# Complete the statement about a new carbamazepine prescription for a client taking apixaban for atrial fibrillation.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522057&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Complete the statement about a new carbamazepine prescription for a client taking apixaban for atrial fibrillation.

Carbamazepine can ::선택::increasedecreasestabilizemeasure apixaban exposure through strong enzyme and transporter ::선택::inhibitionsaturationinductionreplacement. The nurse should ::선택::avoid and clarifydouble independentlymonitor by INR onlyadminister unchanged the combination and obtain an alternative plan.

## Explanation

Carbamazepine is a combined P-gp and strong CYP3A4 inducer that can decrease apixaban exposure and increase thromboembolic risk; the combination should be avoided and an alternative plan obtained.

## In-depth explanation

Quick answer
The prescription creates an enzyme-induction loss of anticoagulant protection.

Why this is correct
Apixaban labeling says to avoid combined P-gp and strong CYP3A4 inducers such as carbamazepine because exposure decreases and stroke or systemic embolism risk can rise.

Easy analogy or mental picture
Carbamazepine opens faster exit routes, so apixaban leaves before it can provide the intended protection.

Memory hook
Strong inducer means apixaban lower, stroke risk higher.

NCLEX decision rule
Clarify the combination before administration rather than compensating with an unapproved self-selected dose.

Why the other choices are wrong
Increasing apixaban without authorization or relying on routine INR testing does not solve this interaction.References
1FDA: ELIQUIS Prescribing InformationAvoid combined P-gp and strong CYP3A4 inducers because apixaban exposure decreases and thromboembolic risk rises

## Clinical scenario

Induction interaction check
Verify seizure indication, interacting alternatives, apixaban indication and dose, adherence, renal and hepatic function, and the authorized replacement strategy.

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