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Anti-epileptics Flashcard Supplement

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WEEK 10 Quiz on Anti-epileptics Flashcard Supplement, created by Victoria Wright on 22/03/2017.
Victoria Wright
Quiz by Victoria Wright, updated more than 1 year ago
Victoria Wright
Created by Victoria Wright over 7 years ago
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Resource summary

Question 1

Question
Which of the following are First Generation anti-epileptics?
Answer
  • Phenytoin
  • Carbamazepine
  • Ethosuximide
  • Pregabalin
  • Phenobarbital
  • Levetiracetam
  • Valproic acid
  • Felbamate
  • Clonazepam

Question 2

Question
Which of the following are Second Generation anti-epileptics?
Answer
  • Topiramate
  • Oxcarbazepine
  • Phenytoin
  • Pregabalin
  • Ethosuximide
  • Valproic acid
  • Felbamate
  • Lamotrigine
  • Gabapentin
  • Levetiracetam

Question 3

Question
[blank_start]Epilepsy[blank_end] is chronic disorder characterized by recurring seizures.
Answer
  • Epilepsy

Question 4

Question
Pharmacological treatment can control but not cure epilepsy.
Answer
  • True
  • False

Question 5

Question
Status epilepticus is a medical [blank_start]emergency[blank_end].
Answer
  • emergency

Question 6

Question
[blank_start]Generalized[blank_end] – no evidence of localized onset  [blank_start]Absence[blank_end] – sudden onset, abrupt cessation; 10-45 sec duration; may occur >100 times per day; characterized by a spike and wave pattern on EEG; patient may simply stare (daydream) or show postural changes, autonomic phenomena, automatisms  [blank_start]Tonic-clonic[blank_end] – tonic rigidity of all extremities, followed by relaxation, then by massive jerking of the body; patient is groggy/disoriented afterwards, urinary incontinence is common, 1-2 min duration  [blank_start]Tonic[blank_end] – increased tone of all muscles  [blank_start]Atonic[blank_end] – sudden loss of postural tone  [blank_start]Myoclonic[blank_end] – muscles spasm and limbs jerk; contractions and relaxations repeat rapidly
Answer
  • Generalized
  • Absence
  • Tonic-clonic
  • Tonic
  • Atonic
  • Myoclonic
  • Simple
  • Complex
  • Secondarily generalized
  • Focal

Question 7

Question
[blank_start]Focal (partial)[blank_end] – seizure initiates in a specific site  [blank_start]Secondarily generalized[blank_end] – focal seizure precedes a generalized tonic-clonic seizure  [blank_start]Simple[blank_end] – minimal spread within brain; often clonic jerking, no diminished awareness, 20-60 sec duration  [blank_start]Complex[blank_end] – localized onset but discharge spreads; alteration of consciousness (but not unconscious), automatisms (integrated motor behavior, e.g. lip smacking, button picking)
Answer
  • Focal (partial)
  • Secondarily generalized
  • Simple
  • Complex
  • Tonic-clonic
  • Absence
  • Tonic
  • Atonic
  • Clonic and myoclonic

Question 8

Question
Classify the following seizures:  [blank_start]Generalized Tonic-Clonic Seizure[blank_end]: “When it starts, she suddenly shrieks with this unnatural cry, then she falls, and every muscle in her body seems to be activated. Her teeth clench. Shortly after she falls, her arms and upper body start to jerk while her legs are more or less still stiff. This is the longest part of the seizure. Then it finally stops and she passes into a deep sleep.”  [blank_start]Generalized Absence Seizure[blank_end] "He is a 7 year old boy. He often “blanks out” for a few seconds. His teacher calls his name, but he doesn’t seem to hear her. He usually blinks a few times, and his eyes may roll up a bit. Then he is right back where he left off. Some days he has more than 50 of these spells.”  [blank_start]Secondary Generalization Focal Seizure[blank_end] "They start with a tingling in the right thumb. Then the thumb starts jerking. In a few seconds, the whole right hand is jerking. The jerking spreads up my arm. When it reaches the shoulder, I pass out and people tell me that my whole body starts to jerk.”
Answer
  • Secondary Generalization Focal Seizure
  • Generalized Absence Seizure
  • Generalized Tonic-Clonic Seizure
  • Generalized Tonic Seizure
  • Generalized Atonic Seizure
  • Complex Focal Seizure
  • Simple Focal Seizure

