Deck 12: Drugs Affecting the Central Nervous System

Question 1

A child, Dwayne, has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels may be:

A)Dwayne hasn't been taking his carbamazepine because it causes insomnia.
B)Carbamazepine autoinduces metabolism, leading to lower levels in spite of good compliance.
C)Dwayne was not originally prescribed the correct amount of carbamazepine.
D)Carbamazepine is probably not the right antiseizure medication for Dwayne.

Answer 1

Carbamazepine autoinduces metabolism, leading to lower levels in spite of good compliance.

Question 2

Long-term monitoring of patients who are taking carbamazepine includes:

A)Routine testing of troponin levels to assess for cardiac damage
B)Annual eye examinations to assess for cataract development
C)Monthly pregnancy tests for all women of childbearing age
D)Complete blood count every three to four months

Answer 2

Complete blood count every three to four months

Question 3

Levetiracetam has known drug interactions with:

A)Combined oral contraceptives
B)Carbamazepine
C)Warfarin
D)Few, if any, drugs

Answer 3

Few, if any, drugs

Question 4

A 10-year-old child is diagnosed with major depression. The appropriate first-line antidepressant for children is:

A)Fluoxetine
B)Fluvoxamine
C)Sertraline
D)Escitalopram

Question 5

A patient is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding them:

A)To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
B)To wear sunscreen due to photosensitivity from levetiracetam
C)To get an annual eye exam while on levetiracetam
D)To report weight loss if it occurs

Question 6

A patient has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be:

A)Increase her dose
B)Assess for suicidal ideation
C)Discontinue the medication immediately
D)Decrease her dose to half then slowly titrate up the dose

Question 7

A patient is started on paroxetine (Paxil), an SSRI, for depression. Education regarding antidepressants includes:

A)SSRIs may take two to six weeks before she will have maximum drug effects.
B)Red-green color blindness may occur and should be reported.
C)If she experiences dry mouth or a heart rate greater than 80, she should stop taking the drug immediately.
D)She should eat lots of food high in fiber to prevent constipation.

Question 8

Before prescribing phentermine, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St. John's Wort due to:

A)Additive respiratory depression risk
B)Additive effects affecting liver function
C)The risk of serotonin syndrome
D)The risk of altered cognitive functioning

Question 9

A patient is taking lamotrigine (Lamictal) for their seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:

A)Contraceptive failure
B)Excessive weight gain
C)Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
D)Induction of estrogen metabolism, requiring higher estrogen content OCs to be prescribed

Question 10

Monitoring of a patient on gabapentin to treat seizures includes:

A)Routine testing of therapeutic drug levels every three to four months
B)Assessing for dermatologic reactions, including Steven's Johnson
C)Routine testing of serum electrolytes, especially in hot weather
D)Recording seizure frequency, duration, and severity

Question 11

A three-year-old child has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for _________ to be used for an episode of status epilepticus.

A)IV phenobarbital
B)Rectal diazepam (Diastat)
C)IV phenytoin (Dilantin)
D)Oral carbamazepine (Tegretol)

Question 12

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner (NP) managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):

A)He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex).
B)MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce.
C)Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment.
D)All of the above

Question 13

Tricyclic antidepressants should be prescribed cautiously in patients with:

A)Eczema
B)Asthma
C)Diabetes
D)Heart disease

Question 14

A six-year-old has recently started taking ethosuximide (Zarontin) for seizures. The patient should be monitored for:

A)Increased seizure activity, as this drug may autoinduce seizures
B)Altered renal function, including renal failure
C)Blood dyscrasias, which is uncommon but possible
D)Central nervous system (CNS) excitement, leading to insomnia

Question 15

Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

A)He should not play sports due to the risk of increased seizures
B)He should monitor his temperature and ability to sweat in the heat while playing
C)Reminding him that he may need higher doses of topiramate when exercising
D)Encouraging him to use sunscreen due to photosensitivity from topiramate

Question 16

Carbamazepine has a black box warning due to life threatening:

A)Renal toxicity, leading to renal failure
B)Hepatotoxicity, leading to liver failure
C)Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis
D)Cardiac effects, including supraventricular tachycardia

Question 17

An overweight patient recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be:

A)Tell her to increase her caloric intake to counter the effects of the topiramate.
B)Consult with a neurologist, as this is not a common adverse effect of topiramate.
C)Decrease her dose of topiramate.
D)Reassure her that this is a normal side effect of topiramate and continue to monitor her weight.

