Anti-epileptics Practice Questions

A 39-year-old man was hit by a motorcycle while walking across a street. He did not lose consciousness, but suffered a deep laceration just above his right ear. Tests were negative for concussion or hematoma and the patient went home the next day. 10 months later the patient’s wife reported behavior consistent with a complex partial seizure. Which medication is unlikely to provide therapeutic benefit for this patient’s seizure ?

A 9 -year-old boy was brought into the emergency room with significant pruritus and flushing across all areas of his arms, trunk and legs. He was wheezing and his blood pressure was dangerously low. He was diagnosed with absence seizures and had started a course of ethosuximide 2 days prior. The attending physician identified the allergic reaction and after stabilizing the boy and consulting the boy’s neurologist, restarted him on a different anti-epileptic agent. Which of the following agents would be the best anti-epileptic to start in this case?

An 83-year-old man was found on his side and unresponsive on a city bus. Earlier in the day he took his anti-epileptic medication, became confused and took a second dose. The medication, Phenobarbital, causes this sedating effect because its mechanism of action is:

A 22-year-old female came into clinic reporting that she was finding it exceedingly difficult to keep her gums clean, and that she didn’t really smile anymore because they “looked horrible”. Examination revealed hyperplasia of her gums. Her medical history is significant for an anti-epileptic agent known to cause this in up to 40% of patients. This agent is:

A 32-year-old woman was brought to the emergency department by her husband who described symptoms consistent with a secondarily generalized seizure. It had been the second such episode over the prior week. The patient met with the neurologist who prescribed lamotrigine to control her seizures. The patient’s history included type-1 diabetes, treated with insulin and oral birth control. Both agents were continued as she started lamotrigine. Although the lamotrigine was started slowly and titrated properly, the patient’s seizures did not abate. The most likely cause of failure of lamotrigine was:

A 46-year-old man was started on carbamazepine for his recently diagnosed Complex Partial seizures. After 2 months of therapy, his seizures had not abated, and so valproic acid was added to his regimen. This combination worked well and he remained seizure free for 9 months. Although his serum level for the drug was within therapeutic limits, the patient showed signs of hyponatremia, a side effect more commonly seen in patients with higher serum concentrations of the agent. Why is this patient experiencing hyponatremia while maintaining therapeutic levels of carbamazepine? A 46-year-old man was started on carbamazepine for his recently diagnosed Complex Partial seizures. After 2 months of therapy, his seizures had not abated, and so valproic acid was added to his regimen. This combination worked well and he remained seizure free for 9 months. Although his serum level for the drug was within therapeutic limits, the patient showed signs of hyponatremia, a side effect more commonly seen in patients with higher serum concentrations of the agent. Why is this patient experiencing hyponatremia while maintaining therapeutic levels of carbamazepine?

A 54-year-old man had been receiving carbamazepine since he was diagnosed with complex focal seizures 5 years earlier. His seizures were completely controlled by the drug therapy. Blockade of which of the following molecular targets most likely mediated the therapeutic effect of the drug in the patient’s disease?

A 52-year-old man suffering from partial seizures has been receiving high doses of carbamazepine for 6 months. Which of the following dose-related adverse effects most likely occurred during the therapy?