skip to main content

Hypothyroidism and warfarin — GPhC CRA MCQ

Instant feedback + full explanation. One question, done properly.

HardEndocrine TherapeuticsHypothyroidism and warfarinGPhC CRA

A woman of childbearing potential collects valproate. The PMR shows no recent specialist review, the annual risk-acknowledgement documentation is overdue and she says her contraception stopped last month. She denies current pregnancy symptoms. What is the best action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Urgently contact the specialist, reinstate PPP safeguards and advise no abrupt cessation

Valproate is highly teratogenic and, in a woman of childbearing potential, requires the Pregnancy Prevention Programme unless a documented exception applies. Missing contraception and overdue annual review need prompt specialist/prescriber action, counselling, current materials and pregnancy-risk assessment. Abrupt cessation can precipitate seizures or psychiatric relapse, while symptoms, waiver or pharmacist substitution do not meet the regulatory safeguards.

Reference: MHRA: valproate Pregnancy Prevention Programme. https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met