Valproate Flashcards
What labs to test with valproate acid
Liver panel
CBC with WBC and platelet count
Serum hCG
Valproate level
What is in the liver panel
ALT, AST, ALP, albumin , bilirubin, total protein
How often should we check the valproate level
Baseline
Monthly for the first several months
Then 6 - 24 months
Therapeutic level for valproate
50-120 mcg/mL
What labs can be affected when you first start valproate
Elevated ALT, AST
Occurs on the first 6 months then levels out. This is more common in children
When should we expect AST/ALT to return to normal with valproate usage
After the medication is discontinued
What to suspect if AST/ALT does not return to normal after D/C of valproate
Hepatic disease
When to discontinue valproate acid early ?
If AST/ALT is 2-3x above the upper limits
Bone marrow depression
When should patients contact the NP with this therapy
If they see signs of liver dysfunction or hematologic dysfunction
Indications of liver dysfunction
Abdominal pain
Nausea
Vomiting
Jaundice
How often does liver failure occur with valproate
Rarely
Usually occurs in children less than 10 years old
Signs of hematology dysfunction
Easy bruising
Bleeding won’t stop
Slow healing wounds
High fever
Rare condition that can occur with carbamazepine
Steven Johnson syndrome
Which population is at risk for Steven Johnson syndrome
Patients with Asian ancestry
Which allele is recommended to test for in Asian patients before starting carbamazepine
HLA-B 1502
