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Pharmacology > Antiepileptic medication and mood stabilisers > Flashcards

Antiepileptic medication and mood stabilisers Flashcards

1
Q

Three forms of valproate available

A

Semi-sodium valproate
Valproic acid
Sodium valproate

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2
Q

Brand name of semi-sodium valproate

A

Depakote

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3
Q

Mix of medications in semi-sodium valproate

A

Equimolar mix of sodium valproate and valproic acid

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4
Q

Very common side effects of sodium valproate

A

Nausea
Tremor
Weight gain

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5
Q

Cause of weight gain in people taking sodium valproate

A

Impaired beta-oxidation of fatty acids; independent of calorie intake

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6
Q

Common side effects of sodium valproate

A 
Liver injury
Vomiting and diarrhoea
Gingival hyperplasia
Memory impairment/confusion
Somnolence
Anaemia/thrombocytopaenia
Alopecia with curly regrowth
Polycystic ovarian disease
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7
Q

Serious side effects of sodium valproate

A

Pancreatitis

Severe liver damage

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8
Q

Timing of liver injury in patients taking sodium valproate

A

Usually occurs during the start of treatment and is transient
Severe liver damage usually occurs in the first 6 months, more likely in younger patients

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9
Q

Congenital malformations of children exposed to sodium valproate in utero

A

Neural tube defects
Facial dysmorphism
Cleft lip and palate
Craniostenosis
Cardiac defects
Renal and urogenital defects including hypospadias
Limb defects - bilateral aplasia of the radius

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10
Q

Neurodevelopmental effects of exposure to sodium valproate in utero

A

Dose dependent relationship with developmental delay
30-40% of children have early developmental delay
3x increased rate of autism

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11
Q

Uses for carbamazepine

A

Epilepsy
Neuropathic pain
Bipolar disorder

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12
Q

Drug combination where carbamazepine is contraindicated

A

MAOIs and carbamazepine

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13
Q

Serious side effects of carbamazepine

A 
Toxic epidermal necrolysis/Stevens Johnson syndrome
Agranulocytosis and aplastic anaemia
Fulminant hepatic damage
Pancreatitis
SIADH
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14
Q

Features of Stevens Johnson syndrome/toxic epidermal necrolysis

A

Prodromal flu-like illness
Abrupt onset of painful rash initially on the trunk and spreading to face and limbs
Sheets of skin detachment
Severe mucosal involement

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15
Q

Difference between Stevens Johnson syndrome and toxic epidermal necrolysis

A

Stevens Johnson syndrome has skin detachment <10% of total body area
TEN has skin detachment >10% total body area

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16
Q

Very common side effects of carbamazepine

A 
Leucopaenia
Ataxia, dizziness
Vomiting, nausea
Urticaria
Fatigue
Weight gain
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17
Q

Specific side effect of vigabatrin

A

Visual field defects

18
Q

Serious side effects of lamotrigine

A

Stevens Johnson syndrome/TEN

19
Q

Main teratogenic effects of carbamazepine

A

Spina bifida

Fingernail hypoplasia

20
Q

Main teratogenic effect of carbamazepine

A

Spina bifida

21
Q

Acute side effects of phenytoin

A 
Dizziness
Diplopia
Nystagmus
Slurred speech
Ataxia
Confusion
22
Q

Common chronic side effects of phenytoin

A

Gingival hyperplasia
Hirsutism
Coarsening of facial features
Drowsiness

23
Q

Uncommon chronic side effects of phenytoin

A

Megaloblastic anaemia
Peripheral neuropathy
Osteomalacia
Lymphadenopathy

24
Q

Idiosyncratic side effects of phenytoin

A 
Fever
Rash including SJS/TEN
Hepatitis
Dupuytren's contracture
Aplastic anaemia
Lupus
25
Q

Teratogenic effects of phenytoin

A 
Cleft palate
Congenital heart disease
Fingernail hypoplasia
Craniofacial defects
Intellectual disability
Limb defects
26
Q

Most teratogenic mood stabiliser

A

Valproate

27
Q

First line mood stabiliser for manic/mixed episode

A

Lithium

28
Q

Alternative mood stabiliser for manic/mixed episode

A

Valproate

29
Q

Equivalent dose required when using sodium valproate compared to semi-sodium valproate

A

10% higher dose of sodium valproate required

30
Q

Forms of valproate licensed for treatment and prophylaxis of bipolar disorder

A

Valproic acid

Semi-sodium valproate

31
Q

Mood stabiliser associated with weight loss

A

Topiramate

32
Q

Mood stabiliser known for causing kidney stones via metabolic acidosis

A

Topiramate

33
Q

Medications sometimes used as mood stabilisers which should not be used in acute mania

A

Lamotrigine
Gabapentin
Topiramate

34
Q

Mood stabiliser which can inhibit the breakdown of lamotrigine and increase risk of toxicity

A

Valproate

35
Q

Antiepileptic medications which can reduce the efficacy of oral contraceptives

A

Phenobarbitone
Phenytoin
Carbamazepine
Topiramate at high doses

36
Q

Antiepileptic most associated with behavioural disturbance, especially in children

A

Vigabatrin

37
Q

Percentage of patients given lamotrigine who develop a rash

A

10-14%

38
Q

Mood stabiliser known to cause nephrogenic diabetes insipidus

A

Lithium

39
Q

Usual antiepileptic of choice for clozapine induced seizures

A

Valproate

40
Q

Atypical antipsychotic licensed only as a treatment for moderate to severe episodes of mania related to bipolar disorder

A

Asenapine

41
Q

Antidepressant class which carbamazepine has a similar structure to

A

Tricyclics

42
Q

Antiepileptic medication associated with hyperammonaemia

A

Valproate

Pharmacology (34 decks)

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