Case Studies

Elizabeth S. Mearns, PharmD, and Craig I. Coleman, PharmD
Published Online: Wednesday, December 18, 2013
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CASE 1
CB is a 28-year-old woman with epilepsy that is currently well controlled with valproic acid. She is interested in becoming pregnant for the first time and asks you for advice about epilepsy medication management during her pregnancy. She wants to know if valproic acid is safe during pregnancy. She has no other medical problems, has no allergies, and does not drink or smoke. She does not take any other medications or supplements.
As the pharmacist, what do you tell CB about valproic acid and pregnancy?

CASE 2
JG is a 22-year-old woman who comes to your pharmacy with a prescription for Ortho Tri-Cyclen Lo. She has been newly diagnosed with bipolar affective disorder and has a history of substance abuse and disordered eating. She was recently taken to an acute psychiatry inpatient program for suicidality but states that she was discharged and is feeling much better. She can tell her mood is more stable and well controlled on her current medication. You verify that she is taking lamotrigine (Lamictal) 200 mg daily. She denies any recent substance abuse or smoking and is coping well without any illicit drugs or alcohol.
Would there be a drug interaction with her new prescription? If so, how can it be managed?
Dr. Mearns is a health economics and outcomes research fellow at Hartford Hospital Evidence-Based Practice Center, and Dr. Coleman is professor of pharmacy practice, as well as co-director and methods-chief at Hartford Hospital Evidence-Based Practice Center at the University of Connecticut School of Pharmacy.


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