NAME MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING ACTION

Generic Name: Sodium Increase level of GABA, Manic episodes CNS: Suicidal thoughts, Dx
Divalproex an inhibitor associated with bipolar agitation, dizziness, BEFORE: Note if patient
Brand Name: Depakote, neurotransmitter in the disorder. Prevention of headache, insomnia, is done eating his
Depakote ER CNS. migraine and headache. sedation, confusion, meal.
Classification: Suppression of seizure depression DURING: Assess
anticonvulsants, activity. Decreased Contraindicated in: CV: peripheral edema patient’s condition
vascular headache manic episodes. Hypersensitivity; EENT: visual after taking the drug.
suppressants Decreased frequency of Hepatic impairment; disturbances AFTER: Assessed for
Dosage: 250 mg 1 tab headaches and migraine. Known/suspected urea GI: Hepatotoxicity, suicidal tendencies.
TID cycle disorders (may pancreatitis, abdominal
result in fatal pain, anorexia, Tx
hyperammonemic diarrhea, indigestion, BEFORE: Administer drug
encephalopathy). nausea, vomiting, after meal to minimize
constipation, increased GI irritation.
Drug-Drug Interaction: appetite DURING: Provide
Increased risk of DERM: alopecia, rashes necessary precautions
bleeding with warfarin, ENDO: weight gain and information about
Blood levels and HEMAT: leukopenia, the drug.
toxicity may be thrombocytopenia AFTER: Provide safety
increased by aspirin, METAB: hyperammonemia and comfort measures to
carbamazepine, NEURO: hypothermia, minimize risk of injury
chlorpromazine, tremor, ataxia due to dizziness.
cimetidine,
erythromycin, or Edx:
felbamate. Increased BEFORE: Instruct
CNS depression with patient to avoid taking
other CNS depressants, alcohol, OTC
including alcohol, medications and herbal
antihistamines, products concurrently
antidepressants, opioid with valproates without
analgesics, M AO consulting health care
inhibitors, and professional.
sedative hypnotics. MAO DURING: Instruct
inhibitors and other patient to notify
antidepressants may health care
decrease seizure professional if
threshold and decrease anorexia, abdominal
effectiveness of pain, severe nausea and
valproate. vomiting, yellow skin
Carbamazepine, or eyes, fever, sore
meropenem, throat, malaise,
phenobarbital, weakness, facial edema,
phenytoin, or rifampin lethargy, unusual
may decrease valproate bleeding or bruising,
blood levels. Valproate or loss of seizure
may increase toxicity control occurs.
of carbamazepine, AFTER: Instruct patient
diazepam, and family to notify
amitriptyline, health care
nortriptyline, professional if thought
ethosuximide, about suicide or dying;
lamotrigine, new or worse
phenobarbital, depression; new or
phenytoin, topiramate, worse anxiety; feeling
or zidovudine. agitated or restless;
Concurrent use with panic attacks; trouble
topiramate may increase sleeping; new or worse
risk of hypothermia. irritability; acting
Ertapenem, imipenem, or aggressive, or other
meropenem may decrease unusual changes in
valproate blood levels. behavior and mood.