A woman has just learned she is pregnant and is in her 10th gestational week. The woman reports that she takes valproic sodium (Depakote) for a seizure disorder and has been seizure-free for several years. The NP should:
a. prescribe folic acid supplements.
b. change her antiepileptic drug to lamotrigine (Lamictal).
c. order prophylactic vitamin K to be given in the second trimester.
d. recommend that she discontinue taking the valproic sodium by 12 weeks.
A
Maternal folic acid deficiency is induced by anticonvulsants, especially valproic acid, so folic acid supplements must be given. Although antiepileptic drugs can have consequences for the developing fetus, once a woman is pregnant, the benefit-risk ratio favors continued use of the woman's current antiepileptic medication, so she should not discontinue the medication or change to lamotrigine. Vitamin K is recommended beginning at 36 weeks of gestation and for the newborn at birth to counter the possibility of hemorrhagic disease of the newborn.
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