LOILO DOCTORS’ COLLEGE

College of Nursing
West Avenue, Molo, Iloilo City
Name of patient: ________________________________ DRUG TEST Impression & Diagnosis: ________________________
Age & Sex: _____________________________________ Ward / Bed: __________________________________

Prescribed Drug Classification and Indication and Side Effects or Adverse

Special Precautions Nursing Responsibilities
(Dosage, Route, frequency, Timing) Mechanism of Action Contraindication Reaction
Depakote Classification: Indication: CNS: confusion, dizziness, Use cautiously in: ● Instruct patient to take

BRAND NAME: Pharmacologic class: Complex partial seizures headache, sedation, ataxia, ● bleeding disorders, organic with food to minimize GI

divalproex sodium Carboxylic acid derivative paresthesia, asthenia, tremor, Brain disease, bone marrow upset.

DOSAGE: Therapeutic class: Contraindication: drowsiness, emotional lability, depression, renal impairment ● Tell patient taking extended

Adults: 250 mg (divalproex delayed- Anticonvulsant, mood stabi- ● Hypersensitivity to drug or abnormal thinking, amnesia ● posttraumatic seizures -release tablets to swallow

released) P.O. b.i.d. Or 500 mg lizer, antimigraine agent Tartrazine (some products) EENT: amblyopia, blurred caused by head injury (use not them whole without chewing
● Hepatic impairment
(divalproex extended-release) vision, nystagmus, tinnitus, recommended) or breaking.

P.O. daily for 1 week (up to 1 g/day) Action: ● Urea cycle disorders pharyngitis ● history of hepatic disease ● Tell patient (or parents)
● Pregnancy
Maximum dosage is 1 g/day. Increases level of gamma- GI: nausea, vomiting, diarrhea, ● breastfeeding patients that valproate syrup shouldn’t

Aminobutyric acid in brain, Abdominal pain, dyspepsia, ● children. be taken with carbonated
reducing seizure activity. anorexia, pancreatitis beverages.

Musculoskeletal: back pain

Respiratory: dyspnea

Students Name: ____________________ Yr. & Sec: ___________ Date: _________ C.I’s Printed Name & Signature: _____________________________
Prepared by: Mrs. Maria Luz M. Chan
NAL Coordinator