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Again, the Pills!

Topic: Adult

Created on Monday, October 27 2008 by rednucleus

Last modified on Monday, October 27 2008.

A 32-year-old woman visits the neurologist's office because of having many seizures during the past week. She takes daily lamotrigine 300 mg for the last 3 years for idiopathic grand mal epilepsy. She says that she was seizure-free. She is compliant with her medication and denies doing drugs. The woman is single but has started to take oral contraceptives pills since 2 months. Which one of the following would you do?

A) Add valproic acid

B) Double the dose of lamotrigine

C) Add levitiracetam

D) Stop lamotrigine gradually and prescribe phenytoin

E) Stop lamotrigine rapidly and give carbamazepine

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This question was created on October 27, 2008 by rednucleus.
This question was last modified on October 27, 2008.

ANSWERS AND EXPLANATIONS

A) Add valproic acid

This answer is incorrect.

No need to add a second anti-epileptic. She was well-controlled using lamotrigine; simply increase the dose of lamotrigine. (See References)

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B) Double the dose of lamotrigine

This answer is correct.

Oral contraceptive pills have been shown to reduce the plasma level of lamotrigine by 30-50%; therefore, the dose of lamotrigine can be doubled to restore seizure control. Note that lamotrigine does not produce contraceptive failure. (See References)

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C) Add levitiracetam

This answer is incorrect.

No need to add a second anti-epileptic. She was well-controlled using lamotrigine; simply increase the dose of lamotrigine. (See References)

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D) Stop lamotrigine gradually and prescribe phenytoin

This answer is incorrect.

Phenytoin reduces the effectiveness of oral contraceptive pills. (See References)

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E) Stop lamotrigine rapidly and give carbamazepine

This answer is incorrect.

Long-term anti-epileptics should not be stopped rapidly or suddenly; besides, carbamazepine reduces the effectiveness of oral contraceptive pills. (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Again, the Pills!
Question ID: 102708107
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/27/2008
Modified: 10/27/2008
Estimated Permutations: 120