Question 9

Question
What are the goals of therapy with anti-epileptics? Improve [blank_start]quality of life[blank_end] by:  Controlling [blank_start]seizures[blank_end]  Rarely are seizures eliminated; even occasional seizures are still a concern for patients  Minimizing [blank_start]adverse effects[blank_end]  Usually lifelong treatment
Answer
  • quality of life
  • seizures
  • adverse effects

Question 10

Question
Which anti-epileptic drugs have the following mechanism of action? Inhibit voltage dependent Na+ channels
Answer
  • oxcarbazepine
  • phenytoin
  • valproate
  • topiramate
  • felbamate
  • gabapentin
  • carbamazepine
  • clonazepam
  • lamotrigine
  • ethosuximide

Question 11

Question
Which anti-epileptic drugs have the following mechanism of action? Inhibit glutamate receptors
Answer
  • valproate
  • felbamate
  • phenobarbital
  • oxcarbazepine
  • pregabalin
  • topiramate

Question 12

Question
Which anti-epileptic drugs have the following mechanism of action? Modulate glutamate release (putative)
Answer
  • levetiracetam
  • pregabalin
  • topiramate
  • ethosuximide
  • felbamate
  • gabapentin

Question 13

Question
Which anti-epileptic drugs have the following mechanism of action? Increase inhibitory neurotransmission  Enhance GABA-A activity (positive allosteric modulation)
Answer
  • ethosuximide
  • clonazepam
  • lamotrigine
  • phenobarbital
  • valproate
  • topiramate

Question 14

Question
Which anti-epileptic drugs have the following mechanism of action? Inhibit T-type Ca2+ channels  Depolarization of thalamic neurons activates cortical neurons
Answer
  • topiramate
  • carbamazepine
  • clonazepam
  • valproate
  • ethosuximide
  • phenytoin

Question 15

Question
In a normal neuron (A), excitation and inhibition are [blank_start]balanced[blank_end] Neurons susceptible to seizure activity show [blank_start]decreased[blank_end] inhibition (B) or [blank_start]increased[blank_end] excitation (C) (D) [blank_start]Increasing[blank_end] GABA activity can [blank_start]decrease[blank_end] seizure activity in both situations (D) Similarly, [blank_start]decreasing[blank_end] Glutamate activity can also [blank_start]decrease[blank_end] seizure activity
Image:
09b0d481-4c15-403e-923b-45558501806d (image/jpeg)
Answer
  • balanced
  • unbalanced
  • increased
  • decreased
  • increased
  • decreased
  • Increasing
  • Decreasing
  • increase
  • decrease
  • increasing
  • decreasing
  • increase
  • decrease

Question 16

Question
Block voltage-activated calcium channels − Neurons in thalamus are dependent on calcium channel [blank_start]pacemaker[blank_end] currents for depolarization − Blocking these channels slows the [blank_start]pacemaker[blank_end] − Depolarization of [blank_start]thalamic[blank_end] neurons activates [blank_start]cortical[blank_end] neurons
Answer
  • pacemaker
  • pacemaker
  • thalamic
  • cortical

Question 17

Question
Which four of the following are drugs of choice for Focal Epileptic Seizures?
Answer
  • Valproate
  • Gabapentin
  • Oxcarbazepine
  • Pregabalin
  • Carbamazepine
  • Ethosuximide
  • Topiramate
  • Phenytoin
  • Lamotrigine
  • Levetiracetam

Question 18

Question
Which five of the following are alternative drugs for Focal Epileptic Seizures?
Answer
  • Valproate
  • Topiramate
  • Gabapentin
  • Oxcarbazepine
  • Phenytoin
  • Clonazepam
  • Carbamazepine
  • Levetiracetam
  • Pregabalin
  • Lamotrigine

Question 19

Question
Which three of the following are drugs of choice for Primary GTC Seizures?
Answer
  • Topiramate
  • Valproate
  • Lamotrigine
  • Levetiracetam
  • Phenytoin
  • Pregabalin

Question 20

Question
Which two of the following are alternative drugs for Primary GTC Seizures?
Answer
  • Topiramate
  • Phenytoin
  • Levetiracetam
  • Gabapentin
  • Valproate
  • Lamotrigine

