PRESENTED BY ANUMOL TOMY MSc nursing 1ST YEAR

SODIUM VALPROATEValproate ( Depakene, Depakote) is used to treat bipolar I disorder & is equal in efficacy & safety to lithium . Valproate is also used in treatment of schizoaffective disorders, impulse control disorders & behavioural agitation. Valproate is an effective prophylaxis against migraine headaches.

INTRODUCTIONAvailable formulations include valproic acid (Depakene); divalproex ,a 1:1 mixture of valproic acid & sodium valproate. Valproate is also called valproic acid because it is rapidly converted to the acid forms in the stomach.

CHEMISTRYAll valproate formulations are rapidly & completely absorbed after the oral administration .The steady half life of valproate is about 8-17 hours,& clinically effective plasma concentrations can be usually be maintained with dosing one to four times a day. Protien binding becomes saturated & concentrations of therapeutically effective free valproate increase at serum concentrations above 50-100 ug/mL.

PHARMACOLOGICAL ACTION

The therapeutic effects of valproate in bipolar I disorder may be mediated by as yet undefined effects of the drug on gamma aminobutyric acid neurotransmitter system.

CONTD.Bipolar I disorderSchizoaffective disorderOther mental disorder-It is effective for the treatment of intermittent explosive disorder, kleptomania,& other behavioural dyscontrol syndromes, particularly if these disorders are comorbid with bipolar symptoms..

THERAPEUTIC INDICATIONSValproate can effectively control physical aggression, restlessness, agitation,& to a lesser degree, verbal aggression associated with dementia ,organic brain disease or traumatic brain injuryCONTD.PregnancyLactating mothersBleeding disordersHepatic disordersRenal diseases

CONTRAINDICATIONS

Valproic acid produces false positive results for urine ketones, elevated AST, ALT, LDH , serum alkaline phosphatase, prolonged bleeding time, altered thyroid time. DIAGNOSTIC TEST INTERFERENCECNS-Seizures,increased alertness,hallucinations,aggression,sedation,GI- Nausea ,vomiting, indigestion , hyper salivation ,anorexia with weight loss, abdominal cramps with diarrhoea, hepatic failure.Hematolgical-Prolonged bleeding time , leukopenia, thrombocytopenia ,bone marrow depression & anemia.Other-Skin rashes, transient hair loss, irregular menses, secondary ammenhoreaOverdose-Deep coma ,pulmonary edema,death

ADVERSE EFFECTS

ADMINISTRATION

Tablets & capsules should not be chewed. It should be swallowed the whole.

To reduce gastric irritation administer drug with food .Enteric coated tablets or syrup is well tolerated.

Abrupt discontinuation of the drug can lead to loss of seizure control. Warn the patient not to stop or alter the treatment regimen without consultation.

NURSING IMPLICATIONS

Therapeutic effectiveness is indicated by decrease in BP.

Periodically monitor liver functions,BUN & creatinine,serum potassium,CBC.

ASSESSMENT

Women who become pregnant should immediately inform their physicians.Weight gain is a common side effect especially in long term treatment & can be treated by limited calorie intake.The risk of valproate induced neural tube defects can be reduced by administration of folic acid supplements.

PATIENT TEACHING

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