Antiepileptic medication and mood stabilisers Flashcards
Three forms of valproate available
Semi-sodium valproate
Valproic acid
Sodium valproate
Brand name of semi-sodium valproate
Depakote
Mix of medications in semi-sodium valproate
Equimolar mix of sodium valproate and valproic acid
Very common side effects of sodium valproate
Nausea
Tremor
Weight gain
Cause of weight gain in people taking sodium valproate
Impaired beta-oxidation of fatty acids; independent of calorie intake
Common side effects of sodium valproate
Liver injury Vomiting and diarrhoea Gingival hyperplasia Memory impairment/confusion Somnolence Anaemia/thrombocytopaenia Alopecia with curly regrowth Polycystic ovarian disease
Serious side effects of sodium valproate
Pancreatitis
Severe liver damage
Timing of liver injury in patients taking sodium valproate
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
Congenital malformations of children exposed to sodium valproate in utero
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
Neurodevelopmental effects of exposure to sodium valproate in utero
Dose dependent relationship with developmental delay
30-40% of children have early developmental delay
3x increased rate of autism
Uses for carbamazepine
Epilepsy
Neuropathic pain
Bipolar disorder
Drug combination where carbamazepine is contraindicated
MAOIs and carbamazepine
Serious side effects of carbamazepine
Toxic epidermal necrolysis/Stevens Johnson syndrome Agranulocytosis and aplastic anaemia Fulminant hepatic damage Pancreatitis SIADH
Features of Stevens Johnson syndrome/toxic epidermal necrolysis
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
Difference between Stevens Johnson syndrome and toxic epidermal necrolysis
Stevens Johnson syndrome has skin detachment <10% of total body area
TEN has skin detachment >10% total body area
Very common side effects of carbamazepine
Leucopaenia Ataxia, dizziness Vomiting, nausea Urticaria Fatigue Weight gain
Specific side effect of vigabatrin
Visual field defects
Serious side effects of lamotrigine
Stevens Johnson syndrome/TEN
Main teratogenic effects of carbamazepine
Spina bifida
Fingernail hypoplasia
Main teratogenic effect of carbamazepine
Spina bifida
Acute side effects of phenytoin
Dizziness Diplopia Nystagmus Slurred speech Ataxia Confusion
Common chronic side effects of phenytoin
Gingival hyperplasia
Hirsutism
Coarsening of facial features
Drowsiness
Uncommon chronic side effects of phenytoin
Megaloblastic anaemia
Peripheral neuropathy
Osteomalacia
Lymphadenopathy
Idiosyncratic side effects of phenytoin
Fever Rash including SJS/TEN Hepatitis Dupuytren's contracture Aplastic anaemia Lupus
Teratogenic effects of phenytoin
Cleft palate Congenital heart disease Fingernail hypoplasia Craniofacial defects Intellectual disability Limb defects
Most teratogenic mood stabiliser
Valproate
First line mood stabiliser for manic/mixed episode
Lithium
Alternative mood stabiliser for manic/mixed episode
Valproate
Equivalent dose required when using sodium valproate compared to semi-sodium valproate
10% higher dose of sodium valproate required
Forms of valproate licensed for treatment and prophylaxis of bipolar disorder
Valproic acid
Semi-sodium valproate
Mood stabiliser associated with weight loss
Topiramate
Mood stabiliser known for causing kidney stones via metabolic acidosis
Topiramate
Medications sometimes used as mood stabilisers which should not be used in acute mania
Lamotrigine
Gabapentin
Topiramate
Mood stabiliser which can inhibit the breakdown of lamotrigine and increase risk of toxicity
Valproate
Antiepileptic medications which can reduce the efficacy of oral contraceptives
Phenobarbitone
Phenytoin
Carbamazepine
Topiramate at high doses
Antiepileptic most associated with behavioural disturbance, especially in children
Vigabatrin
Percentage of patients given lamotrigine who develop a rash
10-14%
Mood stabiliser known to cause nephrogenic diabetes insipidus
Lithium
Usual antiepileptic of choice for clozapine induced seizures
Valproate
Atypical antipsychotic licensed only as a treatment for moderate to severe episodes of mania related to bipolar disorder
Asenapine
Antidepressant class which carbamazepine has a similar structure to
Tricyclics
Antiepileptic medication associated with hyperammonaemia
Valproate
