{
  "abstract": "Background and Importance The trauma intensive care unit (ICU) is a complex environment for the management and prevention of seizures due to safety of antiepileptic drugs (AEDs) and pharmacokinetic changes of the targeted population.These AEDs are known for clinically significant adverse effects, especially with drugs that have narrow therapeutic range such as sodium valproate, thus requiring therapeutic drug monitoring. On the other hand, drugs like phenobarbital and carbamazepine are potent enzyme inducers of many molecules and therefore can alter the pharmacokinetics of co-administered drugs.Aim and Objectives To describe and evaluate pharmaceutical interventions related to antiepileptic therapy in trauma ICU patients.Material and Methods We conducted a prospective observational study over a period of six months in a trauma ICU. The pharmaceutical interventions related to AEDs therapy were documented and discussed with the medical team, with the acceptance rate recorded. We categorised interventions as drug addition, discontinuation, substitution, drug monitoring, adverse effect management, and formulation switch. Drug-related problems were classified as issues related to dosing problem, drug–drug interactions, drug monitoring, inappropriate formulation, and therapeutic inefficacy. Interventions were documented and analysed in an Excel sheet.Results The pharmacist performed 64 interventions related to antiepileptic therapy on 33 patients (85% male, median age 30.5 [24, 52.5] years). The most frequent categories included dose adjustment (48.5%), drug discontinuation (20%), and addition of an antiepileptic (12.5%). Among drug problems that were recorded we mention primarily therapeutic inefficacy (28%), drug-drug interactions (28%) and adverse drug reactions (19%). Antiepileptic drugs that were involved in these drug problems were represented majorly by sodium valproate (32%), phenobarbital (31%) and levetiracetam (22%). The acceptance rate for these interventions was approximately 90%.Conclusion and Relevance In our study, the pharmacist helped with antiepileptic challenges when it comes to therapeutic inefficacy by either adding another antiepileptic, or adjusting to a higher dose. Drug-drug reactions were frequently seen with the association of sodium valproate and carbapenems, which led to inefficacy of the antiepileptic and required substitution with another antiepileptic like levetiracetam. Our findings show the importance of integrating a clinical pharmacist in a multidisciplinary ICU team to ensure efficacy and safety of antiepileptics in a sensitive population.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "IBN Sina University Hospital of Rabat, Pharmacy, Rabat, Morocco"
      ],
      "name": "A Hida"
    },
    {
      "affiliations": [
        "IBN Sina University Hospital of Rabat, Pharmacy Department, Rabat, Morocco"
      ],
      "name": "M Benabbes"
    },
    {
      "affiliations": [
        "Faculty of Medicine and Pharmacy of Rabat, Laboratory of Pharmaceutics, Rabat, Morocco"
      ],
      "name": "M Alami Chentoufi"
    },
    {
      "affiliations": [
        "IBN Sina University Hospital of Rabat, Department of Resuscitation and Surgical Emergencies, Rabat, Morocco"
      ],
      "name": "L Aberouch"
    },
    {
      "affiliations": [
        "IBN Sina University Hospital of Rabat, Department of Resuscitation and Surgical Emergencies, Rabat, Morocco"
      ],
      "name": "M Faroudy"
    },
    {
      "affiliations": [
        "IBN Sina University Hospital of Rabat, Pharmacy Department, Rabat, Morocco"
      ],
      "name": "Y El Alaoui"
    }
  ],
  "title": "4CPS-326 Pharmaceutical optimisation of anticonvulsant therapy in critically ill trauma patients",
  "uid": "e2773fc5-ee2d-5562-a8cd-d29e438308c8"
}