A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. What action will the nurse take?
a. Ask the patient about usual dietary preferences.
b. Reassure the patient that this is a therapeutic drug level.
c. Report a subtherapeutic drug dose to the provider.
d. Suspect a drug-drug interaction.
ANS: A
This patient's carbamazepine level is high. When taken with grapefruit juice, an interaction may occur that causes toxicity. The nurse should question the patient about food and fluid preferences. The therapeutic level is 5 to 12 mcg/mL. This is a toxic level, not subtherapeutic.
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