CPT: epilepsy perspective practice

Question 1

When taking AEDs what alterations or drugs should women avoid using in regards to contraception?

Answer 1

• POP/ implant not reccomended
• 50mcg of oestrogen minimum
• Emergency contraception pill - dose should be increased as inducer therfore other wise drug would be metabolised and not effective

Question 2

When on AEDs women who are pregnant should be aware of what drugs and what consequences?

Answer 2

• Phenyotin: congenital malformations
• Sodium valporate: neural tube defects
• Carbamazepine: neural tube defects

Increases the risk of neonate bleeding

Question 3

What treatments should be put in place with people on AEDs and contraception or pregnant

Answer 3

• follic acid to prevent neural tube defects
• monotherpay preferred to reduce risks
• antenateal screening
• vit k to prevent bleed on delivery

Question 4

What is NICE guidance for sodium valporate

Answer 4

• Valproate medicines are contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met.
• Sodium Valproate must not be used in pregnancy -increased risk of teratogenicity.

Question 5

What should the pharmasist do when dispensing SV

Answer 5

• ensure patient leaflet
• dispense whole pack where possible and ensure warning label
• discuss pregancy risks every time dispensing

Question 6

Which drugs are inducers and which are inhibitors?

Answer 6

Inducers:

• Phenytoin
• phenobarbitone
• carbamazepine

inhibitors: SV

Protein binding: SV/ phenytoin compete = increase conc active drug = toxicity

Question 7

In stratus epilepticus what treatment should be used?

Answer 7

• Iv lorazepam
• rectal diazepam
• buccal liquid midazolam

Question 8

What are practical considerations?

Answer 8

• first aid- treat feavers quickly
• avoud strobe lights
• avoid alcohol
• avoid sleep deprivation
• avoid substance misues
• ketogenic diet