PHAM1126 Professional Dilemma Coursework Case Essay Case Background Karl Foster is a 36 year old computer programmer with a 20 year history of epilepsy. As part of his epilepsy syndrome Karl experiences generalised seizures that last for approximately 5 minutes. For the last 15 years he has remained seizure free and been well maintained on sodium valproate (Epilim Chrono) 1000mg twice daily. Ten years ago Karl attempted to come off his antiepileptic medication, but this was unsuccessful. Within 1 month of stopping his valproate he started having generalised seizures again, approximately two seizures per month. Fortunately when the valproate was recommenced his seizure control was regained and he has remained seizure free since that time. Currently Karl’s seizures are so well controlled that he has held a driving license for the last 6 years. Today Karl has come into the pharmacy where you are working, with a prescription for: Rx Epilim Chrono 500mg tablets – Take TWO tablets Twice daily. Mitte 112 Karl has no tablets at home. Unfortunately your pharmacy has also run out of Epilim Chrono tablets. Due to a heavy snowfall, you are unable to obtain any further supplies either today or tomorrow. The pharmacy is situated in a small village, and consequently it is the only pharmacy. A supply of sodium valproate 500mg E/C tablets is available in your pharmacy today. Karl is married and lives in his own home with his wife and two young children. He has no other medical conditions and the only medication he regularly takes is Epilim Chrono. Part 1 – With reference to the concept of seizure threshold explain the mechanism of action for sodium valproate. [250 words; 25%] Part 2 – Detail the various options that are available to you as the pharmacist, with regard to the supply of valproate in this case. Explain fully the consequences to both yourself as a pharmacist and to the patient of any decision to supply or not supply any medication today. [750 words; 75%] Both Part 1 and Part 2 are to be completed. Excessive length will be penalised. Your submitted essays should be completed in an appropriate academic writing style. All essays will be referenced using the Vancouver reference style. E/C enteric coated , drug is released slowly and does not break down by stomach acid Issues to consider: Switching between oral formulations should be based on clinical judgment and consultation, taking into account the risk factors such as seizures frequency and treatment history (BNF) Switching from a drug composed of two combined drugs ( Epilim Chrono ) to one of the prescribed drug composition( sodium valproate ) Do not priories pharmacist in terms of low, instead prioritise patient health (please consider this) Sodium Valproate fails in the second category of MHRA guidance for antiepileptic drugs , which implies that the doctor is the health care professional who should decide with the individual, if it is necessary to keep using the same version/brand continuously https://www.pharmacyregulation.org/sites/default/files/document/guidance_on_student_fitness_to_practise_procedures_in_schools_of_pharmacy_november_2017.pdf https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjpjcnJ19LYAhUEK1AKHdiBBOoQFgguMAA&url=https%3A%2F%2Fwww.pharmacyregulation.org%2Fsites%2Fdefault%2Ffiles%2Fstandards_for_pharmacy_professionals_may_2017.pdf&usg=AOvVaw0OF8rW1N15lC8GreUeI565 https://academic.oup.com/biohorizons/article/doi/10.1093/biohorizons/hzt003/302011 any decision made should be supported with evidences