Prescription of Medications to Women of Chidbearing Age

read the following paper from my college and response in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence, or research.
Share an insight from having read the below postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom and/or from your own research in the Montante library.
Cite a minimum of three credible sources
When prescribing medications to the pediatric population, the prescriber has to ensure that the dosages are suitable for the weight of the child. The dosage must be titrated as the child grows/gains or loses weight (Conn et al., 2019). Another consideration is the mental capacity to consent, as Molly will need to demonstrate that she is capable of understanding the changes to her anti-seizure medication regimen and will need to receive education about the new medication, including potential side effects. The prescriber would also want to educate Molly about the type of birth control that she may want to consider (if she is not already taking it) along with letting her know the risks associated with anti-seizure medication and unplanned pregnancy. The prescriber may benefit from asking Molly to repeat the teaching back, including the appropriate way to administer the medications and the timing/frequency at which to take them.
Women of childbearing age should use effective contraception during treatment with Tegretol, as this anticonvulsant and many others (including Lamictal) may alter how oral contraception works (i.e. breakdown or alter enzyme and hormone levels), rendering them ineffective and allowing for an unplanned pregnancy (Novartis, 2022). Research shows that estrogen (i.e. birth control pill) can decrease the effectiveness of Lamictal, resulting in a loss of adequate seizure control (Patel & Grindrod, 2020). Molly is also taking Dilantin, which induces hepatic microsomal enzymes of the P-450 system, increasing the metabolism of ethinyl estradiol in oral contraceptives (Brenner & Stevens, 2018; Parekh et al., 2022). Oral contraceptives are not the preferred method of birth control for women of childbearing age who are taking anticonvulsants. Dilantin (phenytoin) works by suppressing the influx of sodium ions into the neuron, inhibiting depolarization and desensitizing sodium channels. This process of desensitization prevents the spread of disruptive electrical charges in the brain that result in seizures (Brenner & Stevens; Fiani et al., 2021). This mechanism of action allows prophylaxis of seizures but Molly seems to have uncontrolled breakthrough seizures despite taking the maximum dosage. I wonder if Molly is taking the maximum dosage for her current weight. Do any of my peers agree that Molly’s daily maximum may be increased if her current dosage is based on an older/initial weight?
Lamictal has been shown an effective add-on treatment when epileptic seizures have become drug-resistant, such as in this case. Lamictal has been shown to increase seizure control by 50% when added on to an epileptic drug regimen but often comes with a higher risk of adverse effects including unsteadiness, dizziness, double vision (diplopia), and nausea (Panebianco et al., 2020). Up to 6% of women with seizure disorders who continue anti-seizure medications while pregnant will a child with a fetal malformation—this is double to triple the incidence in the general population (Patel & Grindrod, 2020). If Molly were pregnant or trying to become pregnant, it would be imperative that she notify the healthcare team immediately, as many anti-seizure medications are harmful to the fetus and her dosages may have to be titrated down or medications switched altogether.
References
Brenner, G. & Stevens, C. (2018). Brenner and Stevens’ pharmacology (5th edition). Elsevier
Conn, R. L., Kearney, O., Tully, M. P., Shields, M. D., & Dornan, T. (2019). What causes prescribing errors in children? Scoping review. BMJ Open, 9(8), e028680. https://doi(dot)org/10.1136/bmjopen-2018-028680
Fiani, B., Andraos, C., Mabry, I., & Siddiqi, J. (2021). A comparison of seizure prophylaxis: phenytoin versus levetiracetam. Cureus, 13(5), e14956. https://doi(dot)org/10.7759/cureus.14956
Novartis. (2022). TEGRETOL® 100, 200 and 400 mg tablets (carbamazepine). https://www(dot)medicines(dot)org(dot)uk/emc/files/pil.1040.pdf
Panebianco, M., Bresnahan, R., Ramaratnam, S., & Marson, A. G. (2020). Lamotrigine add-on therapy for drug-resistant focal epilepsy. The Cochrane Database of Systematic Reviews, 3(3), CD001909. https://doi(dot)org/10.1002/14651858.CD001909.pub3
Parekh, K., Kravets, H. D., & Spiegel, R. (2022). Special considerations in the management of women with epilepsy in reproductive years. Journal of Personalized Medicine, 12(1), 88. https://doi(dot)org/10.3390/jpm12010088
Patel, T., & Grindrod, K. A. (2020). Antiseizure drugs and women: Challenges with contraception and pregnancy. Canadian Pharmacists, 153(6), 357-360. https://doi(dot)org/10.1177/1715163520959735