Psych Vivas · Psychopharmacology — valproate
Valproate — loads, levels, pregnancy, PCOS and ammonia viva
Fellowship viva on valproate mechanisms, dosing and loading, TDM, pregnancy hierarchy, PCOS-like effects, ammonia encephalopathy, and landmark evidence.
On this page
Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
Examiner places a valproate product box, a blank trough target card, a pregnancy warning card, and an ammonia result slip. You must cover acute mania evidence, loading, levels, BALANCE limits, teratogenicity hierarchy, Isojärvi endocrine caution, and hyperammonaemic encephalopathy in under 10 minutes.
Station structure
Time: 8–10 minutes. Depth: consultant teaching registrar. Expect accurate loading/level literacy, absolute pregnancy hierarchy, ammonia pathway, and named trials — not vague “monitor bloods.”[1][2][3]
References8ShowHide
- [1]Bowden CL, Brugger AM, Swann AC, et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group JAMA, 1994.PMID 8120960
- [2]Geddes JR, Goodwin GM, Rendell J, et al. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial Lancet, 2010.PMID 20092882
- [3]Tomson T, Battino D, Bonizzoni E, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry Lancet Neurol, 2011.PMID 21652013
- [4]Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs N Engl J Med, 2009.PMID 19369666
- [5]Isojärvi JI, Laatikainen TJ, Pakarinen AJ, et al. Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy N Engl J Med, 1993.PMID 8413434
- [6]Segura-Bruna N, Rodriguez-Campello A, Puente V, et al. Valproate-induced hyperammonemic encephalopathy Acta Neurol Scand, 2006.PMID 16774619
- [7]Hirschfeld RM, Allen MH, McEvoy JP, et al. Safety and tolerability of oral loading divalproex sodium in acutely manic bipolar patients J Clin Psychiatry, 1999.PMID 10665626
- [8]Christensen J, Grønborg TK, Sørensen MJ, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism JAMA, 2013.PMID 23613074