A patient who has been taking phenobarbital for epilepsy begins taking valproic acid (Depakote) as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?
a. Explain to the patient that tolerance to sedation eventually will develop.
b. Notify the prescriber, and request an order to reduce the dose of phenobarbital.
c. Notify the prescriber of the need to increase the dose of valproic acid.
d. Request an order for liver function tests to monitor for hepatotoxicity.
ANS: B
Valproic acid competes with phenobarbital for drug-metabolizing enzymes and can increase plasma levels of phenobarbital by approximately 40%. When this combination is used, the dose of phenobarbital should be reduced. Increasing the dose of valproic acid would compound the problem. Patients taking phenobarbital alone experience sedation, which diminishes as tolerance develops. Liver toxicity is a rare adverse effect of valproic acid and is marked by symptoms of nausea, vomiting, and malaise, not drowsiness.
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