Valproates Divalproex Sodium

INTRODUCTION

Indications

Monotherapy and adjunctive therapy for simple and complex absence seizures. Monotherapy and adjunctive therapy for complex partial seizures. Adjunctive therapy for patients with multiple seizure types, including absence seizures. Divalproex sodium only: Manic episodes associated with bipolar disorder, Prevention of migraine headache.

Action

Increase levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the CNS. Therapeutic Effects: Suppression of seizure activity; ↓ manic episodes; ↓ frequency of migraine headaches.

Adverse Reactions/Side Effects

CNS: SUICIDAL THOUGHTS, agitation, dizziness, headache, insomnia, sedation, confusion, depression. CV: peripheral edema. EENT: visual disturbances. GI: HEPATOTOXICITY, PANCREATITIS, abdominal pain, anorexia, diarrhea, indigestion, nausea, vomiting, constipation, increased appetite. Derm: alopecia, rashes. Endo: weight gain. Hemat: leukopenia, thrombocytopenia. Metab: HYPERAMMONEMIA. Neuro: HYPOTHERMIA, tremor, ataxia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of hepatotoxicity (anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, unusual bleeding or bruising), or pancreatitis (upper abdominal pain after eating, indigestion, weight loss, oily stools). Report these signs to the physician immediately.

• Be alert for suicidal thoughts and ideology; notify physician immediately if patient exhibits signs of depression or other changes in mood and behavior.

• Monitor signs of hypothermia, including shivering, confusion, drowsiness, slurred speech, incoordination, weak pulse, shallow slow breathing, and progressive loss of consciousness. Notify physician immediately, and request emergency assistance if these signs occur.

• Be alert for signs of increased ammonia levels (hyperammonemia), including anxiety, irritability disorientation, combativeness, loss of appetite, vomiting, lethargy, somnolence, and decreased consciousness that can progress to coma and death. Report these signs to the physician immediately.

• Document the number, duration, and severity of seizures to help document whether this drug is effective in reducing seizure activity.

• Be alert for signs of leukopenia (fever, sore throat, mucosal lesions, signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs to the physician immediately.

• Assess dizziness, ataxia, or tremor that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor daytime drowsiness, confusion, or anxiety. Repeated or excessive symptoms may require change in dose or medication.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling ...