MHRA/CHM

Question 1

Category 1

Answer 1

Patient must be maintained on a specific brand/generic drug manufacturer.

Question 2

Category 1 - drugs

Answer 2

Phenytoin (Epanutin)
Phenobarbital
Carbamazepine (Tegretol)
Primidone

Question 3

Category 2

Answer 3

Patient maintained on a specific brand based on clinical judgement e.g. seizure frequency, treatment history

Question 4

Category 2 - drugs (common)

Answer 4

Valproate
Lamotrigine
Clobazam
Oxcarbazepine
Clonazepam
Topiramate

Question 5

Category 2 - drugs (less common)

Answer 5

Perampanel
Retigabine
Rufinamide
Zonisamide
Eslicarbazepine

Question 6

Category 3

Answer 6

Patient does NOT need to be maintained on a specific brand

Question 7

Category 3 - drugs (common)

Answer 7

Levetiracetam
Gabapentin
Pregabalin
Lacosamide

Question 8

Category 3 - drugs (less common)

Answer 8

Tiagabine
Ethosuximide
Vigabatrin

Question 9

Suicidal thoughts/behaviour

Answer 9

• Risk with all anti-epileptic drugs
• Can occur within 1 week of starting treatment
• Advise patients to report any mood changes, distressing thoughts/feelings about suicide or self-harm
• Seek help
• Do not stop/switch medication without professional advice

Question 10

Antiepileptic Hypersensitivity Syndrome (AHS)

Answer 10

Occurs within 8 weeks of exposure to medication
Discontinue immediately and seek specialist advice.
Occurs with all Category 1 drugs AND lamotrigine
* Rash
* Fever
* Lymphadenopathy

Question 11

Withdrawal

Answer 11

• Avoid abrupt withdrawal - can precipitate severe rebound seizures
• Gradually reduce dose under specialist supervision
• Withdraw one antiepileptic drug at a time
• Benzodiazepines and Barbiturates require longer to reduce dose.

Question 12

Driving

Answer 12

Can drive if:
* Seizure free for 1 year.
* Established seizure pattern with no influence on consciousness
* No history of unprovoked seizures.
* Seizure due to prescribed change or withdrawal
* History of no awake seizures for 1 year from first sleep seizure.
* Established pattern of sleep seizures for 3 years is previous awake seizure.

Question 13

Pregnancy

Answer 13

Antiepileptic medicines have an increased risk of teratogenicity.
Particularly in the 1st trimester or if using more than 1 epilepsy medication

Question 14

Teratogenicity - highest risk

Answer 14

Valproate/valproic acid
Minor and major congenital malformation + long-term developmental disorders.

Question 15

Teratogenicity - increased risk

Answer 15

Carbamazepine
Phenytoin (anti-folate)
Phenobarbital
Primidone
Lamotrigine

Question 16

Topiramate

Answer 16

Risk of cleft palate if used in 1st trimester

Question 17

Pregnancy - general advice

Answer 17

• Refer to specialist if planning a pregnancy
• Notify the UK epilepsy and pregnancy register
• Folic acid 5 mg OD (pre-conception and during 1st trimester) - reduces the risk of neural tube defects.
• Vitamin K injection - minimises risk of neonatal haemorrhage

Question 18

Pregnancy - monitor foetal growth

Answer 18

• Topiramate
• Levetiracetem

Question 19

Pregnancy - monitor plasma drug conc.

Answer 19

Adjust dose based on plasma-drug concentration.
* Phenytoin
* Carbamazepine
* Lamotrigine

For other drugs, dose adjustments are made based on clinical judgement.

Question 20

Breastfeeding

Answer 20

Avoid abrupt withdrawal of BF - risk of withdrawal symptoms especially with phenobarbital/primidone
Monitor infants for:
* Drowsiness
* Weight gain
* Feeding difficulty
* Adverse effects
* Developmental milestones

Question 21

What drugs are present in high amounts in breastmilk?

Answer 21

ZELP
* Zosinamide
* Ethosuximide
* Lamotrigine
* Primidone

Question 22

What drugs accumulate due to slower metabolism in infants?

Answer 22

• Phenobarbital
• Lamotrigine

Question 23

What drugs inhibit the sucking reflex?

Answer 23

• Phenobarbital
• Primidone

Question 24

What drugs cause drowsiness in babies?

Answer 24

• Benzodiazepines
• Phenobarbital
• Primidone