Question 21

Question
Which two of the following are drugs of choice for Absence Seizures?
Answer
  • Topiramate
  • Clonazepam
  • Ethosuximide
  • Lamotrigine
  • Valproate
  • Levetiracetam

Question 22

Question
Which two of the following are alternative drugs for Absence Seizures?
Answer
  • Topiramate
  • Ethosuximide
  • Lamotrigine
  • Clonazepam
  • Valproate
  • Levetiracetam

Question 23

Question
Which five of the following are some of the adverse effects of Phenytoin?
Answer
  • Hiccups
  • Hepatic failure
  • Nystagmus
  • Depression
  • Diplopia
  • Gingival hyperplasia
  • Mild parasthesias
  • Acne / Hirsuitism / Coarsening of facial features
  • Anorexia
  • Concern with HLA-B*1502 allele and skin reactions

Question 24

Question
Which six of the following are some of the adverse effects of Phenytoin?
Answer
  • May interfere with learning
  • Sedation
  • Ataxia
  • Rare serious blood dyscrasias
  • Fulminant hepatitis
  • Folate and Vitamin D deficiencies (megaloblastic anemia, osteomalacia)
  • Transient diplopia
  • Dizziness
  • Involuntary movements
  • Mild parasthesias

Question 25

Question
Which five of the following are some of the adverse effects of Carbamazepine and Oxcarbazepine?
Answer
  • Ataxia
  • Hyperammonemia
  • Hyponatremia
  • Hallucinations
  • Alopecia
  • Transient diplopia
  • Dizziness
  • Rare serious blood dyscrasias
  • Weight gain
  • Menstrual abnormalities

Question 26

Question
Which five of the following are some of the adverse effects of Carbamazepine and Oxcarbazepine?
Answer
  • Anorexia
  • Nausea
  • Mild parasthesias
  • Dependence
  • Drowsiness
  • Acute pancreatitis
  • Difficulty with speech
  • Insomnia
  • Skin rash
  • Stevens-Johnson syndrome

Question 27

Question
Which six of the following are some of the adverse effects of Valproate?
Answer
  • Menstrual abnormalities
  • Hyperammonemia
  • Aggression
  • Ataxia
  • Fulminant hepatitis
  • Dizziness
  • Alopecia
  • Rare serious blood dyscrasias
  • Hyponatremia
  • Acute pancreatitis

Question 28

Question
Which six of the following are some of the adverse effects of Valproate?
Answer
  • Nervousness
  • GI discomfort (tolerance)
  • Stevens-Johnson syndrome
  • Tremor
  • Diplopia
  • Somnolence
  • Weight gain
  • Thrombocytopenia
  • Polycystic ovaries
  • Folate and Vitamin D deficiencies (Megaloblastic anemia, Osteomalacia)

Question 29

Question
Which four of the following are the adverse effects of Ethosuximide?
Answer
  • Fulminant hepatitis
  • Hiccups
  • Vomiting
  • Difficulty with speech
  • Behavioral changes
  • Weight gain
  • Tolerance
  • Dependance
  • Stevens-Johnson syndrome
  • Nausea

Question 30

Question
Which four of the following are the adverse effects of Phenobarbital?
Answer
  • Hepatic failure
  • Sedation
  • Respiratory depression
  • Impaired concentration and memory
  • Difficulty with speech
  • Lower extremity edema
  • Tolerance
  • Dependance
  • Hyperammonemia
  • Hyponatremia

Question 31

Question
Which three of the following are the adverse effects of Clonazepam?
Answer
  • Diplopia
  • Dependance
  • Anorexia
  • Sedation
  • Respiratory depression
  • Gingival hyperplasia
  • Weight gain
  • Tolerance
  • Involuntary movements
  • Polycystic ovaries

Question 32

Question
Which six of the following are the adverse effects of Lamotrigine?
Answer
  • Dizziness
  • Skin rash
  • Hallucinations
  • Confusion
  • Stevens-Johnson syndrome
  • Insomnia
  • Aggression
  • Headache
  • Hiccups
  • Nausea

Question 33

Question
Which six of the following are the adverse effects of Topiramate?
Answer
  • Mild parasthesias
  • Difficulty with speech
  • Confusion
  • Depression
  • Nervousness
  • Insomnia
  • Impaired concentration and memory
  • Hallucinations
  • Aggression
  • Somnolence

