A Reducing the carbamazepine dose to 50 mg twice daily B Reducing the

A. Reducing the carbamazepine dose to 50 mg twice daily B. Reducing the lamotrigine dose to 225 mg twice daily C. Increasing the carbamazepine dose to 200 mg twice daily D. Increasing the lamotrigine dose to 500 mg twice daily NCLEX-RN Need to Know Medications

A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine 100 mg twice daily to be added to the patient’s medication regimen. The nurse reviewing the patient’s medical history notes that the patient is already taking lamotrigine 375 mg twice daily. The nurse will contact the provider to discuss which action? A. Reducing the carbamazepine dose to 50 mg twice daily B. Reducing the lamotrigine dose to 225 mg twice daily C. Increasing the carbamazepine dose to 200 mg twice daily D. Increasing the lamotrigine dose to 500 mg twice daily NCLEX-RN Need to Know Medications

LEVETIRACETAM • MOA – Decreases severity and incidence of seizures (anticonvulsant) • Indications – Seizure disorders • Nursing Implications – May cause suicidal thoughts, dizziness, weakness – May alter RBC, WBC, and liver function – May cause somnolence – Should be infused over 15 minutes NCLEX-RN Need to Know Medications

LEVOFLOXACIN • MOA – Inhibits DNA synthesis in bacteria (anti-infective – fluoroquinolone) • Indications – UTI – Gonorrhea – Respiratory tract infections (bronchitis, pneumonia) – Skin and bone infections • Nursing Implications – Assess for allergies – May cause prolonged QT prolongation – avoid use with other drugs that can impact QT – Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson Syndrome – May decrease phenytoin levels – Monitor renal panel and LFTs – Assess for infection – OBTAIN CULTURES PRIOR TO THERAPY NCLEX-RN Need to Know Medications

LEVOTHYROXINE • MOA – Thyroid hormone replacement in hypothyroidism (hormone – thyroid preparations) • Indications – Thyroid hormone replacement in hypothyroidism • Nursing Implications – Assess pulse and monitor for tachyarrythmias and chest pain – Monitor TSH levels – Overdose is presented as hyperthyroidism – Start with low doses and titrate up – Therapy is lifelong – Take directly after breastfeeding – Increases the effects of warfarin NCLEX-RN Need to Know Medications

LISINOPRIL • MOA – Blocks conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation (antihypertensive – ACE inhibitor) • Indications – Hypertension – Management of CHF • Nursing Implications – Dry cough – Assess for hypotension on initial dose – Use cautiously with potassium supplements and potassium sparing diuretics – Use cautiously with diuretic therapy – Administer 1 hour before meals – Monitor fluid status – daily weight – Monitor renal panel and LFTs NCLEX-RN Need to Know Medications