Antiepileptic medication and mood stabilisers

Question 1

Three forms of valproate available

Answer 1

Semi-sodium valproate
Valproic acid
Sodium valproate

Question 2

Brand name of semi-sodium valproate

Answer 2

Depakote

Question 3

Mix of medications in semi-sodium valproate

Answer 3

Equimolar mix of sodium valproate and valproic acid

Question 4

Very common side effects of sodium valproate

Answer 4

Nausea
Tremor
Weight gain

Question 5

Cause of weight gain in people taking sodium valproate

Answer 5

Impaired beta-oxidation of fatty acids; independent of calorie intake

Question 6

Common side effects of sodium valproate

Answer 6

Liver injury
Vomiting and diarrhoea
Gingival hyperplasia
Memory impairment/confusion
Somnolence
Anaemia/thrombocytopaenia
Alopecia with curly regrowth
Polycystic ovarian disease

Question 7

Serious side effects of sodium valproate

Answer 7

Pancreatitis

Severe liver damage

Question 8

Timing of liver injury in patients taking sodium valproate

Answer 8

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

Question 9

Congenital malformations of children exposed to sodium valproate in utero

Answer 9

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

Question 10

Neurodevelopmental effects of exposure to sodium valproate in utero

Answer 10

Dose dependent relationship with developmental delay
30-40% of children have early developmental delay
3x increased rate of autism

Question 11

Uses for carbamazepine

Answer 11

Epilepsy
Neuropathic pain
Bipolar disorder

Question 12

Drug combination where carbamazepine is contraindicated

Answer 12

MAOIs and carbamazepine

Question 13

Serious side effects of carbamazepine

Answer 13

Toxic epidermal necrolysis/Stevens Johnson syndrome
Agranulocytosis and aplastic anaemia
Fulminant hepatic damage
Pancreatitis
SIADH

Question 14

Features of Stevens Johnson syndrome/toxic epidermal necrolysis

Answer 14

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

Question 15

Difference between Stevens Johnson syndrome and toxic epidermal necrolysis

Answer 15

Stevens Johnson syndrome has skin detachment <10% of total body area
TEN has skin detachment >10% total body area

Question 16

Very common side effects of carbamazepine

Answer 16

Leucopaenia
Ataxia, dizziness
Vomiting, nausea
Urticaria
Fatigue
Weight gain

Question 17

Specific side effect of vigabatrin

Answer 17

Visual field defects

Question 18

Serious side effects of lamotrigine

Answer 18

Stevens Johnson syndrome/TEN

Question 19

Main teratogenic effects of carbamazepine

Answer 19

Spina bifida

Fingernail hypoplasia

Question 20

Main teratogenic effect of carbamazepine

Answer 20

Spina bifida

Question 21

Acute side effects of phenytoin

Answer 21

Dizziness
Diplopia
Nystagmus
Slurred speech
Ataxia
Confusion

Question 22

Common chronic side effects of phenytoin

Answer 22

Gingival hyperplasia
Hirsutism
Coarsening of facial features
Drowsiness

Question 23

Uncommon chronic side effects of phenytoin

Answer 23

Megaloblastic anaemia
Peripheral neuropathy
Osteomalacia
Lymphadenopathy

Question 24

Idiosyncratic side effects of phenytoin

Answer 24

Fever
Rash including SJS/TEN
Hepatitis
Dupuytren's contracture
Aplastic anaemia
Lupus

Question 25

Teratogenic effects of phenytoin

Answer 25

``` Cleft palate Congenital heart disease Fingernail hypoplasia Craniofacial defects Intellectual disability Limb defects ```

Question 26

Most teratogenic mood stabiliser

Answer 26

Valproate

Question 27

First line mood stabiliser for manic/mixed episode

Answer 27

Lithium

Question 28

Alternative mood stabiliser for manic/mixed episode

Answer 28

Valproate

Question 29

Equivalent dose required when using sodium valproate compared to semi-sodium valproate

Answer 29

10% higher dose of sodium valproate required

Question 30

Forms of valproate licensed for treatment and prophylaxis of bipolar disorder

Answer 30

Valproic acid | Semi-sodium valproate

Question 31

Mood stabiliser associated with weight loss

Answer 31

Topiramate

Question 32

Mood stabiliser known for causing kidney stones via metabolic acidosis

Answer 32

Topiramate

Question 33

Medications sometimes used as mood stabilisers which should not be used in acute mania

Answer 33

Lamotrigine Gabapentin Topiramate

Question 34

Mood stabiliser which can inhibit the breakdown of lamotrigine and increase risk of toxicity

Answer 34

Valproate

Question 35

Antiepileptic medications which can reduce the efficacy of oral contraceptives

Answer 35

Phenobarbitone Phenytoin Carbamazepine Topiramate at high doses

Question 36

Antiepileptic most associated with behavioural disturbance, especially in children

Answer 36

Vigabatrin

Question 37

Percentage of patients given lamotrigine who develop a rash

Answer 37

10-14%

Question 38

Mood stabiliser known to cause nephrogenic diabetes insipidus

Answer 38

Lithium

Question 39

Usual antiepileptic of choice for clozapine induced seizures

Answer 39

Valproate

Question 40

Atypical antipsychotic licensed only as a treatment for moderate to severe episodes of mania related to bipolar disorder

Answer 40

Asenapine

Question 41

Antidepressant class which carbamazepine has a similar structure to

Answer 41

Tricyclics

Question 42

Antiepileptic medication associated with hyperammonaemia

Answer 42

Valproate