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ICS pneumonia risk COPD — GPhC CRA MCQ

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HardRespiratory TherapeuticsICS pneumonia risk COPDGPhC CRA

A 48-year-old man with a new diagnosis of focal epilepsy has never taken valproate. One neurologist recommends starting valproate because of convenience, but effective alternatives have not been tried and no second specialist opinion is documented. What should the pharmacist do?

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Correct answer: B — Query initiation because a new patient under 55 requires two documented specialist opinions

Since January 2024, valproate should not be initiated in a new male or female patient younger than 55 unless two specialists independently consider and document that no other effective or tolerated treatment exists, or that compelling reasons make reproductive risk inapplicable. Neither condition is demonstrated here, so initiation should be queried rather than retrospectively regularised. The rule is not restricted to women, one opinion is insufficient for a new under-55 patient, and the age threshold is 55 rather than 50.

Reference: MHRA: New valproate safety measures apply from 31 January 2024. https://www.gov.uk/government/news/new-valproate-safety-measures-apply-from-31-january