Week 6

Question 1

What are the different indications for sodium valporate

Answer 1

all forms epilepsy
bi-polar and mania
migraine prophylaxis (though not licensed)

Question 2

What is a major risk and MHRA warning of all anti-epileptic medications

Answer 2

risk of suicidal thoughts and depression

Question 3

What are the contra-indications of sodium valporate

Answer 3

liver toxicity
prolonged thrombin time
acute porphyrias
pancreatitis

Question 4

does sodium valporate require vitamin d supplementation in patients who

do not get enough calcium
do not get enough sun exposure
are immobile

Answer 4

yes

Question 5

what condition is the reason vit d supplementation is needed in sodium valporate

Answer 5

osteoporosis

Question 6

what is the most effective form of contraception for sodium valporate

Answer 6

copper iud

can additionally use barrier methods

Question 7

what two anti-epileptic medications are used if a patient becomes pregnant

love life = pregnancy

Answer 7

lamotrigine and levetiractem

Question 8

when is a pregnancy prevention plan put in place

Answer 8

whenever a patient is starting a medication that can be highly teratanogenic for example with sodium valproate

Question 9

what are the key parts of a pregnancy prevention programme

Answer 9

introduce highly effective contraception

introduce a review

discuss risks

and develop a plan if something goes south

Question 10

what is the pnuemonic to remember the side effects of sodium valporate

Answer 10

Valproate + hyponatraemia

Question 11

list the different side effects of sodium valproate using the valproate pnuemonic

Answer 11

VALPORATE has the following side effects
appetite increased
liver failure
pancreatitis and is a p450 inhibitor
reversible hairloss
oedema
ataxia
teratogenic and tremor
encephalopathy

hyponatremia
male infertility

Question 12

what does the first a in valproate stand for

Answer 12

appetite increased

Question 13

what does the l in valproate stand for

Answer 13

liver failure

Question 14

what does the p in valproate stand for

Answer 14

pancreatitis and p450 inhibitor

Question 15

what does the r in valproate stand for

Answer 15

reversible hair loss

Question 16

what does the o in valproate stand for

Answer 16

oedema

Question 17

what does the second a in valproate stand for

Answer 17

ataxia

Question 18

what does the t in valproate stand for

Answer 18

tremor and teratogenic

Question 19

what does the e in valproate stand for

Answer 19

encephalopathy

Question 20

what is ataxia

Answer 20

Ataxia describes poor muscle control that causes clumsy movements

Question 21

what is encephalopathy

Answer 21

a disease in which the functioning of the brain is affected by some agent or condition

Question 22

what are some symptoms of encephalopathy

Answer 22

altered mental state and neurological changes, including confusion, drowsiness, memory loss, and difficulty concentrating

Question 23

how does sodium valproate affect lamotragine

Answer 23

increases its exposure increasing risk of adverse affects such as sjs

Question 24

how does sodium valproate affect olanzapine

Answer 24

increases side effect

Question 25

how does phenytoin affect sodium valproate

Answer 25

affects its concentration in the blood

Question 26

how does sodium valproate affect the anticoagulant affect of warfarin

Answer 26

increases it

Question 27

what monitoring for valproate needs to be done

Answer 27

monitor the LFTs closely for the first 6 months also monitor full blood counts

Question 28

before valproate can be initiated in under 55s what must be done

Answer 28

two specialists must sign off and then they must sign off the review if the ppp is in place

Question 29

what must we as pharmacists make sure a patient has whenever we give out sodium valporate

Answer 29

ensure patient has a patient card ensure patient has leaflets check for signs of depression and suicide

Question 30

at what age with sodium valporate is liver failure most common

Answer 30

<3

Question 31

what is lamotrigine indicated for

Answer 31

focal seizures secondary generalized tonic clonic bipolar

Question 32

what is one of the major risks with lamotrigine

Answer 32

skin reactions such as sjs but can be caused due to the epileptic hypersensitivity syndrome

Question 33

if a patient presents to you with a rash while on lamotrigine what should we do

Answer 33

refer to gp and explain that they may need to withdraw the medication but should contact their doctor asap

Question 34

what anti-epileptic is cautioned in parkinsons disease

Answer 34

lamotrigine

Question 35

what type of seizures can lamotrigine worsen

Answer 35

myoclonic

Question 36

at what points should lamotrigine levels be measured in a pregnant person

Answer 36

before, during and even after this is because after birth lamotrigine levels can spike

