Module 10

Module 10c: New Medication or Changed Dose

Moico Module 6 Alt

Updates to this module are made as changes are made, but are also prompted in the 6th update.

7.2 Medication/ Intervention Started/ Changed (ANGMedIntCurrent2)
NoCodeQuestionResponse
7.2.1ANGMedIntWhat2Please tell us what medication your child/ adult has started or changed dose?

1 – Cabamazepine (Tegretol)
2 – Clobazam (Frisium, Onfi)
3 – Clonozepam (Rivotril)
4 – Ethosuximide (Zarontin)
5 – Folate (Folic acid)
6 – Lamotrigine (Lamictal, Lamogine)
7 – Levetiracetam (Keppra)
8 – Oxcarbazepine (Trileptal)
9 – Phenobarbintone aspen (Dilantin)
10 – Sodium valproate (Epilim)
11 – Topiramate (Topamax)
12 – Aripiprazole (Abilify)
13 – Methylphenidate (Ritalin)
14 – Risperidone (Risperdal)
15– Efalex (Efamol)
16 – Evening primrose oil (Efamol)
17 – Amitriptyline (Endep)
18 – Diazepam (Valium)
19– Melatonin (Circadin)
20 – Midazolam (Versed)
21 – Nitrazepam (Mogadon)
22 – Phenobarbital (Phenobarb)
23 – Promethazine (Phenergan)
24 – Trimeprazine tartrate (Vallergan forte)
25 – Lactulose (Actilax, Dulose)
26 – Ommeprazole (Losec, Acimax, Maxor)
27 – Ondansetron (Zofran)
28 – Macrogol (Osmolax)
29 –  Probiotic (Cytopro)
30 – Psyllium (Metamucil)
31 – Baclofen (Lioresal, Gablofen)
32 – Benzatropine (Benztrop)
33 – Calcium (Caltrate)
34 – Celepram (Citalopram)
35 – Cephalexin (Keflex)
36 – Clonidine (Diaformin)
37 – Cyproheptadine (Periactin)
38 – Fluticasone (Flixotide)
39 – Hexamine hipp (hiprex)
40 – Minocycline (Akamin, Minomycin)
41 – Mometasone (Nasonex)
42 – Montelukast (Singulair)
43 – Netformin (Diaformin)
44 – Oxybutynin (Ditropan)
45 – Pantoprazole (Somac)
46 – Miralax /polyethylene glycol
47 – Lactulose
48 – Dulcolax/Bisacodyl
49 – Benefiber/Metamucil or other fiber laxative
50 – Cannabis or cannabinoid
51 – Ketogenic diet
52 – LGIT diet
53 – Other diet (please specify)
54 – Vagus Nerve Stimulation (VNS)

7.2.2ANGMedIntNameOTHIf medication is not listed above, please state 
7.2.3ANGMedIntReasonWhat is the reason for using this drug/intervention? Check all that apply1 – Anti epileptic;
2 – Behavioural;
3 – Sleep;
4 – Gastrointestinal;
5 – Complimentary;
6 – Diet;
7 – Vagus nerve stimulation;
8 – Other
7.2.3aANGMedIntReasonOthOther reason 
7.2.4aANGMedIntAgeStarted2What was your child/ adult’s age when medication/ intervention was started? 
7.2.7aAngMedIntOften2How often is this medication given?1 – Once a day;
2 – Twice a day;
3 – 3 times a day;
4 – 4 times a day;
5 – 5 times a day;
6 – 6 times a day;
7 – As needed;
8 – Other
7.2.7aiANGDoseSameIs the same dose given each time?Yes/ No
7.2.6aANGDose2Dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitDosage unit. Please indicate the dosage unit

1 – Grams (g);
2 – Milligrams (mg);
3 – Micrograms (mcg);
4 – Grams per millilitre (g/ml);
5 – Milligrams per millilitre (mg/ml);
6 – Micrograms per millilitre (mcg/ml);
7 – Millilitres (ml);
8 – Other

7.2.6cANGDoseUnitOthPlease specify If other, please specify 
7.2.7bAngMedIntOftenT1Medication time 1 Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2T1Time 1 dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitT1Time 1 dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthT1Please specify If other, please specify 
7.2.7cAngMedIntOftenT2Medication time 2 Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2T2Time 2 dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitT2Time 2 dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthT2Please specify If other, please specify 
7.2.7dAngMedIntOftenT3Medication time 3 Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2T3Time 3 dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitT3Time 3 dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthT3Please specify If other, please specify 
7.2.7eAngMedIntOftenT4Medication time 4 Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2T4Time 4 dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitT4Time 4 dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthT4Please specify If other, please specify 
7.2.7fAngMedIntOftenT5Medication time 5 Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2T5Time 5 dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitT5Time 5 dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthT5Please specify If other, please specify 
7.2.7gAngMedIntOftenT6Medication time 6 Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2T6Time 6 dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitT6Time 6 dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthT6Please specify If other, please specify 
7.2.7hAngMedIntOftenTOthMedication time other Please indicate what time this medication/ intervention is given 
7.2.6aANGDose2TOthOther time dosage (as a number) Please indicate units of dosage as a number(e.g. 100, 2.5) 
7.2.6bANGDoseUnitTOthOther time dosage unit. Please indicate the dosage unit1 – Grams (g); 
2 – Milligrams (mg); 
3 – Micrograms (mcg); 
4 – Grams per millilitre (g/ml); 
5 – Milligrams per millilitre (mg/ml); 
6 – Micrograms per millilitre (mcg/ml); 
7 – Millilitres (ml); 
8 – Other
7.2.6cANGDoseUnitOthTOthPlease specify If other, please specify 
7.2.9ANGMedIntOtherComments 
Providing Insight & Research into Angelman Syndrome
Creating new opportunities, insight & understanding.
Hi Holding Hands
Hi Patient Data

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