Question 34

Question
Which three of the following are the adverse effects of Gabapentin and Pregabalin?
Answer
  • Lower extremity edema
  • Hyperammonemia
  • Acne, Hirsuitism, Coarsening of facial features
  • Stevens-Johnson syndrome
  • Mild parasthesias
  • Drowsiness
  • Insomnia
  • Weight Gain
  • Tolerance
  • Dependence

Question 35

Question
Which four of the following are the adverse effects of Levetiracetam?
Answer
  • Irritability
  • Vomiting
  • Transient diplopia
  • Ataxia
  • Headache
  • Depression
  • Nausea
  • Hallucinations
  • Acute pancreatitis
  • Aggression

Question 36

Question
Which two of the following are the adverse effects of Felbamate?
Answer
  • Respiratory depression
  • Hyponatremia
  • Confusion
  • Tremor
  • Aplastic anemia
  • Tolerance
  • Rare serious blood dyscrasias
  • Dependance
  • Lower extremity edema
  • Hepatic failure

Question 37

Question
Which of the following are the drug-drug interactions of Phenytoin?
Answer
  • Can reduce blood levels of contraceptive hormones
  • Enzyme inducers can increase clearance
  • Metabolism inhibited by valproate
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • Warfarin: can decrease anticoagulant effect
  • No significant drug interactions
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • Interactions due to plasma protein binding

Question 38

Question
Which of the following are the drug-drug interactions of Valproate?
Answer
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • Interactions due to plasma protein binding
  • Can reduce blood levels of contraceptive hormones
  • Enzyme inducers can increase clearance
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • No significant drug interactions
  • Can increase plasma levels of carbamazepine metabolite, phenytoin, phenobarbital, ethosuximide, lamotrigine and tricyclic antidepressants

Question 39

Question
Which of the following are the drug-drug interactions of Ethosuximide?
Answer
  • Affected by CYP3A4 inducers
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • Enzyme inducers can increase clearance
  • Metabolism inhibited by valproate
  • Can reduce blood levels of contraceptive hormones
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • No significant drug interactions

Question 40

Question
Which of the following are the drug-drug interactions of Phenobarbital?
Answer
  • Reduces blood levels of contraceptive hormones
  • Warfarin: can decrease anticoagulant effect
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • Metabolism inhibited by valproate
  • Can increase plasma levels of carbamazepine metabolite, phenytoin, phenobarbital, ethosuximide, lamotrigine and tricyclic antidepressants
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • Enzyme inducers can increase clearance

Question 41

Question
Which of the following are the drug-drug interactions of Clonazepam?
Answer
  • Interactions due to plasma protein binding
  • Metabolized by CYP3A4
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • Can reduce blood levels of contraceptive hormones
  • Metabolism inhibited by valproate
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • No significant drug interactions

Question 42

Question
Which of the following are the drug-drug interactions of Lamotrigine?
Answer
  • Enzyme inducers can increase clearance
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • Metabolism induced by carbamazepine, phenobarbital, phenytoin
  • Metabolism inhibited by valproate
  • Oral contraceptives can reduce levels
  • Interactions due to plasma protein binding
  • No significant drug interactions

Question 43

Question
Which of the following are the drug-drug interactions of Lamotrigine?
Answer
  • Can reduce blood levels of contraceptive hormones
  • Affected by CYP3A4 inducers
  • Warfarin: can decrease anticoagulant effect
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • Interactions due to plasma protein binding
  • No significant drug interactions

Question 44

Question
Which of the following are the drug-drug interactions of Gabapentin, Levetiracetam, and Pregabalin?
Answer
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • Significant enzyme induction: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
  • Warfarin: can decrease anticoagulant effect
  • Enzyme inducers can increase clearance
  • Can increase plasma levels of carbamazepine metabolite, phenytoin, phenobarbital, ethosuximide, lamotrigine and tricyclic antidepressants
  • Reduces blood levels of contraceptive hormones
  • No significant drug interactions

