P2T3 - Questions CNS Anti-seizure Medication

A 47-year-old man is unconscious and is having continuous seizure activity for at least 30 minutes. Which drug would you use first to stop this patients status epilepticus? A. Amitriptyline B. Diazepam C. Fluoxetine D. Lamotrigine E. Propofol

B. Diazepam or lorazepam are the first treatment for status epilepticus. General anesthesia using propofol is used if the benzodiazepines fail to stop seizure.

A 22-year-old college student applies a cream containing lidocaine to her legs prior to driving a laser-hair-removal salon. Unfortunately she does not make it to the salon. She is found in her car by paramedics and presents with episodes of myoclonic jerking. She is transported to the emergency department and presents with consistent tonic-clonic seizures. Which of the following drugs if given promptly could stop this woman's seizures and prevent permanent neurotoxicity? A. Diazepam B. Flumazenil C. Physostigmine D. Propranolol E. Valproic Acid

A. Diazepam or lorazepam are the first emergent treatment for seizure activity

A 35-year-old woman is suffering from temporal lobe or complex partial epilepsy and has been having frequent episodes of seizure activity. Which of the drugs listed above would be the best to reduce the likelihood of future seizures in this woman? A. Phenytoin B. Clonazepam C. Gabapentin D. Ethosuximide E. Phenobarbital

A. Phenytoin.

A 35-year-old woman undergoing epilepsy treatment is cautioned to use another form of birth control besides oral contraceptives because her anti-epileptic drug can induce enzymes that speed hormone metabolism. Which drug was used on this patient? A. Phenytoin B. Clonazepam C. Gabapentin D. Ethosuximide E. Lamotrigine

A. Phenytoin. A generalized metabolic enzyme inducer will affect the metabolism of other molecules including drugs and sex steroid hormones.

A 4-year-old girl is having repeated episodes of sudden onset seizures that last for approximately 10 seconds. An EEG is performed which revealed an abnormal firing pattern with a 3-per-second spike and wave pattern. Which drug would most likely be used for long-term management of this patient? A. Diazepam B. Ethosuximide C. Felbamate D. Phenobarbital E. Phenytoin

B. Ethosuximide. This describes a classic case of absence seizure. The treatment of absence seizures involves suppressing burst patterns in the thalamus produced by activation of calcium channels in neurons projecting to cortex.

Which drug is correctly matched? A. Carbamazepine: is structurally similar to valproic acid B. Ethosuximide: reduces low-threshold (T-type) Ca++ currents C. Felbamate: is not associated with serious toxicities D. Phenytoin: drug of choice for absence (Petit Mal) seizures E. Valproic acid: is effective for only absence (Petit Mal) seizures

B. Ethosuximide: reduces low-threshold (T-type) Ca++ currents

Which of the following medication has a mechanism of action that may include blockade of NMDA receptors and is effective for treating partial seizure but is considered a third line therapy due to the frequent toxicity of aplastic anemia. A. Clonazepam B. Felbamate C. Ketamine D. Phenobarbital E. Valproic Acid

B. Felbamate, Alters glutaminergic neurotransmission. Key Side effects Significant toxicity issue, aplastic anemia, hepatitis

Which statement is true? If all statements A-D are correct mark E! A. Phenytoin prevents the metabolism of oral steroids B. Phenytoin is sometimes dissolved in potentially cardiotoxic propylene glycol C. Phenytoin is the drug of choice for febrile seizures D. The metabolism of phenytoin is proportional to the dose given at all doses E. All responses A through D are correct

B. Phenytoin is sometimes dissolved in potentially cardiotoxic propylene glycol

A 24-year-old woman presents with a seizure disorder characterized by tonic rigidity lasting 15-30 seconds followed by a tremor that progresses into clonic body jerking that lasts for 60 seconds. She is currently using the hormonal contraceptive Levonorgestrel. Initially you treat this patient with diazepam for immediate symptomatic relief followed by long-term management with phenytoin. Which statement best describes phenytoin's properties in this patient? A. Phenytoin increases glutaminergic neurotransmission B. Phenytoin may reduce the effectiveness of levonorgestrel C. Phenytoin has a large therapeutic index D. Phenytoinís metabolism is always proportional to its dose E. Phenytoin should be administered rapidly to achieve rapid plasma levels

B. Phenytoin may reduce the effectiveness of levonorgestrel. Phenytoin, phenobarbital and carbamazepine are all general CYP inducers. The increase in CYP enzymes can increase metabolism of other drugs and steroids.

A 35-year-old woman being treated, for pain caused by trigeminal neuralgia, with an anti-seizure medication is cautioned to use another form of birth control besides oral contraceptives while on this medication because it is known to induce enzymes that speed hormone metabolism. Which drug was used on this patient? A. Aspirin B. Alprazolam C. Carbamazepine D. Diazepam E. Methadone

C. Carbamazepine

A 54-year-old male diabetic patient is complaining of an unusual burning and tingling pain that is triggered by light touch. His physician determines that this patient's advanced diabetes is causing nerve damage, which in turn is causing his neuropathic pain. Which medication listed below is useful in treating this type of pain? A. Aspirin B. Atracurium C. Gabapentin D. Phenobarbital E. Succinylcholine

