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valproic acid Nursing Considerations & Management

Drug Name
Generic Name : valproic intelligent , sodium valproate , valproate intelligent ,divalproex sodium Brand Name:
  • Apo-Valproic Intelligent (CAN), Gen-Valproic (CAN), Novo-Valproic (CAN), Nu-Valprox (CAN), ratio-Valproic (CAN)
  • Capsules: Depakene
  • Syrup: Depakene
  • Injection: Depacon, Epiject (CAN)
  • Tablets, enteric coated: Depakote, Depakote ER, Depakote Sprinkle, Divalproex, Epival (CAN)
Classification: Antiepileptic Pregnancy Category D 
Dosage & Route
ADULTS
Dosage is developed as valproic intelligent equivalents. Initial dose is 10–15 mg/kg/day PO, increasing at 1-wk intervals by 5–10 mg/kg/day until rapines are controlled or verge goods bar prefer acceptions. Maximum recommended dosage is 60 mg/kg/day PO. If unimpaired dose > 250 mg/day, afford in disconnected doses.
  • Acute insanity or bipolar assumption: Initially, 25 mg/kg/day PO once daily. Dose should be acceptiond fast to end the lowest hygienic dose. Maximum dose 60 mg/kg/day PO (Depakote ER merely).
  • Bipolar insanity: 750 mg PO daily in disconnected doses; do not abound 60 mg/kg/day (Divalproex DR tablets merely).
  • Migraine: 250 mg PO bid; up to 1,000 mg/day has been used (Divalproex DR tablets); 500 mg ER tablet once a day.
PEDIATRIC PATIENTS > 10 YR
  • 10-15 mg/kg/day PO.
PEDIATRIC PATIENTS
  • Use remote calculation. Mortal hepatotoxicity has occurred. Outcome < 2 yr are distinctly tender. Instructor all outcome preservationfully.
Therapeutic exercises
  • Mechanism of exercise not understood: antiepileptic courage may be akin to the metabolism of the inhibitory neurotransmitter, GABA; divalproex sodium is a combination containing resembling proportions of valproic intelligent and sodium valproate.
Indications
  • Sole and adjunctive therapy in uncompounded (petit mal) and compound deficiency rapines
  • Depakote ER: Treatment of epilepsy in outcome > 10 yr; treatment of intelligent manic or qualified episodes associated after a while bipolar assumption, after a while or after a whileout psychotic features
  • Adjunctive therapy after a while multiple rapine types, including deficiency rapines
  • Depakote ER: Treatment of bipolar insanity
  • Depakote, Depacote ER: Prophylaxis of migraine headaches
  • Divalproex, sodium valproate injection: Treatment of compound unfair rapines as monotherapy or after a while other antiepileptics
  • Unlabeled uses: Adjunct in premonition address of schizophrenia, treatment of foul outbursts in outcome after a while attention-deficit hypercourage assumption, constitutional brain syndrome
Adverse goods
  • CNS: Sedation, trepidation (may be dose-related), moving overturn, lowering, psychosis, incursion, hyperactivity, behavioral recompense, weakness
  • Dermatologic: Temporary acceptions in hair privation, indiscreet, petechiae
  • GI: Nausea, vomiting, indigestion, diarrhea, abdominal cramps, constipation, anorexia after a while moment privation, acceptiond craving after a while moment form, life-threatening pancreatitis, hepatic failure
  • GU: Irregular menses, unimportant amenorrhea
  • Hematologic: Slight ameliorations in AST, ALT, LDH; acceptions in serum bilirubin, unnatural diversifys in other LFTs, altered bleeding occasion; thrombocytopenia; bruising; hematoma formation; sincere hemorrhage; not-absolute lymphocytosis; hypofibrinogenemia; leukopenia, eosinophilia, anemia, blight gist suppression
Contraindications
  • Contraindicated after a while hypersensitivity to valproic intelligent, hepatic sickness or suggestive hepatic decrepitude.
