Author Question: A patient who has recently begun taking carbamazepine Equetro for bipolar disorder reports having ... (Read 18 times)

elizabeth18 · **on:** Jul 23, 2018

A patient who has recently begun taking carbamazepine Equetro for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?

a. Ask the provider whether another medica-tion 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 oc-cur 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.

Question 2

A patient with Parkinson's disease is taking levodopa/carbidopa Sinemet along with amanta-dine Symmetrel 400 mg/day to treat dyskinesias. The patient reports having increased dyskine-sias several months after beginning the amantadine.

The nurse will contact the provider to discuss which action? a. Increasing the dose of amantadine Sym-metrel
b. Interrupting treatment with amantadine for several weeks
c. Ordering renal function tests
d. Ordering another anticholinergic medica-tion

skipfourms123 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

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.

Answer to Question 2

B
When amantadine is added to therapy to treat dyskinesias associated with levodopa, it often loses effectiveness after several months. If the effects diminish, they can be restored by either increasing the dosage or by interrupting treatment for several weeks. The maximum dosage of amantadine is 400 mg/day, so it is incorrect to increase the dose. Altered renal function would result in drug toxicity, not ineffectiveness of the drug. It is not necessary to order another drug until determining whether the effectiveness can be restored.