Pharmacology Seizure meds #4

Question

A patient with seizure disorder has a gastrostomy feeding tube. All medications are administered through the tube. A new order for carbamazepine is received; however, the medication has a warning “not to crush”. After assessment of the patient and medical record, the nurse‚Äôs priority action is to:

Answers

  1. Contact the health care provider to discuss an alternate medication that can be given via gastrostomy tube.
    • Rationale:

      This answer is correct because carbamazepine is an anticonvulsant medication that is usually available in an extended release capsule, and cannot be crushed for placement in a gastrostomy feeding tube The nurse should contact the health care provider to discuss an alternative medication that can be given via gastrostomy tube.

  2. Contact the pharmacy and have an oral suspension made from the medication.
    • Rationale:

      This answer is not correct because a new prescription will be needed because although this medication might be available as a liquid preparation, it would not be extended release and would require a new prescription from the health care provider.

  3. Crush the medication and dissolve in juice.
    • Rationale:

      This answer is not correct because this medication should not be crushed and placed in juice. Extended release medications, such as carbamazepine, cannot be crushed since the medication may enter into the system and result in toxic levels.

  4. Crush the medication and dissolve in normal saline.
    • Rationale:

      This answer is not correct because this medication should not be crushed and placed in anything, including normal saline. Extended release medications, such as carbamazepine, cannot be crushed since the medication may enter into the system and result in toxic levels.

Overview

Carbamazepine is an anticonvulsant medication that is usually available in an extended release capsule, and cannot be crushed for placement in a gastrostomy feeding tube The nurse should contact the health care provider to discuss an alternative medication that can be given via gastrostomy tube.

Explanation

The correct answer is A. Extended release medications cannot be crushed since the medication may enter into the system and result in toxic levels. Selection B is incorrect, because although the medication comes in a suspension, it is not and extended release prescription, and the pharmacist would still require a new prescription with the medication, dose, and frequency (especially since frequency on extended release versus regular release may affect dosages such as taking every 4 hours for regular medication versus every 12 hours for extended release). Selection C and D are both incorrect since the nurse must NOT in any circumstance administer the drug after crushing.

Learning Outcomes

Extended release medications, such as carbamazepine, cannot be crushed since the medication may enter into the system and result in toxic levels. Carbamazepine is an anticonvulsant, used to treat seizure disorders. It is also used to treat bipolar disorder and nerve pain. An alternate medication should be obtained if a patient is unable to swallow due to a gastrostomy feeding tube. The health care provider should be contacted and an alternate medication and route should be requested.

Test Taking Tip

Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points.

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