Question 45

Question
Which of the following are the drug-drug interactions of Carbamazepine?
Answer
  • Induces metabolism of phenytoin, ethosuximide, valproate, clonazepam
  • Enzyme inducers can increase clearance
  • Reduces blood levels of contraceptive hormones
  • Drug level affected by CYP3A4 inducers (phenytoin, phenobarbital), inhibitors
  • Can increase plasma levels of carbamazepine metabolite, phenytoin, phenobarbital, ethosuximide, lamotrigine and tricyclic antidepressants
  • Significant enzyme induction: CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
  • No significant drug interactions

Question 46

Question
Which of the following statements are true for Phenytoin?
Answer
  • Many PO formulations available – IR / ER formulations
  • 10-20 mg/L is common therapeutic range
  • Metabolism: dose-dependent capacity-limited pharmacokinetics (zero order metabolism)
  • Oldest non-sedating, anti-seizure drug
  • MUST MONITOR SERUM LEVELS
  • Used in bipolar disorder
  • 90% in vascular space is bound to albumin
  • At steady-state, 10% in vascular space, 90% tissue
  • Weight loss common (80% patients; 3-4% bodyweight loss)
  • Takes up to 6 weeks to achieve steady state, depending on dose

Question 47

Question
Which of the following statements are true for Carbamazepine?
Answer
  • Oldest non-sedating, anti-seizure drug
  • Also used for migraine prophylaxis and bipolar disorder
  • Used in children more than adults
  • Adjunctive therapy in children with focal seizures and generalized tonic clonic seizures
  • Induces its own metabolism; t1/2 ~36 hr ~20 hr
  • Used for migraine prophylaxis
  • Used for neuropathic pain
  • Is often Drug of Choice for focal seizures
  • 100% renal elimination
  • Monotherapy in >16 yr old for focal seizures

Question 48

Question
Which of the following statements are true for Valproate?
Answer
  • Used in children more than adults
  • Effective and well tolerated so used for many seizure types
  • No longer a drug of 1st choice for women of childbearing potential
  • Many PO formulations available – IR / ER formulations
  • 90% protein bound – can be significant
  • Many enzymes responsible for its metabolism (2A6, 2B6, 2C9, UGT, etc.)
  • Weight loss common (80% patients; 3-4% bodyweight loss)
  • Used for migraine prophylaxis
  • Used for neuropathic pain
  • Used for bipolar disorder

Question 49

Question
Which of the following statements are true for Phenobarbital?
Answer
  • Used for febrile seizures
  • 100% renal elimination
  • Used for weight management
  • Used in children more than adults
  • Weight loss common (80% patients; 3-4% bodyweight loss)
  • Infrequently used for seizures due to adverse effects and risks
  • Off label use for bipolar disorder
  • Induces its own metabolism; t1/2 ~36 hr ~20 hr
  • Oldest non-sedating, anti-seizure drug
  • Commonly used in monotherapy

Question 50

Question
Which of the following statements are true for Lamotrigine?
Answer
  • Monotherapy in >16 yr old for focal seizures
  • 90% in vascular space is bound to albumin
  • Used for migraine prophylaxis
  • Adjunctive therapy in children with focal seizures and generalized tonic clonic seizures
  • Used for weight management
  • Used in children more than adults
  • Used in absence (better tolerated than ethosuximide, valproate)
  • Used in bipolar disorder
  • Used for neuropathic pain
  • Does not induce or inhibit CYP enzymes

Question 51

Question
Which of the following statements are true for Topiramate?
Answer
  • At steady-state, 10% in vascular space, 90% tissue
  • Weight loss common (80% patients; 3-4% bodyweight loss)
  • Used for bipolar disorder
  • Oldest non-sedating, anti-seizure drug
  • Used for migraine prophylaxis
  • Used for weight management
  • Induces its own metabolism; t1/2 ~36 hr ~20 hr
  • Used for neuropathic pain
  • 100% renal elimination
  • Adjunctive therapy in children with focal seizures and generalized tonic clonic seizures

Question 52

Question
Which of the following statements are true for Levetiracetam?
Answer
  • 90% in vascular space is bound to albumin
  • Used in bipolar disorder
  • Oldest non-sedating, anti-seizure drug
  • Adjunct for Focal and generalized tonic-clonic seizures
  • Not an inhibitor or inducer of CYP enzymes
  • Commonly used for monotherapy
  • Used for migraine prophylaxis
  • Renal elimination (>70%)
  • Used for weight management
  • Used in children more than adults