Question 18

A patient is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

A)Reassuring her she has a viral infection and telling her to call if she isn't better in four or five days
B)Ruling out a hypersensitivity reaction that may lead to multiorgan failure
C)Rapid strep test and symptomatic care if strep test is negative
D)Observation only, with further assessment if she worsens

Question 19

A child is prescribed phenytoin for seizures. Monitoring includes assessing:

A)For phenytoin hypersensitivity syndrome three to eight weeks after starting treatment
B)For pedal edema throughout therapy
C)Heart rate at each visit, as therapy may have to be altered if heart rate is less than 60 beats per minute (bpm)
D)For vision changes, such as red-green blindness, at least annually

Question 20

A 42-year-old female requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

A)Understanding that obesity is a contraindication to prescribing phentermine
B)Anorexiants may cause tolerance and should only be prescribed for six months
C)Patients should be monitored for postural hypotension
D)Renal function should be monitored closely while on anorexiants

Question 21

A patient fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

A)Ibuprofen (Advil)
B)Acetaminophen with hydrocodone (Vicodin)
C)Oxycodone (Oxycontin)
D)Oral morphine (Roxanol)

Question 22

When prescribing temazepam (Restoril) for insomnia, patient education includes:

A)Take temazepam nightly approximately 15 minutes before bedtime.
B)Temazepam should not be used more than three times a week for less than three months.
C)Drinking one ounce of alcohol will cause additive effects and the patient will sleep better.
D)Exercise for at least 30 minutes within two hours of bedtime to enhance the effects of temazepam.

Question 23

A patient with anxiety and depression may respond to:

A)Duloxetine (Cymbalta)
B)Fluoxetine (Prozac)
C)Oxazepam (Serax)
D)Buspirone (Buspar) and an SSRI combined

Question 24

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

A)Orthostatic hypotension
B)Agitation and irritability
C)Drowsiness and nausea
D)Painful urination and abdominal distention

Question 25

Monitoring for a child on methylphenidate for attention-deficit/hyperactivity disorder (ADHD) includes:

A)ADHD symptoms
B)Routine height and weight checks
C)Amount of methylphenidate being used
D)All of the above

Question 26

An 8-year-old male has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:

A)Slurred speech and insomnia
B)Bradycardia and confusion
C)Dizziness and orthostatic hypotension
D)Insomnia and decreased appetite

Question 27

When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:

A)The medication may cause sedation and they should not drive.
B)Constipation is a common side effect and they should increase fluids and fiber.
C)Patients should not take any other acetaminophen-containing medications at the same time.
D)All of the above

Question 28

An adult is taking lithium for bipolar disorder. They should be taught to:

A)Take lithium with food
B)Eat a diet with consistent levels of salt (sodium)
C)Drink at least two quarts of water if they are in a hot environment
D)Monitor blood glucose levels

Question 29

A 19-year-old male was started on risperidone. Monitoring for risperidone includes watching for common side effects, including:

A)Bradykinesia, akathisia, and agitation
B)Excessive weight gain
C)Hypertension
D)Potentially fatal agranulocytosis

Question 30

A patient presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for the patient would be:

A)Fluoxetine (Prozac)
B)Paroxetine (Paxil)
C)Amitriptyline (Elavil)
D)Duloxetine (Cymbalta)

Question 31

Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:

A)Reduce the chance of tardive dyskinesia
B)Potentiate the effects of the drug
C)Reduce the tolerance that tends to occur
D)Increase CNS depression

Question 32

A patient sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:

A)Ibuprofen (Advil)
B)Acetaminophen with hydrocodone (Vicodin)
C)Oxycodone (Oxycontin)
D)Oral morphine (Roxanol)

Question 33

An adult female is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

A)Valproate is safe during all trimesters of pregnancy.
B)She can get pregnant while taking valproate, but she should take adequate folic acid.
C)Valproate is not safe at any time during pregnancy.
D)Valproate is a known teratogen, but may be taken after the first trimester if necessary.

Question 34

In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of causing rapidly developing dependence is:

A)Chlordiazepoxide (Librium)
B)Clonazepam (Klonopin)
C)Alprazolam (Xanax)
D)Oxazepam (Serax)

Question 35

A 45-year-old patient with schizophrenia was recently hospitalized for acute psychosis due to medication noncompliance. They were treated with intramuscular (IM) long-acting haloperidol. Besides monitoring schizophrenia symptoms, the patient should be assessed:

A)By his primary care provider, for excessive weight loss
B)By his primary care provider, using the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
C)By his primary care provider, monthly for tolerance to the haloperidol
D)Only by a mental health provider, as most NPs in primary care do not care for mentally ill patients

Question 36

Patients who are prescribed olanzapine (Zyprexa) should be monitored for:

A)Insomnia
B)Weight gain
C)Hypertension
D)Galactorrhea

Question 37

When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the NP will need to monitor:

A) Blood pressure
B) Blood glucose levels
C) Urine ketone levels
D) Liver function

Question 38

Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:

A)Zolpidem should be taken just before going to bed.
B)Zolpidem may cause dry mouth and constipation.
C)They may need to double the dose for effectiveness.
D)They should stop drinking alcohol at least 30 minutes before taking zolpidem.