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Question 1

Which antiepileptics have the highest increased risk of teratogenicity if given during pregnancy?

Answer 1

• sodium valproate
• valproic acid

Question 2

Which antiepileptics have an increased risk of teratogenicity when given during pregnancy?

Answer 2

• carbemazepine
• primidone
• phenobarbital
• phenytoin
• lamotrigine

(CP3L) <- How to remember

Question 3

(1) Which antiepileptic has increased risk of cleft palate formation if given during pregnancy? (2) Which trimester does this occur in?

Answer 3

(1) Topiramate

(2) First trimester

Question 4

Which antiepileptics reduce the efficacy of hormonal contraception?

Answer 4

Enzyme-inducing

e.g. carbemazepine

Question 5

For which antiepileptics does foetal growth need to be monitored when given in pregnancy?

Answer 5

• Topiramate
• Levetiracetam

Question 6

(1) Why does folic acid need to be given during pregnancy? (2) At what dose? (3) For how long?

Answer 6

(1) Prevention of formation of neural tube defects

(2) 5mg OD

(3) Taken before conception until 12th week of pregnancy

Question 7

What is required at birth for patients taking antiepileptics?

Answer 7

Vitamin K injection in newborn

Question 8

What needs to be monitored when a patient taking antiepileptics is breastfeeding?

Answer 8

• drowsiness
• weight gain
• feeding difficulty
• developmental milestones

Question 9

Which antiepileptics are present in high amounts in breastmilk?

Answer 9

• Zosinamide
• Ethosuximide
• Lamotrigine
• Primidone

(ZELP) <- how to remember

Question 10

Which antiepileptics accumulate due to slower metabolism in the infant, if given during pregnancy?

Answer 10

• Phenobarbital
• Lamotrigine

Question 11

Which antiepileptics can inhibit the sucking reflex of newborns, when given during pregnancy?

Answer 11

• Phenobarbital
• Primidone (metabolised to phenobarbital)

Question 12

For which antiepileptics should abrupt withdrawal of breastfeeding be avoided, when having been given during pregnancy?

Answer 12

All

Phenobarbital and primidone especially

Question 13

Which antiepileptics have an established risk of drowsiness in babies, when having been given in pregnancy?

Answer 13

• Benzodiazepines
• Phenobarbital
• Primidone

Question 14

What are some symptoms of antiepileptic hypersensitivity syndrome?

Answer 14

• rash
• fever
• lymphadenopathy
• systematic involvement within first 1-8 weeks of starting

Question 15

Which antiepileptics are associated with increased risk of antiepileptic hypersensitivity syndrome?

Answer 15

Same as those at increased risk of teratogenicity

• carbemazepine
• phenytoin
• phenobarbital
• primidone
• lamotrigine

(CP3L) <- how to remember

Question 16

Which antiepileptics have an increased risk of cross-sensitivity between antiepileptic drugs?

Answer 16

Carbemazepine and phenytoin

Question 17

What are some MHRA warnings associated with antiepileptics?

Answer 17

• small increased risk with ALL antiepileptics: suicidal behaviour and thoughts
• risk of severe respiratory depression with gabapentin

Question 18

Which antiepileptic is associated with increased risk of Steven-Johnson syndrome?

Answer 18

Lamotrigine

Question 19

Which antiepileptic is associated with increased risk of toxic epidermal necrolysis?

Answer 19

Lamotrigine

Question 20

Which antiepileptic(s) is/ are associated with increased risk of blood dyscrasias?

Answer 20

• carbamazepine
• valproate
• ethosuximide
• topiramate
• phenytoin
• lamotrigine
• zonisamide

C VET PLZ <- How to remember

Question 21

Which antiepileptic(s) is/ are associated with increased risk of eye problems?

Answer 21

• vigabatrin - visual field defects
• topiramate - acute myopia

Question 22

(1) Which antiepileptic(s) is/ are associated with increased risk of encephalopathic symptoms? (2) How can this be managed?

Answer 22

(1) Vigabatrin - marked sedation, stupor and confusion

(2) Withdraw or lower dose