A 37-year-old woman with a history of type 2 diabetes mellitus and obesity presents after a late period. The urinary hCG test is positive. Her current medication is as follows:
Which one of her medications must be stopped straight away?
Correct Answer C: Simvastatin is contraindicated in pregnancy and must be stopped immediately. Metformin is sometimes used in pregnancy although many diabetic women are converted to insulin for the duration of the pregnancy to try and maximize control and minimize complications. Whilst orlistat is not a known teratogen it should be used with 'caution' in pregnancy according to the BNF and the benefits are very likely outweighed by risks.
Prescribing in pregnant patients:
Very few drugs are known to be completely safe in pregnancy. The list below largely comprises of those known to be harmful. Some countries have developed a grading system.
Antibiotics:
Other drugs:
The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk.
A 22-year-old female presents with a history of fits, describing focal seizures associated with impairment of consciousness.
What is the most suitable first-line treatment?
Correct Answer E:
The 2007 SANAD study indicated that lamotrigine may be a more suitable first-line drug for partial seizures although this has yet to work its way through to guidelines.
Epilepsy: treatment:
Most neurologists now start antiepileptics following a second epileptic seizure. NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:
Sodium valproate is considered the first line treatment for patients with generalized seizures with carbamazepine used for partial seizures.
Generalized tonic-clonic seizures:
Absence seizures* (Petit mal):
Myoclonic seizures:
Partial seizures:
*Carbamazepine may actually exacerbate absence seizure
**The 2007 SANAD study indicated that lamotrigine may be a more suitable first-line drug for partial seizures although this has yet to work its way through to guidelines
Which one of the following is least recognized as causing idiopathic intracranial hypertension?
Correct Answer C:
Idiopathic intracranial hypertension:
Idiopathic intracranial hypertension (also known as pseudotumour cerebri and formerly benign intracranial hypertension) is a condition classically seen in young, overweight females.
Features:
Risk factors:
Management:
*If intracranial hypertension is thought to occur secondary to a known causes (e.g. Medication) then it is of course not idiopathic.
A 19-year-old presents as she would like to start a combined oral contraceptive pill. During the history she states that in the past she has had migraine with aura. She asks why the combined oral contraceptive pill is contraindicated.
What is the most appropriate response?
Correct Answer B:
Migraine: pregnancy, contraception and other hormonal factors:
SIGN produced guidelines in 2008 on the management of migraine, the following is selected highlights:
Migraine during pregnancy:
Migraine and the combined oral contraceptive (COC) pill:
Migraine and menstruation:
Migraine and hormone replacement therapy (HRT):
Which one of the following statements regarding absence seizures is incorrect?
Correct Answer C: Seizures are characteristically provoked by hyperventilation.
Absence seizures:
Absence seizures (petit mal) are a form of generalized epilepsy that is mostly seen in children. The typical age of onset of 3-10 years old and girls are affected twice as commonly as boys.
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