Anti-epileptics

Question 1

Valproate and pregnancy prevention program

Answer 1

All women of child bearing age must have appropriate contraception method in place before taking valproate.

Valproate can cause birth defects

Question 2

Valproate side effects

Answer 2

• Appetite stimulation
• Weight gain
• Thinning and loss of hair (dose related)
• Hepatotoxicity
• Blood disorders (anaemia, thrombocytopenia and agranulocytosis)
• Pancreatitis

Question 3

Carbamazepine side effects

Answer 3

• Hyponatraemia
• Bone marrow depression
• Toxic hepatitis
• Stevens-Johnson syndrome

Question 4

Generalised tonic-clonic seizures

Answer 4

Valproate or lamotrigine

Question 5

Generalised absence seizures

Answer 5

Ethosuximide, valproate, lamotrigine

Question 6

Focal seizures

Answer 6

Lamotrigine or carbamazepine

Question 7

Anti-epileptics which are enzyme inducers

Answer 7

• Carbamazepine
• Phenobarbital
• Phenytoin

Question 8

Anti-epileptics which are enzyme inhibitors

Answer 8

• Valproate

Question 9

Lamotrigine and oral contraceptives

Answer 9

The efficacy of lamotrigine is reduced

Question 10

Brand vs Generic

Answer 10

Category 1 - no switching between branded and generic [phenytoin, carbamazepine, phenobarbital and primidone]

Category 2 - Switching based on clinical judgement if deemed appropriate [Valproate, lamotrigine, topiramate]

Category 3 - Can be switched between different versions [Levetirecetam, gabapentin, pregabalin, ethosuximide]

Question 11

Valproate and other anti-epileptics

Answer 11

Carbamazepine, phenytoin, phenobarbital and primidone reduce valproate serum levels