Board Review: Depakote

Practice quiz, content review & patient scenario

Today we will briefly review Depakote and it’s use for bipolar d/o. Let’s start with some practice questions:

DISCLAIMER

The content provided in this Substack post is for entertainment and informational purposes only and is not intended to serve as medical advice. The views and opinions expressed herein are those of the writer and should not be taken as definitive or authoritative. Readers should not rely solely on the information provided in this post to make decisions about patient care. Instead, use this content as a starting point for further research and consult a qualified healthcare professional before making any changes to treatment or medication regimens.

1. A patient has recently started taking Depakote for bipolar disorder. Which of the following is a potential side effect of this medication?

   1. Alopecia

   2. Hypothyroidism

   3. Diabetes insipidus

   4. Edema

2. A PMHNP is reviewing a patient's medication regimen and notes that the patient is taking Depakote. What is the therapeutic range for Depakote?

   1. 10-50 mcg/mL

   2. 30-100 mcg/mL

   3. 50-125 mcg/mL

   4. 75-150 mcg/mL

3. A patient is taking Depakote for bipolar disorder. Which of the following is a sign of hepatotoxicity associated with Depakote use?

   1. RUQ pain or brown/red urine

   2. Polyuria

   3. Maculopapular rash

   4. T-wave inversions

4. A patient who is taking Depakote for bipolar disorder expresses a desire to become pregnant. What is the PMHNP's recommendation regarding the use of Depakote during pregnancy?

   1. Depakote is safe to use during pregnancy and can be continued.

   2. Depakote should be avoided during pregnancy if possible.

   3. Depakote should be discontinued immediately upon conception.

   4. Depakote can be used during pregnancy, but only at a reduced dose.

5. A patient taking Depakote presents with disorientation, lethargy, and respiratory depression. These symptoms are most likely indicative of:

   1. Lithium toxicity

   2. Depakote toxicity

   3. An adverse reaction to NSAIDs

   4. Hypothyroidism

6. A patient with a history of bipolar disorder is prescribed Depakote for mood stabilization. Which of the following liver function tests should the PMHNP monitor to assess for potential hepatotoxicity associated with Depakote use?

   1. Alanine transaminase (ALT) and Aspartate transaminase (AST)

   2. Gamma-glutamyl transferase (GGT) and Alkaline phosphatase (ALP)

   3. Bilirubin and Prothrombin time (PT)

   4. Creatinine and Blood urea nitrogen (BUN)

7. A patient has been prescribed Depakote for the treatment of bipolar disorder. Which of the following medications may interact with Depakote

   1. Warfarin

   2. Metformin

   3. Albuterol

   4. Acetaminophen

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Questions with Answers + Rationales

1. A patient has recently started taking Depakote for bipolar disorder. Which of the following is a potential side effect of this medication?

   1. Alopecia

   2. Hypothyroidism

   3. Diabetes insipidus

   4. Edema

Correct Answer: a) Alopecia

Rationale: Alopecia (a) is a potential side effect of Depakote. Hypothyroidism (b), diabetes insipidus (c), and edema (d) are potential adverse effects associated with lithium, not Depakote. It is important for healthcare providers to monitor patients for potential side effects and adjust treatment accordingly.

2. A PMHNP is reviewing a patient's medication regimen and notes that the patient is taking Depakote. What is the therapeutic range for Depakote?

   1. 10-50 mcg/mL

   2. 30-100 mcg/mL

   3. 50-125 mcg/mL

   4. 75-150 mcg/mL

Correct Answer: c) 50-125 mcg/mL

Rationale: The therapeutic range for Depakote is 50-125 mcg/mL (c). Levels below or above this range are not considered therapeutic and may lead to suboptimal treatment or toxicity. The other options (a, b, d) do not represent the correct therapeutic range for Depakote.

3. A patient is taking Depakote for bipolar disorder. Which of the following is a sign of hepatotoxicity associated with Depakote use?

   1. RUQ pain or brown/red urine

   2. Polyuria

   3. Maculopapular rash

   4. T-wave inversions

Correct Answer: a) RUQ pain or brown/red urine

Rationale: Right upper quadrant (RUQ) pain or brown/red urine (a) can be a sign of hepatotoxicity associated with Depakote use. Polyuria (b), maculopapular rash (c), and T-wave inversions (d) are not specific signs of hepatotoxicity related to Depakote. It is important for healthcare providers to monitor patients for potential side effects and adjust treatment accordingly.

4. A patient who is taking Depakote for bipolar disorder expresses a desire to become pregnant. What is the PMHNP's recommendation regarding the use of Depakote during pregnancy?

   1. Depakote is safe to use during pregnancy and can be continued.

   2. Depakote should be avoided during pregnancy if possible.

   3. Depakote should be discontinued immediately upon conception.

   4. Depakote can be used during pregnancy, but only at a reduced dose.

Correct answer: b) Depakote should be avoided during pregnancy if possible.

