A 26-year-old pregnant client with Type II Diabetes and a history of Bipolar I Disorder is 3 months out from her due date and has

A 26-year-old pregnant client with Type II Diabetes and a history of Bipolar I Disorder is 3 months out from her due date and has been taking her usual dose of 150mg daily Lamictal throughout pregnancy. She reports to the PMHNP at medication follow up that she has felt extremely depressed, beginning one month ago and does not understand why this dose has suddenly stopped working. The PMHNP incorporates the following in patient education: a. Lamotrigine is best absorbed when taken on an empty stomach and likely has exhibited decreased efficacy due to the patient’s increased appetite b. Lamotrigine is cleared much more rapidly in pregnancy due to alterations in glomerular filtration rate c. Lamotrigine is cleared much more slowly in patients who have Type II Diabetes due to increased glycogenesis d. Lamotrigine no longer has therapeutic utility when used longer than 3 years and is less effective when used in antepartum bipolar depression