

[Mr3Hunna]

A patient with bipolar disorder takes lamotrigine (Lamictal). Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment?
 
  a. I get a little dizzy sometimes.
  b. I had a headache last week that lasted for about an hour.
  c. I've broken out in a rash on my chest and back.
  d. Last night I woke up twice with a bad dream.

Question 2

A patient who has recently begun taking carbamazepine (Tegretol) for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?
 
  a. Ask the provider whether another medication can be used for this patient, because the patient is showing signs of toxicity.
  b. Contact the provider to request a complete blood count (CBC) to evaluate for other, more serious side effects.
  c. Reassure the patient that these effects occur early in treatment and will resolve over time.
  d. Review the patient's chart for cytochrome P450 enzymes to see whether an increased dose is needed.

[yotaSR5]

Answer to Question 1

ANS: C
Evidence of a rash in a patient taking lamotrigine requires further assessment, because this may indicate the development of Stevens-Johnson syndrome. Although dizziness and headaches are side effects of lamotrigine, they are not potentially life threatening. A bad dream is not necessarily related to the lamotrigine.

Answer to Question 2

ANS: C
Carbamazepine can cause several neurologic side effects early in treatment, including vertigo and headaches. These resolve with continued drug use. These side effects are not related to drug toxicity. A CBC should be obtained at baseline and periodically thereafter. Carbamazepine can cause changes in hematologic laboratory values. The side effects reported by this patient are not associated with hematologic side effects. Carbamazepine induces cytochrome P450 enzymes and can accelerate its own metabolism, which would reduce the amount of drug and decrease side effects, so an increased dose is not appropriate.