The nurse is talking with a patient who was just prescribed ...

[APUS57]

The nurse is talking with a patient who was just prescribed zonisamide (Zonegran). Which patient statement should the nurse immediately discuss with the patient's health care provider?
 
  1. Did I mention that I used to take phenobarbital for my seizures?
  2. I forgot to tell the doctor that I am allergic to sulfa drugs.
  3. I have lactose intolerance, so I can't drink milk.
  4. My husband and I plan to have a baby in a couple of years.
  5. My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started.

Question 2

The patient who is prescribed valproic acid (Depakote) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this patient?
 
  1. Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication.
  2. Thankfully, most modern antiepileptic medications will not interfere with you getting pregnant.
  3. Your current antiepileptic medication should not be used when you are pregnant.
  4. Folic acid supplementation is important for you.
  5. You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy.

[carojassy25]

Answer to Question 1

Correct Answer: 2,5
Rationale 1: There is no indication that previous phenobarbital use is problematic with the use of zonisamide (Zonegran).
Rationale 2: Zonisamide (Zonegran) is an oral sulfonamide.
Rationale 3: There is no indication that inability to drink milk is problematic with the use of zonisamide (Zonegran).
Rationale 4: Zonisamide (Zonegran) is Pregnancy Category C.
Rationale 5: The most common adverse effects of zonisamide (Zonegran) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring.

Answer to Question 2

Correct Answer: 3,4
Rationale 1: Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant patients.
Rationale 2: Women who have epilepsy have a reduced fertility rate, and some do not ovulate.
Rationale 3: Valproic acid (Depakote) is Pregnancy Category D.
Rationale 4: Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency.
Rationale 5: Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this patient, but should provide information to the patient and then support the patient's choice.