C3.1 R4(e): Perform & document a pharmacokinetic interpretation (OTHER drug)

ID: 72 yo female with bipolar type II disorder and mild Alzheimer’s

s/o:

  • Taking divalproex EC 1000mg po daily at 800hr since Sept 28, 2016 (no compliance issue in hospital)
    • As per P’net, patient was also on divalproex EC 1000mg po daily PTA (but likely non-compliant as valproic acid level on admission (Sept 26) was 36 umol/L)
  • Valproic acid level: 513 umol/L (350-835 umol/L)
    • Taken on Oct 5, 2016 (12 hours post 800 hr dose)
      SPH lab bases on 12 hr-post dose trough concentration, regardless of dosing frequency as studies have shown that its best for interpretation
  • Oct 5, 2016 Labs:
    Alb: 30g/L, AST = 20, ALT = 12, GGT = 8, ALP = 57, total bilirubin = 5 umol/L
  • As of Oct 6, 2016 – patient denies any concerns or side effects with divalproex (e.g. no tremors, weakness, dizziness, stomach upset). Patient feels that her mood is stable (denies low or elevated mood, issues with sleep and energy)

A:

  1. Level is drawn appropriately and at steady state
  2. Level is within therapeutic range. However, albumin is slightly low and also considering her age the protein binding to valproic acid might be lower and total valproic acid level might noe be reflective that free valproic acid level is within therapeutic range. Her free valproic acid level is likely higher than someone who is younger and have normal albumin levels.
  3. Patient denies any issues with her mood and there are no significant safety concerns with divalproex

P:

  1. Continue current dose of divalproex 1000mg EC po daily
  2. Monitor for adverse reactions of divalproex (e.g. tremors, dizziness, insomnia, stomach upset)
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