Epilepsy

Question 1

Which AED has the worst risk of fetal harm?
A.) Valproic Acid
B.) Phenobarbital
C.) Carbamazepine
D.) Ethosuximide

Answer 1

A.) valproic acid

Question 2

What test is used to diagnose epilepsy?
A.) ECG
B.) EKG
C.) CT
D.) EEG

Answer 2

D.) EEG

An electroencephalogram (EEG) is a test used to evaluate the electrical activity in the brain

Question 3

Which antibiotics can lower seizure threshold? Select all that apply?
A.) Penicillin
B.) Carbapenems
C.) Quinolones
D.) Macrolides

Answer 3

A, B, C

Question 4

Hyperammonemia is a side effect associated with which AEDs? (Select all)
A.) Lamotrigine
B.) Valproic acid
C.) Topiramate
D.) Oxcarbazepine

Answer 4

B, C

Question 5

Which supplements must be given with all AEDs?
A.) Folate
B.) Calcium
C.) Zinc
D.) Vitamin D

Answer 5

B, D

All AEDs can cause bone loss and lead to fractures especially in the elderly therefore, patients taking AEDs should be taking calcium and vitamin D.

Question 6

Which drug is a T-Type Ca++ channel blocker?
A.) Keppra
B.) Depakene
C.) Tegretol
D.) Zarontin

Answer 6

D.) Zarontin (ethosuximide)

Most of AEDs block the sodium channels as a general rule.

Question 7

Which electrolyte much be monitored carefully with oxcarbazepine (Trileptal)/carbazepine (Tegretal)?

A.) Potassium
B.) Calcium
C.) Magnesium
D.) Sodium

Answer 7

D (sodium)

Question 8

A patient is concurrently talking lamictal and valproic acid, which color lamictal dosing kit must be dispensed?

A.) Blue
B.) Green
C.) Red
D.) Orange

Answer 8

A (Blue)

Question 9

Standard Lamictal kit comes in what color?

A.) Red
B.) Blue
C.) Orange
D.) Green

Answer 9

C (Orange)

Question 10

Which drugs can cause metabolic acidosis, oligohidrosis, nehprolithiasis? (select all that apply)
A.) Topiramate
B.) Gabapentin
C.) Zonisamide (Zonegran)
D.) Phenobarbital

Answer 10

A, C

Question 11

A patient is taking Depakote to manage SE, which is causing her to lose her hair, which supplement should you recommend?

A.) Calcium
B.) Zinc
C.) Folate
D.) Selenium

Answer 11

B, D

Zinc
Selenium

Question 12

Patient has a total phenytoin level of 13 mcg/mL, Labs: Scr: 1.1, alb 3.1. Calculate the correct phenytoin? (nearest tenth)?

A.) 15.4 mcg/mL
B.) 19.2 mcg/mL
C.) 18.1 mcg/mL
D.) 12.5 mcg/mL

Answer 12

C

Question 13

A child is taking topiramate for SE? What should the pharmD counsel the parents on? (Select all)

A.) Stay hydrated
B.) Risk of hyperthermia
C.) Concentration problems in school
D.) Alopecia

Answer 13

A, B, C

Topiramate is a AED that comes with a lot of warnings which are especially NECESSARY to counsel the parents of the patients.

No sweating (oligohidrosis) 
Risk of hyperthermia 
Make sure to stay hydrated 
Concentration problems in school 
Loss of appetite/weight loss

Question 14

Therapeutic range for phenytoin?

A.) 20-40 mcg/mL
B.) 5-10 mcg/mL
C.) 4-12 mcg/mL
D.) 10-20 mcg/ml

Answer 14

D (10-20 mcg/ml)

Question 15

Management of symptomatic hyprammonemia patient who is currently taking valproic acid?

A.) Atropine
B.) Carnitine
C.) IV fluids
D.) Dopamine

Answer 15

B (Carnitine)

Question 16

Dose related toxicity associated with phenytoin?
Select all
A.) CV (Bradycardia, Hypotension, cardiac arrhythmias)
B.) GI (Nausea/vommiting)
C.) Neuro (Nystagmus, ataxia, blurred vision)
D.) Hepatotoxicity

Answer 16

D (Hepatotoxicity is a NOT a side effect associated with phenytoin)

Question 17

A 10 yoa child with seizures is seen by his dentist. Patient has overgrowth of gum tissue. What drug is he taking?

A.) clonazepam
B.) zonisamide
C.) phenytoin
D.) ethosuximide

Answer 17

C (phenytoin)

Question 18

The metabolism of which AED frequently displays zero-order kinetics following moderate to high therapeutic doses?

A.) Phenytoin
B.) Carbamazepine
C.) Phenobarbital
D.) Valproic acid

Answer 18

A.) Phenytoin

Question 19

Sodium Channel Blocking antiepileptic agents include, all EXCEPT?

A.) Topiramate
B.) Valproic Acid
C.) Phenytoin
D.) Carbamazepine

Answer 19

B.) Valproic acid increased GABA.

Question 20

The most serious adverse effect associated with valproic acid is:

A.) Dementia
B.) Hepatic Failure
C.) Glaucoma
D.) Mood disorder

Answer 20

B (hepatic failure)

Question 21

Which of the following toxic side effect is related to use of topiramate?

A.) Aplastic anemia
B.) Nephrolithiasis
C.) Stevens-Johnson syndrome
D.) Hepatotoxicity

Answer 21

B (nephrolithiasis -kidney stones)

Question 22

Excitatory neurons release the neurotransmitter _____________, while inhibitory neurons release the neurotransmitter ___?

A.) Norepinephrine, GABA
B.) Glutamate, GABA
C.) GABA, glutamate
D.) Dopamine, glutamate

Answer 22

B

Glutamate (excitatory)
GABA (inhibition)

Question 23

Patients who are at MOST risk for seizures. Select all that apply?

A.) A 58-year-old experiencing ETOH withdrawal.
B.) A 16-year-old with bacterial meningitis.
C.) A 72-year-old who is post opt day 5 from open heart surgery.
D.) A 32-year-old with a blood glucose of 20 mg/dL

Answer 23

A, B, D

Question 24

A patient with a history of epilepsy is taking Phenytoin. Morning labs are back, Phenytoin level of 7 mcg/mL?

A.) Assess the patient for a rash
B.) Hold the next dose of Phenytoin
C.) Initiate seizure precautions
D.) Continue to monitor the patient

Answer 24

C.)

Question 25

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. What should we monitor for? (select all)

A.) Respiratory Depression
B.) Hypertension
C.) Hypotension
D.) Fever

Answer 25

A, C

Question 26

Lorazepam is given for SE. What is the reversal agent for it?

A.) Flumazenil
B.) Narcan
C.) Idarucizumab
D.) Calcium chloride

Answer 26

A.)