# A nurse is teaching a client newly prescribed topiramate for migraine prophylaxis. Which set of self-care instructions is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391751&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse is teaching a client newly prescribed topiramate for migraine prophylaxis. Which set of self-care instructions is most important?

## Option

1. Drink 2-3 liters of water daily, report flank pain or paresthesias, and notify the provider about word-finding difficulty or significant weight loss **✔ Correct answer**
2. Use a vegetarian diet to avoid CYP3A4 induction
3. Take with grapefruit juice to enhance absorption
4. Avoid green leafy vegetables and dairy products

**Correct answer: 1**

## Explanation

Correct (2): Topiramate inhibits carbonic anhydrase, causing metabolic acidosis, increased risk of calcium phosphate kidney stones, and paresthesias (tingling in fingers/toes). Cognitive side effects ("dopamax") include word-finding difficulty and slowed thinking. Anorexia and weight loss are common. Adequate hydration (2-3 L/day) reduces stone risk. (1,3,4) Irrelevant dietary advice.

## In-depth explanation

Memory Tip Topiramate = "Topa-MAX side effects" — kidney stones, slowness, sensation (paresthesia), slim (weight loss). CPG Avoid in clients with kidney stone history; check baseline bicarbonate.

## Clinical scenario

Scenario 38-year-old female starting topiramate 25 mg PO daily titrating to 100 mg/day for chronic migraine prophylaxis. Receiving outpatient teaching.

## Key concepts

- **Carbonic anhydrase inhibition** — Topiramate's mechanism for metabolic acidosis and stone formation.
- **Calcium phosphate kidney stones** — Stone type favored by alkaline urine; increased risk with topiramate.
- **Cognitive side effects** — Topiramate's "dopamax" effect — word-finding difficulty, slowed thinking, paresthesias.

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