[Verified Answer]: A 27 yo female with a PMH of GERD, seizure…

A 27 yo female with a PMH of GERD, seizure disorders, and panic disorder presented to the epilepsy clinic 3 weeks after starting a new antiepileptic regimen. The patient states adherence to the medications and has not had any seizures during this time. She admits to not always practicing safe sex and is concerned about getting pregnant. She now presents to your pharmacy with a prescription for the contraceptive Balziva-28 (ethinyl estradiol (CYP3A4 substrate) + norethindrone (CYP3A4 substrate)). Current Medications: Trileptal 300 mg PO BID (CYP3A4 substrate, CYP3A4 inducer) (seizures) Protonix 40 mg PO daily (CYP2C19, 2D6, 3A4) (GERD) Paxil 20 mg PO daily (CYP2D6 substrate, CYP2D6 inhibitor) (panic disorder) 1. What potential drugs interactions are there with this new prescription? 2. What is the mechanism of these interactions and the potential therapeutic outcome?