Sodium Valportae,pregabalin,gabapentin And ADHD Flashcards
(12 cards)
What is sodium Valporate indicated for?
For all forms of epilepsy, mania, ALL forms of epilepsy,mania and migraine prophylaxis (unlicensed)
Highly teratogenic and use in pregnancy leads to foetal birth defects and congenital malformations
- avoid in women of child bearing age, unless conditions of the PPP have been met
- Liver toxicity can occur, especially in children under the age of 3
- can affect clotting so discontinue if prolonged prothrombin time
- blood and hepatic disorders
- pancreatitis can occur (n,v and abdominal pain) - discontinue treatment if it occurs
Valporate - important safety information
- risk of suicidal thoughts and behavioural (all antiepileptics)
- spontaneous adverse reactions when switching anti epileptic drugs in patients previously stabilised on branded products to generics
- Valporate medicines are contraindicated in women and girls of child bearing age unless conditions of the PPP are met
- What is the best method of contraception for women? IUD AND BARRIER
- Lamotrigine and levitericitam are the safest anti epileptics used in pregnancy
VALPORATE CAUTIONS
- MHRA advices to consider vitamin D supplement in patients that are immobilised from long periods of time, inadequate sun exposure of dietary intake of calcium is low( correcting vitamin D deficiency may reduce the seizure risk in people with epilepsy, Sodium Valporate reduces bone density)
- liver toxicity - assess any patients with raised liver enzymes and monitor them
Side effects of Valporate
- VALPORTAE
- Appetite increase - weight gain
- Liver failure
- Pancreatitis, P-450 inhibitor
- Reversible hair loss
-Odema
-Ataxia - Teratogenicity and tremor
- Encephalopathy (brain damage)
Common side effect hyponatraemia
Serious Valporate interactions - enzyme inhibitor
Lamotragine- Valporate increases the exposure of lamotrigine. Manufacturers advised adjusting the dose of lamotrigine and monitoring rash. Lamotrigine causes SJS - higher likelihood in Han Chinese and Thai ethnicities
Olanzapine- increases the risk of adverse effects
Phenytoin- Valporate affects the concentration of phenytoin and phenytoin decreases the concentration of Valporate - so monitor this concentration
- Topiramate - increases the risk of toxicity when given with Valporate - manufacturers advise monitoring
- Pivmexillinam- avoid, increase risk of adverse effects Phenytoin
-Ertapenem,imipenem,meropenem (avoid - decreases the concentration of Valporate)
Patient and carers advice
- recognise signs of blood,hepatic disorders and pancreatitis
- women and girls should not stop taking Valporate without first discussing it with their doctor
- pharmacist must ensure that female patients have a patient card and all important info including leaflets etc.
Vigabatrin
- focal seizures
- worsens (absence, myoclonic,tonic and atomic seizures)
- visual disturbance
- visual defects persist even fitter stopping the drug
- test before treatment and 6 month interval
- report and visual symptoms urgently
Gabapentin and pregabalin
- used to treat focal seizures
- avoid in tonic, atonic,myoclonic and absence seizures
- both licensed for treatment of neuropathic pain
- pregablin is licensed for treatment of generalised anxiety disorder
ADhD
- behavioural syndrome characterised by hyperactivity,impulsivity and inattention - can lead to poor educational and occupational development
- symptoms co- exist but some people are predominantly hyperactive or impulsive
- typically 3-7 y/o
Aim of ADHD treatment
- reduce functional impairment and severity of symptoms
- Improve quality of life
Drugs used to manage ADHD
Methylphenidate or lisdexamphetamine- first line treatment
- methylphenidate counselling advice 0 affects driving and increased by alcohol)
- atomoxetime and dexamfetamine used when not tolerant to 1st line
- CBT can be considered if no response to meds
- Atomoxetine may be used as first line for drug misuse patients
Side effects of atomoxetine
When starting drug treatment, monitor for agitation,irritability, suicidal thought, self harming,unusual behaviour changes in the initial months of treatment after dose change
