Question

Ilona, a 24-year old female who suffers from generalised seizures, is taking carbamazepine as an antiepileptic, as well as an oral contraceptive as she does not want to get pregnant yet. After a few weeks of treatment where she was compliant throughout, she starts to experience nausea in the early mornings. She is confirmed to be pregnant soon thereafter.

a. Explain why her oral contraceptive did not prevent her from becoming pregnant, and how you would have approached the situation differently.

b. Explain pharmacologically how carbamazepine reduces seizure activity in the brain.

c. Discuss the FDA pregnancy category listing of carbamazepine, the potential risks Ilona may need to be aware of using it during pregnancy or withdrawing it immediately, and what could be prescribed to reduce the risks.

Answer 1

CARBAMAZEPINE is FDA category D

CARBAMAZEPINE might increase the risk of spina bifida and cleft palate

A) if patient take carbamazepine and contraceptives together with the action of  antiepileptic drugs the efficiency of oral contraception can be reduced ,SO this patient became pregnant even with the use of oral contraceptives.

CARBAMAZEPINE PHARMACOLOGY

brain is continuously producing electrical discharges and these discharges must be sent at a certain rate for normal functioning of brain   .During convulsions brain work harder and sent more electric discharges.Carbamazepine work on this electric discharges by slowing down the electrical discharges that cause seizure. They work mainly by slowly turning off sodium channels (sodium channels help spread electric activity from one cell to another)

carbamazepine and pregnancy

carbamazepine increase the risk of neural tube defects

treatment of epilepsy is important during pregnancy because seizure can leads to fall,injury and physical stress

- carbamazepine can  change before pregnancy or during early pregnancy with the help of a specialist

DRUG OF CHOICE ( for new seizures)

LAMOTRIGINE AND LEVETIRACETAM - Are commonly using during pregnancy

drug of choice -during labour and delivery is phenytoin