Question 37

what forms of contraception affect lamotrigine levels

Answer 37

combined oral contraception vaginal ring (not the same as IUD) contraceptive patch

Question 38

what is the recommended type of contraception for lamotrigine

Answer 38

continuous contraception without pill free break or Copper coil

Question 39

what are the side effects of lamotrigine

Answer 39

Lethargic Agitation Multi organ failure Oedema of the face Tremor Rash and sjs Irritability Gi disturbance

Question 40

patient should avoid operating heavy machinery, driving, riding a bike during the titration stages of what drug

Answer 40

lamotrigine

Question 41

what anti-epileptics reduce lamotrigine concentration

Answer 41

phenytoin carbamazepine phenobarbitone

Question 42

what two other drugs reduce lamotrigine concentration

Answer 42

rifampicin lopinavir/rionavir

Question 43

what form of contraception lowers lamotrigine concentrations

Answer 43

coc

Question 44

what is the dose of Amiodarone for the treatment of arrythmia

Answer 44

adult dose = 200mg tds for 1 week 200mg bd for 1 week 200mg od maintenance

Question 45

what are the side effects for amiodarone

Answer 45

photosensitivity corneal microdeposits interstitial lung disease Hyperthyroidism Hypothyroidism hepatic hypokalaemia bradycardia

Question 46

what is corneal microdeposits associated with

Answer 46

dazzling at night

Question 47

why does amiodarone cause both hypo and hyper thyroidism

Answer 47

contains iodine which can cause thyroid disorders

Question 48

what are the two conta indications of amiodarone

Answer 48

thyroid dysfunction iodine sensitivity

Question 49

what do we need to monitor in amiodarone

Answer 49

thyroid function liver function serum potassium concentration chest x ray ECG Blood pressure eye tests

Question 50

when would we monitor thyroid and liver function

Answer 50

before treatment every 6 months while on medication

Question 51

one of the main counselling points is protecting skin from sun light with amiodarone what is the minimum spf to use

Answer 51

30

Question 52

would we refer a patient on amiodarone if they had shortness of breath?

Answer 52

yes

Question 53

which of the two situations would we refer a patient on amiodarone palpitations fever

Answer 53

palpitations

Question 54

would we refer a patient with unusual tiredness and light headedness of amiodarone

Answer 54

yes

Question 55

for how many months should patients attempt to protect their skin while on amiodarone

Answer 55

several months

Question 56

describe whether amiodarone has a short or long half life and the consequence of that

Answer 56

long half life means interactions can occur several weeks or even months after the drug has been stopped

Question 57

describe which drugs have their plasma concentration increased due to amiodarone

Answer 57

warfarin digoxin ciclosporin phenytoin

Question 58

what drug increases the risk of arrhythmia with amiodarone

Answer 58

lithium

Question 59

what drug increases the risk of myopathy

Answer 59

statin

Question 60

amiodarone can cause qt prolongation alongside hypokalaemia what other medications can interact with it that also cause that prolongation

Answer 60

antidepressants antipsychotics lithium macrolides quinolones

Question 61

What is the memory trick for digoxin

Answer 61

2kidneys potassium low = toxicity Inotropic drugs Digoxin toxicity Nausea Emesis Yellow vision Spironolactone

Question 62

why should spironolactone be used with digoxin

Answer 62

to stop hypokalaemia

Question 63

what drugs affect renal excretion which is bad for digoxin

Answer 63

nsaids and arbs

Question 64

what drugs decrease digoxin conc

Answer 64

st johns rifampicin

Question 65

what drugs increase digoixn conc

Answer 65

macrolides amiodarone rate limiting ccb

Question 66

what drugs decrease potassium

Answer 66

diuretics theophylline steroids

Question 67

what is the pnuemonic to remember digoxin interactions

Answer 67

CRASED

Question 68

what does the c in crazed mean

Answer 68

calcium channel blockers (verapamil)

Question 69

what does the r in crazed mean

Answer 69

rifampicin

Question 70

what does the a in crazed mean

Answer 70

amiodarone

Question 71

what does the s in crased mean

Answer 71

st johns wort

Question 72

what does the e in crased mean

Answer 72

erythromycin

Question 73

what does the d in crased mean

Answer 73

diuretics

Question 74

list all the main interactions of digoxin using the pnuemonic

Answer 74

calcium channel blockers rifampicin amiodarone st johns wart erythromycin diuretics