Deck 16: Antiepileptic Drugs

Question 1

Why is the additional administration of diazepam (Valium)required to control seizures in the treatment of status epilepticus?

A) Diazepam has a quick onset of action.
B) Diazepam has a short duration of action.
C) Diazepam has a long half-life.
D) None of the above are correct.

Answer 1

Diazepam has a short duration of action.

Question 2

Select the mechanism of action of topiramate (Topamax).

A) Topiramate interferes with the action of Na+ ions and the generation of high-frequency action potentials. The drug may also increase the inhibitory actions of gamma-aminobutyric acid.
B) Topiramate shortens the inactivation period of sodium ion (Na+) channels in the nerve membrane, leading to a reduction in the generation of high-frequency repetitive firing of action potentials from neurons involved in initiating seizures.
C) Topiramate reduces the T-type calcium currents in the thalamus, which reduces the occurrence of seizures.
D) Topiramate prolongs the inactivation period of potassium (K+) channels in the nerve membrane, leading to a reduction in the generation of high-frequency repetitive firing of action potentials from neurons involved in initiating seizures.

Answer 2

Topiramate interferes with the action of Na+ ions and the generation of high-frequency action potentials. The drug may also increase the inhibitory actions of gamma-aminobutyric acid.

Question 3

Differentiate between the groups of drug agents listed,and select the first-line treatment for generalized tonic-clonic seizures.

A) Phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol)
B) Ethosuximide (Zarontin), valproic acid (Depakene), and lamotrigine (Lamictal)
C) Phenytoin (Dilantin) and lorazepam (Ativan)
D) Ethosuximide (Zarontin) and phenytoin (Dilantin)

Answer 3

Phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol)

Question 4

Identify the type of seizure that does not involve motor convulsions.

A) Atonic seizure
B) Myoclonic seizure
C) Absence seizure
D) Partial seizure

Question 5

Describe the difference between anticonvulsant drug agents and antiepileptic drug agents.

A) An anticonvulsant is a drug, usually administered IM or IV, that terminates convulsive seizures. An antiepileptic is a drug, usually administered orally, that can be used prophylactically to reduce or prevent epileptic seizures.
B) An antiepileptic is a drug, usually administered IM or IV, that terminates convulsive seizures. An anticonvulsant is a drug, usually administered orally, that can be used prophylactically to reduce or prevent epileptic seizures.
C) Anticonvulsant agents and antiepileptic agents are interchangeable terms that can be used for any drug agent that is used to treat seizures, regardless of route of administration.
D) None of the above are correct.

Question 6

Select the correct FDA pregnancy category for carbamazepine (Tegretol).

A) Pregnancy Category B
B) Pregnancy Category C
C) Pregnancy Category D
D) Pregnancy Category X

Question 7

Identify the drug that is effective in treating a patient with absence seizures.

A) Clonazepam (Klonopin)
B) Phenobarbital (Luminal)
C) Topiramate (Topamax)
D) Diazepam (Valium)

Question 8

When analyzing an EEG,a medical professional can determine that the patient has had a petit mal seizure by focusing attention on a(n):

A) upward electrical spike wave of approximately 3 seconds.
B) flat-line of approximately 3 seconds.
C) downward electrical spike wave of approximately 3 seconds.
D) flat-line of approximately 6 seconds.

Question 9

In educating a patient about the treatment options for his partial seizures,which of the following should be listed as the adverse effects of carbamazepine (Tegretol)?

A) Bone marrow depression and aplastic anemia
B) Impaired liver function and jaundice
C) Convulsions and breathing difficulty
D) All of the above

Question 10

What is the primary mechanism of action of carbamazepine,phenytoin,and valproic acid?

A) Inhibiting the release of gamma-aminobutyric acid
B) Increasing the influx of Ca++ ions
C) Increasing T-type calcium currents
D) Delaying the inactivation of the Na+ channels

Question 11

Select the statement that is consistent with the mechanism of action of phenytoin (Dilantin)that helps decrease the occurrence of a seizure.

A) Phenytoin prolongs the inactivation period of sodium (Na+) channels in the nerve membrane, leading to a reduction in the generation of high-frequency repetitive firing of action potentials from neurons involved in initiating seizures.
B) Phenytoin decreases the inhibitory effects of the inhibitory neurotransmitter gammaaminobutyric acid (GABA), which suppresses the excitability of epileptogenic neurons.
C) Phenytoin decreases the inactivation of Na+ ion channels to decrease high-frequency firing of neurons and inhibition of Ca ++ ion channels.
D) None of the above are correct.

Question 12

Determine the recommended drug for status epilepticus that can be administered by IV or IM.

A) Clonazepam
B) Diazepam
C) Lorazepam
D) All of the above

Question 13

Identify the parameters used when deciding to treat a patient with lacosamide (Vimpat).

A) Lacosamide is used with lamotrigine for the treatment of generalized tonic-clonic seizures and myoclonic seizures.
B) Lacosamide is primarily used in patients over 12 years of age in combination with other antiepileptic drugs in the treatment of absence seizures.
C) Lacosamide is used as adjunct therapy with other drugs for the treatment of partial seizures in patients 17 years or older.
D) Lacosamide is used as a single therapy for the treatment of partial seizures in patients 17 years or older.

