MHRA advice for all AEDs and random info

Question 1

risk of suicidal thoughts and behaviour

Answer 1

all antiepileptic drugs may be associated with a small increased risk of suicidal thoughts and behaviour; symptoms may occur as early as 1 week after starting treatment.
seek medical advice if any mood changes, distressing thoughts, or feelings about suicide or self-harming develop, and that the patient should be referred for appropriate treatment if necessary.
Patients should also be advised not to stop or switch antiepileptic treatment and to seek advice from a healthcare professional if concerned.

Question 2

a patient has suicidal thoughts. you look at their PMR and they take pregabalin, not for epilepsy. what do you do

Answer 2

All AEDs have the potential to cause suicidal thoughts and behaviour
Refer to GP
Do not stop treatment

Question 3

Switching between different manufacture products

Answer 3

3P and 1C must be maintained on specific brand
Carbamazepine, phenobarbital, phenytoin, primidone.

Question 4

valproate - full pack dispensing - is it for females only?

Answer 4

Pharmacists are advised that all patients (male and female) must receive their valproate medicines in the manufacturer’s original full pack (i.e. original pack dispensing) and the amount dispensed must be as close as possible to the amount stated on the prescription (NHS or private)

Question 5

latest data on valproate - who can it be started in & is it just for epilepsy indications

Answer 5

• do not start in new pt aged under 55 unless 2 specialists independently agree that there is no other effective or tolerated treatment, or there are compelling aeons why the reproductive risks do not apply
• at next annual specialist review, females of CBP to be reviewed using new risk acknowledgement form which will include the need for a 2nd specialist signature if pt is to continue
• subsequent annual reviews with ONE specialist should be carried out
• FOR ALL INDICATIONS not just epilepsy

Question 6

MHRA - valproate and vitamin D

Answer 6

The MHRA advises consider vitamin D supplementation in patients that are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.

Question 7

topiramate - latest MHRA advice re PPP

Answer 7

• teratogenic: congenital malformations, low birth weight, potential increased risk intellectual disability, ASD and ADHD
• do not use in FoCBP unless PPP
  -use in pregnancy CI for migraine prophylaxis
• only use in pregnancy for epilepsy if no suitable alt

Question 8

Cannabidiol epidyolex oral solution - what CD class is it

Answer 8

CD 5

Question 9

What does topiramate PPP consist of

Answer 9

• all new and existing FoCBP on topiramate to be explained conditions of PPP, provided patient guide, complete and sign Risk Awareness Form (at initiation and each annual review)
• Pharmacists: ensure whole pack dispensing wherever possible; all packs dispensed to FoCBP should have warning symbol either on carton or via sticker
• Pharmacists to alos provide Patient Card and check if patient using highly effective contraception; if not refer to GP

Question 10

Which AED is associated with visual field defects

Answer 10

Vigabatrin

carry out testing before treatment and at 6 month intervals

Question 11

Patient with absence seizures is on first line treatment. You warn them of blood disorders and to seek medical attention if symptoms like fever, mouth ulcers, bruising, bleeding develop. What drug?

Answer 11

ethosuximide

Question 12

For lamotrigine, avoid abrupt withdrawal (taper off over 2 weeks or longer) unless

Answer 12

serious skin reaction e.g. SJS, toxic epidermal necrolysis.

Question 13

this AED is associated with acute myopia (near sightedness) with secondary CAG. usually happens within first month of starting

Answer 13

topiramate

Question 14

which AEDS have MHRA advice because they can cause severe respiratory depression

Answer 14

pregabalin
gabapentin

Question 15

the following AEDs can reduce vitamin D absorption by inducing CYP enzyme/increasing metabolism of vitamin D. therefore may need vit D supplementation

Answer 15

phenytoin, phenobarbital, carbamazepine, primidone, oxcarbamazepine

SV

Question 16

what do to if acute myopia with secondary CAG occurs with topiramate

Answer 16

if raised intraocular pressure occurs, seek specialist opthalmologist advice, reduce intraocular pressure and stop topiramate as soon as feasible

Question 17

what AED can cause pancreatitis - if it happens stop & seek medical advice

Answer 17

SV

Question 18

ensure adequate hydration and avoid over heating with this drug due to reports of fatal heat stroke in children

Answer 18

zonisamide

increased further if also prescribed topiramate - avoid combo in children!

Question 19

Which AEDs can cause blood dyscrasias

Answer 19

C VET PLZ: carb, valp, ethosux, topir, pheny, lamot, zonis

Question 20

Which AED can cause encephalopathy

Answer 20

vigabatrin

Question 21

Orlistat interaction

Answer 21

Orlistat might affect the absorption of concurrently administered oral drugs—consider separating administration. Particular care should be taken with antiepileptics, antiretrovirals, oral contraceptives, and drugs that have a narrow therapeutic index.