C. Gapapentin and other seizure medications are also used to treat neuropathic pain with marginal success

Drugs of choice for treating grand mal and partial seizure disorders most likely work through which of the following mechanisms? A. Increase cation influx into neuronal cells B. Increase in dopaminergic neurotransmission C. Increase glutaminergic neurotransmission D. Increase in inactivation of sodium channels E. Increase in inactivation of potassium channels

D. Increase in inactivation of sodium channels

Overstimulation of what neuronal type is most likely to lead to neuronal death through excess calcium entry into neurons (excitotoxicity)? A. Neurons that release endogenous opioids B. Neurons that release dopamine C. Neurons that release GABA (gamma-amino-butyric acid) D. Neurons that release glutamate E. Neurons that release glycine

D. Neurons that release glutamate excessive influx of calcium into neurons activates phospholipases, endonucleases, and proteases that are involved in neuronal cell death. This type of toxicity can be produced during seizure activity.

A 35-year-old woman is diagnosed with myoclonic seizures. She is treated with a drug that requires monitoring liver function test (LFTs), is not associated with pronounced sedation, and is associated with fetal birth defects. Shortly after taking the drug she is experiencing gastrointestinal discomfort. Which drug was likely prescribed to this patient? A. Chlorazepate B. Clonazepam C. Ethosuximide D. Valproic acid

D. Valproic acid

Status epilepticus should be treated promptly with (if A-D are correct mark E) A. Diazepam B. Phenobarbital if unresponsive to benzodiazepines C. A general anesthetic for highly resistant cases D. An I.V. antiepileptic drug to continue therapy E. All of the above might be appropriate treatment

E. All of the above might be appropriate treatment

Which statement is true regarding Carbamazepine? If A-D are correct mark E! A. Carbamazepine is used to treat trigeminal neuralgia B. Carbamazepine is associated with aplastic anemia and agranulocytosis C. Carbamazepine increases the liver metabolism of other drugs D. Carbamazepine has a similar pharmacodynamic profile as phenytoin E. All responses A through D are correct

E. Carbamazepine has all these characteristics

A 46-year-old man is being treated for his bipolar disorder with a drug that increases the inactivation of sodium channels. A. Phenytoin B. Clonazepam C. Gabapentin D. Ethosuximide E. Lamotrigine

E. Lamotrigine, carbamazepine, and phenytoin all increase the inactivation of sodium channels in rapidly firing neurons.

A 47-year-old male patient is having seizures that last from 30-120 sec. Following his seizures he has weakness for hours. He has a brief warning before his seizure but doesn't remember anything while he is having the event. Others who observe his seizure activity observe that he starts scratching himself, walks, and wrings his hands. Which drug listed below would is the drug of choice for reducing the occurrence of these types of seizures. A. Diazepam B. Ethosuximide C. Felbamate D. Phenobarbital E. Phenytoin

E. Phenytoin is a "first line" therapy for treatment for partial seizures. This patient has a complex partial seizure phenotype. Ethosuximide is only used for Absence seizures. Diazepam and phenobarbital are second line and reserved for emergent situations in adults.

The metabolism of which drug listed below can become saturated at high doses? A. Carbamazepine B. Ethosuximide C. Lamotrigine D. Phenobarbital E. Phenytoin

E. Phenytoin. Aspirin, ethanol, and phenytoin are the three drugs that have zero order kinetics at higher doses. In all three cases the metabolic capacity can be saturated at doses close to therapeutic or amount used.

Which of the following is correctly matched? Drug :Mechanism of action or toxicity A. Carbamazepine: activates GABA-A, chloride channels B. Ethosuximide:causes gingival hyperplasia C. Lamotrigine :inhibits NMDA-glutaminergic receptors D. Phenobarbital:inhibits of calcium channel conduction E. Phenytoin:causes hirsutism in women

E. Phenytoin. Phenytoin is a generalized inducer of metabolic enzymes in the liver that are responsible to metabolism of drugs and steroid molecules. Phenytoin induction of cyp's responsible for hormone metabolism can cause changes like—hirsutism in women. Phenytoin is also associated with gingival hyperplasia in patients with poor oral hygiene. Carbamazepine, phenytoin, and lamotrigine have a similar mechanism of action—increased sodium channel inactivation. Phenobarbital is a barbiturate that increases duration of GABA chloride channel opening.

A first grade teacher notices that her student becomes inattentive and stares off into space before resuming his activities. This occurs several times a day. She informs the parents. The parents consult a neurologist who determines, using electroencephalography, and a 2-3 Hz spike and wave pattern of discharges. The neurologist would most likely follow this evaluation with the initiation of which therapy listed below? A. Bupropion B. Lamotrigine C. Phenytoin D. Phenobarbital E. Valproic Acid

E. Vaproic Acid. This is a classic scenario of an absence or petit mal seizure. The treatment involves reducing calcium conduction in thalamic relay neurons. Ethosuximde and vaproic acid are two drugs that can be used to do this.

Which of the following is NOT correctly matched? A. Felbamate:is associated with aplastic anemia B. Gabapentin: antiseizure medication also used for neuropathic pain C. Lamotrigine: antiseizure medication also used in bipolar depression D. Phenobarbital: effectively prevents febrile seizures E. Tiagabine: drug of choice for generalized tonic-clonic seizures

F Tiagabine is a second line therapy for partial seizures. Valproic acid, lamotrigine, and topiramate are first line for generalized tonic-clonic seizures.