NBME F1B1Q34 - 19yo man with nosebleeds for 3 wks - maritzasf

[ArchivalUser]

Q-34
A 19-year-old man comes to the physician because of frequent nosebleeds over the past 3 weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and valproic acid. Physical examination shows no abnormalities except for dried blood in the nares. Mental status examination shows an anxious mood and slight motor restlessness. Serum studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100). Which of the following is the most appropriate next step in management?

A) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B) Measurement of serum bupropion level
C) Platelet count
D) Discontinuation of lithium carbonate therapy
E) Discontinuation of valproic acid therapy

[ArchivalUser]

e.
thrombocytopenia, impaired lft, jaundice are side effect even in normal range

[ArchivalUser]

Answer:
E) Discontinuation of valproic acid therapy

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What is the mechanism of action of VPA?
Inhibition of axonal sodium channels; inhibition of T-type calcium channels; inhibition of GABA transaminase

What type of drug interactions can VPA produce?
Inhibition of cytochrome β-450 enzymes

What conditions, other than epilepsy, can VPA be used in?
Manic-depression; migraine


***** What are the ADVERSE EFFECTS OF VPA?
Hepatotoxicity;
pancreatitis;
alopecia;
nausea; vomiting;
photosensitivity;
sedation;
diarrhea;
abdominal pain;
thrombocytopenia;
rash;
amenorrhea;
dysmenorrhea;
weight gain;
tinnitus



What antiepileptic medication can cause alopecia?
Valproic acid (VPA) "VALD"

Is VPA safe to use in pregnancy?
No, it causes neural tube defects.

Which types of seizures does VPA treat? Simple partial; complex partial; tonic-clonic; absence; myoclonic

[Deja Review Pharmacology, Second Edition]