Question 53

Question
Principles of AED Therapy  Choose monotherapy agent on basis of seizure [blank_start]type[blank_end] (or epilepsy syndrome if known) & patient-specific considerations (usually [blank_start]adverse effect[blank_end] profile)  Increase to [blank_start]usual[blank_end] effective dose or to a serum level within the therapeutic range  If seizures not controlled - increase gradually to [blank_start]maximal[blank_end] tolerated dose (MTD) = highest dose a patient can tolerate without bothersome adverse effects  If monotherapy fails, choose alternate monotherapy agent and repeat process  If monotherapy fails with several drugs, try [blank_start]adjuvant therapy[blank_end]  Concern is management of [blank_start]adverse effects[blank_end] of two drugs
Answer
  • type
  • adverse effect
  • maximal
  • usual
  • adjuvant therapy
  • adverse effects

Question 54

Question
Which of the following drugs reduce blood levels of contraceptive hormone?
Answer
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Felbamate
  • Lamotrigine
  • Oxcarbazepine
  • Topiramate

Question 55

Question
Antiepileptics are [blank_start]gradually[blank_end] increased to therapeutic concentrations to minimize [blank_start]adverse effects[blank_end] and are withdrawn [blank_start]gradually[blank_end] to reduce the risk of inducing [blank_start]seizures[blank_end].
Answer
  • gradually
  • adverse effects
  • gradually
  • seizures

Question 56

Question
 Enhanced vitamin [blank_start]D[blank_end] metabolism can cause osteomalacia (phenytoin, phenobarbital)  Enhanced vitamin [blank_start]K[blank_end] metabolism can cause bleeding disorders (phenytoin, phenobarbital)  Many anti-epileptics enhance [blank_start]metabolism[blank_end] of other anti-epileptics (phenytoin, carbamazepine, phenobarbital)  [blank_start]Valproate[blank_end] inhibits metabolism of some anti-epileptics
Answer
  • D
  • K
  • metabolism
  • Valproate

Question 57

Question
Pregnancy  Teratogenicity: Valproate, phenobarbital, phenytoin, carbamazepine  Prefer [blank_start]lamotrigine[blank_end] (or levetiracetam, oxcarbazepine)  Can increase drug metabolism, which can [blank_start]reduce[blank_end] seizure control  Need to switch drugs or increase dose?
Answer
  • lamotrigine
  • reduce

Question 58

Question
Hepatic disease  Avoid [blank_start]hepatotoxic[blank_end] antiepileptic drugs (e.g., valproate) when possible  Monitor free (unbound) levels of phenytoin, valproate when [blank_start]albumin[blank_end] low
Answer
  • hepatotoxic
  • albumin

Question 59

Question
Which of the following are contraindications / precautions for Phenytoin?
Answer
  • IV use for patients with sinus bradycardia, sinoatrial block, second- and third-degree heart block
  • Risk of dependence is high
  • Black box warning on rate of IV administration (<50mg/min)
  • Teratogenic risk

Question 60

Question
Which of the following are contraindications / precautions for Carbamazepine?
Answer
  • HLA-B*1502, common in Asians, linked to 10X increased incidence of Stevens-Johnson syndrome
  • Teratogenic risk
  • Black box warning on rate of IV administration (<50mg/min)
  • Caution in patients with history of sedative dependence

Question 61

Question
Which of the following are contraindications / precautions for Valproate?
Answer
  • Not used in children <3 yrs because of risk of liver failure
  • IV use for patients with sinus bradycardia, sinoatrial block, second- and third-degree heart block
  • Do not use in patients with history of sedative addiction
  • Teratogenic risk

Question 62

Question
Which of the following are contraindications / precautions for Phenobarbital?
Answer
  • Risk of dependence is high
  • Do not use in patients with history of sedative addiction
  • Teratogenic risk
  • Black box warning on rate of IV administration (<50mg/min)

Question 63

Question
Which of the following are contraindications / precautions for Clonazepam?
Answer
  • Caution in patients with history of sedative dependence
  • Teratogenic risk
  • IV use for patients with sinus bradycardia, sinoatrial block, second- and third-degree heart block
  • HLA-B*1502, common in Asians, linked to 10X increased incidence of Stevens-Johnson syndrome
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