Rationale: Depakote use during pregnancy has been associated with an increased risk of neural tube defects and other congenital malformations. Therefore, it is generally recommended that Depakote be avoided during pregnancy if possible, and alternative treatments be considered. In cases where Depakote use during pregnancy is necessary, the benefits must outweigh the risks, and close monitoring and management are required. Folic acid supplementation may reduce the risk of neural tube defects, but it does not eliminate the risk completely.

5. A patient taking Depakote presents with disorientation, lethargy, and respiratory depression. These symptoms are most likely indicative of:

   1. Lithium toxicity

   2. Depakote toxicity

   3. An adverse reaction to NSAIDs

   4. Hypothyroidism

Correct Answer: b) Depakote toxicity

Rationale: Disorientation, lethargy, and respiratory depression are symptoms of Depakote toxicity (b). Lithium toxicity (a), an adverse reaction to NSAIDs (c), and hypothyroidism (d) can present with different symptoms but are not consistent with the presenting symptoms of Depakote toxicity

6. A patient with a history of bipolar disorder is prescribed Depakote for mood stabilization. Which of the following liver function tests should the PMHNP monitor to assess for potential hepatotoxicity associated with Depakote use?

   1. Alanine transaminase (ALT) and Aspartate transaminase (AST)

   2. Gamma-glutamyl transferase (GGT) and Alkaline phosphatase (ALP)

   3. Bilirubin and Prothrombin time (PT)

   4. Creatinine and Blood urea nitrogen (BUN)

Correct answer: a) Alanine transaminase (ALT) and Aspartate transaminase (AST)

Rationale: Depakote use has been associated with potential hepatotoxicity, and the PMHNP should monitor liver function tests, including Alanine transaminase (ALT) and Aspartate transaminase (AST) (a), to assess for possible liver damage. Gamma-glutamyl transferase (GGT) and Alkaline phosphatase (ALP) (b) are not specific indicators of hepatotoxicity associated with Depakote. Bilirubin and Prothrombin time (PT) (c) are important to assess liver function, but are not specific to Depakote use. Creatinine and Blood urea nitrogen (BUN) (d) are measures of kidney function, not liver function.

Note: Liver function tests should be conducted prior to initiating Depakote treatment and monitored regularly thereafter to detect any potential liver dysfunction.

7. A patient has been prescribed Depakote for the treatment of bipolar disorder. Which of the following medications may interact with Depakote

   1. Warfarin

   2. Metformin

   3. Albuterol

   4. Acetaminophen

Correct Answer: A) Warfarin

Rationale: Depakote may interact with Warfarin (A) and increase the risk of bleeding. Therefore, patients taking both medications should be monitored closely. Metformin (B) is an antidiabetic medication and does not interact with Depakote in this manner. Albuterol (C) is a bronchodilator and has no known interaction with Depakote. Acetaminophen (D) is an analgesic and antipyretic medication and does not interact with Depakote in this manner.

PDF File attached:

Board Review Depakote Practice Questions

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Same questions as above, but in PDF form

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Depakote - Therapeutic Range, Side Effects, Toxicity, and Pregnancy Considerations

A. Therapeutic Range

1. The therapeutic range for Depakote is 50-125 mcg/mL.

   • Levels below or above this range are not considered therapeutic and may lead to suboptimal treatment or toxicity.

B. Side Effects

1. Alopecia is a potential side effect of Depakote.

2. Hepatotoxicity associated with Depakote use can manifest as right upper quadrant (RUQ) pain or brown/red urine.

   • It is important for healthcare providers to monitor patients for potential side effects and adjust treatment accordingly.

C. Toxicity

1. Disorientation, lethargy, and respiratory depression are symptoms of Depakote toxicity.

   • Healthcare providers must closely monitor patients taking Depakote to identify and manage toxicity effectively.

D. Pregnancy Considerations

1. In women of child bearing age, use extreme caution as Depakote is a known teratogen. It is wise to ask that patient utilize two forms of birth control. As a side note, folic acid may reduce risks of neural tube defects, but does not eliminate the risk completely.

   • Patients planning to become pregnant should discuss their medication regimen with their healthcare provider to minimize risks to the developing fetus.

F. Uses

1. Depakote can also be used for mania and mixed episodes, as well as for the maintenance phase of bipolar disorder.

G. Monitoring Paramters

1. Depakote:

   • Therapeutic range: 50-125 mcg/mL

   • Baseline labs: liver function tests (LFTs), complete blood count (CBC), and HCG (for female patients of childbearing age)

   • Ongoing monitoring: serum Depakote levels, LFTs, and CBC

     

Patient Scenario: Depakote

Samantha is a 28-year-old female with Bipolar I Disorder who has been taking 750 mg of Depakote daily, divided into two doses. During her recent visit to her psychiatric mental health nurse practitioner (PMHNP), Samantha reports experiencing breakthrough mood swings and mild difficulty concentrating at her job as a graphic designer. The PMHNP decides to review her medication history and realizes that Samantha has not had a therapeutic drug level check since starting Depakote. As a result, the PMHNP orders a blood test to measure Samantha's valproic acid levels, which come back below the therapeutic range (50-100 mcg/mL).