  • Use cautiously after a while outcome < 18 mo; outcome < 2 yr, distinctly after a while multiple antiepileptics, natural metabolic assumptions, stern rapines accompanied by stern hyperphysical impediment, constitutional brain assumptions (loftier miss of developing mortal hepatotoxicity); pregnancy (fetal neural tube defects; do not cancel to forefend important rapines; discontinuing such medication is mitigated to overwhelm foothold epilepticus, hypoxia and miss to twain dowager and fetus); lactation.
Nursing considerations
CLINICAL ALERT! Confusion has occurred among delayed-release Depakote and Depakote ER. Dosage is very contrariant and earnest counteractive goods can occur; use remote calculation.
Assessment
  • History: Hypersensitivity to valproic intelligent; hepatic decrepitude; pregnancy, lactation
  • Physical: Weight; bark speciousness, lesions; orientation, feign, reflexes; bowel sounds, ordinary output; CBC and contrariantial, bleeding occasion tests, LFTs, serum ammonia roll, exocrine pancreatic business tests, EEG
Interventions
  • Give offal after a while prop if GI overturn occurs; supply of the enteric-coated formulation also may be of benefit; enjoy resigned appropriate SR tablet unimpaired; do not cut, swamp, or munch.
  • WARNING: Reduce dosage, cancel, or depute other antiepileptics gradually; hasty discontinuation of all antiepileptics may overwhelm deficiency rapines.
  • BLACK BOX WARNING: Arrange for numerous LFTs; cancel offal forthafter a while after a while suggestive hepatic decrepitude, reputed or ostensible suggestive hepatic decrepitude; abide LFTs to determine if hepatic decrepitude progresses in malevolence of offal discontinuation.
  • WARNING: Arrange for resigned to enjoy platelet counts, bleeding occasion sensuality precedently therapy, periodically during therapy, and precedent to surgery. Instructor resigned preservationfully for clotting defects (bruising, order-tinged toothbrush). Cancel if there is exemplification of hemorrhage, bruising, or assumption of hemostasis.
  • Monitor ammonia rolls, and cancel if there is clinically suggestive amelioration in roll.
  • Monitor serum rolls of valproic intelligent and other antiepileptic offals affordn contemporaneously, distinctly during the primeval few weeks of therapy. Adjust dosage on the basis of these basis and clinical apology.
  • BLACK BOX WARNING: Arrange for counseling for women of childbearing age who eagerness to befit delay-child; offal may be teratogenic.
  • BLACK BOX WARNING: Cancel offal at any type of pancreatitis.
  • WARNING: Evaluate for hygienic serum rolls—usually 50–100 mcg/mL.
Teaching points
  • Take this offal precisely as prescribed. Do not munch tablets or capsules precedently appropriateing them. Appropriate them unimpaired to forefend national impatience of bung and throat. Sprinkle tablets may be opened and meagre on applesauce or pudding.
  • Do not cancel this offal hastyly or diversify dosage, negative on the teaching of your sanity preservation provider.
  • Avoid alcohol and sleep-inducing and over-the-counter offals. These could object dangerous goods.
  • Have numerous checkups, including order tests, to instructor your offal apology. Keep all appointments for checkups.
  • Use contraceptive techniques at all occasions. If you lack to befit delay-child, ask-advice-of your sanity preservation provider.
  • Wear a medical ID tag to prompt conjunction medical personnel that you enjoy epilepsy and are insertion antiepileptic medication.
  • If you enjoy diabetes, this offal may quarrel after a while urine tests for ketones.
  • You may proof these verge goods: Drowsiness (abandon driving or performing other tasks requiring promptness; use at bedtime); GI overturn (use after a while prop or adjust, eat numerous diminutive meals; if height persists, depute enteric-coated offal); temporary acception in hair privation.
  • Report bruising, pink tarnish on the toothbrush, yellowing of the bark or eyes, lurid feces, indiscreet, pregnancy; abdominal asceticism after a while disgust, vomiting, anorexia.

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