High Risk Medication

Question 1

Sodium Valproate indication

Answer 1

Epilepsy
Mania
Migraine prophylaxis

Question 2

What is the mechanism of sodium valproate?

Answer 2

Inhibits the enzyme that deactivate GABA such as GABA transaminase

Question 3

What are the monitoring requirements for valproate?

Answer 3

Before starting treatment:
- A full FBC
- LFT
- Weight/BMI (can cause weight gain)

6 Months after treatment has been initiated and every 12 months thereafter

Question 4

What are the red flag symptoms of sodium valproate that patients should be aware of and why?

Answer 4

Blood disorders
- Unexplained bleeding
- Bruising
- Sore throat
Valproate can case thrombocytopenia

Liver disorders
- Sudden onset of weakness
- Malaise
- Vomiting

Pancreatitis
- Abdominal pain

Bone marrow suppression - leukocytes, thrombocytes and erythrocytes

Question 5

Contraindications of valproate

Answer 5

Active liver disease
women of childbearing age

Question 6

Medication cautions of valproate

Answer 6

Valproate is highly-protein bound
Aspirin is highly protein bound and can displace valproate

Warfarin is weakly protein bound and can be displaced by valproate

Valproate can increase the plasma levels of tricyclic antidepressants

Question 7

What is the advice for pregnancy (valproate).

Answer 7

For women who are planning a pregnancy, give general pre-conception advice (such as cessation of smoking and alcohol consumption) and prescribe folic acid. Note that high dose (5 mg/day) is indicated in women taking certain medications and who are obese

Do not alter or stop drug treatment without seeking specialist advice

Question 8

What are signs of lithium overdose
‘Priadel can give volatile tremors’

Answer 8

Polyuria
CNS disturbances
GI disturbances
Visual disturbances
Tremor