Question

PN 200 Fundamentals of Nursing II Seizures Depakote The nurse is caring for Mr. JM, a patient who was admitted to the hospital with new onset of seizures. JM had been taking warfarin (Coumadin), a highly protein bound drug that decreases blood clotting. The neurologist has ordered Valporic acid (Depakote), as an anti-seizure medication. Valporic acid is also very highly protein bound. 1. Define what the term "protein bound" means when used to describe a medication. State the laboratory studies as well as the normal values for each of the tests that you have listed. 2. What information needs to be included in the interdisciplinary health teaching plan for this patient? 3. 4. State the therapeutic blood level for Depakote. Reviewed 12/18

Answer 1

1. Protein bound drug refers to the degree to which medications attach to proteins within the blood. A drug's efficiency may be affected by the degree to which it binds. Common blood proteins that drugs bind to are human serum albumin, lipoprotein, etc .

2. The laboratory test are PT ,INR ,APTT( because the patient is taking warfarin an anticoagulant ) Serum protein test like albumin , globulin in liver function test.etc

Normal values :

PT- 11 to 13.5sec

APTT- 30 to 40 sec

PTT- 25 to 35sec

INR - 0.8 to 1.1 sec

ALBUMIN - 3.5 to 5.5 gm

GLOBULIN - 2 to 3.5 gm

3. Health Teaching plan for this patient taking warfarin and valproic acid include :-

- limit intake of vitamin K containing food

- use soft toothbrush

- use of electric raser

- advice to take the medicine at correct time and not to miss or double the dose

- report any unusual bleeding etc to the doctor immediately

- avoid alcohol

- notify physician if experience suicidal thoughts , worsening depression etc

- notify physician for side effects

- advice patient to rise slowly

- monitor gait and balance

4. Therapeutic blood level of depakote is :

Total valproic acid is 50 to 125 microgram /ml

Free valproic acid is 6 to 22microgram /ml