Question 14

Identify an adverse effect most commonly associated with the use of oxazolidinediones.

A) Snow blindness
B) Dry mouth
C) Aplastic anemia
D) Orthostatic hypotension

Question 15

Select the mechanism of action of trimethadione (Tridione).

A) Trimethadione (Tridione) reduces the T-type calcium currents in the thalamus, which reduces the occurrence of seizures.
B) Trimethadione (Tridione) attaches to plasma protein, which reduces the occurrence of seizures.
C) Trimethadione (Tridione) increases the inhibitory effects of the neurotransmitter gamma-aminobutyric acid (GABA).
D) None of the above are correct.

Question 16

Why do some drug agents such as phenytoin (Dilantin)and valproic acid (Depakene)produce greater pharmacologic effects when administered with drugs that are highly plasma protein bound?

A) Phenytoin (Dilantin) and valproic acid (Depakene) cause microsomal enzyme induction that leads to a decrease in drug metabolism causing greater pharmacologic effect.
B) Phenytoin (Dilantin) and valproic acid (Depakene) reduce the T-type calcium currents that leads to increased pharmacologic effect.
C) Phenytoin (Dilantin) and valproic acid (Depakene) are also highly plasma protein bound that leads to an increase in the free drug concentration and causes greater pharmacologic effect.
D) None of the above are correct.

Question 17

Identify the recommended drug for a patient with partial seizures who must be prescribed a liquid medication.

A) Carbamazepine, phenytoin, or valproic acid
B) Lamotrigine, phenytoin, or levotiracetam
C) Diazepam, lacosamide, and phenytoin
D) None of the above

Question 18

Identify the most common adverse effects of phenytoin (Dilantin).

A) Dizziness and ataxia
B) Visual disturbances and postural imbalance
C) Skin rashes, hirsutism, and gingival hyperplasia
D) All of the above

Question 19

Describe the signs to look for to determine that a person has experienced a grand mal seizure.

A) Confusion, fatigue, and muscle soreness usually follow the seizure.
B) Increases in blood pressure and heart rate, urination, and defecation are common.
C) Periods of alternating muscle contractions and relaxation, resembling a jerking motion, are present.
D) All of the above are correct.

Question 20

Despite the risks of developing serious adverse effects,a drug that is used to treat partial seizures in patients who do not respond to other drugs is _____.

A) gabapentin (Neurontin)
B) topiramate (Topamax)
C) felbamate (Felbatol)
D) valproic acid (Depakene)

Question 21

When required to arrest status epilepticus,the administration of diazepam or lorazepam is ideally followed by the administration of _____.

A) phenobarbital or carbamazepine
B) phenytoin or fosphenytoin
C) valproic acid or vigabatrin
D) lacosamide or ethosuximide

Question 22

When a series of seizures occur without any interruption,the treatment option should ideally include immediate administration of _____.

A) phenytoin
B) topiramate
C) diazepam
D) lamotrigine

Question 23

Ramona and Michael bring in their 3-month-old child,Darla,with a complaint of partial seizures.Which of the following drugs should ideally be prescribed for Darla?

A) Carbamazepine
B) Phenobarbital
C) Ethosuximide
D) Trimethadione

Question 24

Which of the following drugs inhibits microsomal enzymes and increases the effects of drugs requiring microsomal metabolism?

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

Question 25

Which of the following is an adverse effect of valproic acid?

A) Bone marrow depression
B) Aplastic anemia
C) Sedation
D) Fatal liver toxicity

Question 26

Identify an accurate statement about complex partial seizures.

A) They can become tonic-clonic and involve the entire body.
B) They may be sensory or motor in nature.
C) They are often manifested by a sensory change.
D) They are often accompanied by a muscular twitch that is confined to one body part.

Question 27

Carla is affected by generalized seizures.Recently,she had a seizure during which she fell and hurt her head.This was the third occurrence of her falling and hurting herself during a seizure.From this evidence,the most likely conclusion is that Carla is prone to _____.

A) simple partial seizures
B) myoclonic seizures
C) atonic seizures
D) absence seizures

Question 28

One of the differences between simple partial seizures and complex partial seizures is that:

A) simple partial seizures stem from changes in the activity of the neurons, whereas complex partial seizures originate from external factors such as allergens.
B) simple partial seizures are accompanied by some characteristic movement, whereas complex partial seizures often involve staring into space.
C) simple partial seizures cause loss of memory, whereas complex partial seizures do not impair memory.
D) simple partial seizures do not cause loss of consciousness, whereas complex partial seizures often impair consciousness for a minute or two.

Question 29

Which of the following drugs is associated with the "fetal hydantoin syndrome"?

A) Phenobarbital
B) Valproic acid
C) Phenytoin
D) Felbamate Phenytoin has been associated with birth defects referred to as the "fetal hydantoin syndrome." It is listed as FDA Pregnancy Category

Question 30

What is the primary mechanism of action of tiagabine in the treatment of partial seizures?

A) Inactivation of Na+ ion channels to decrease high-frequency firing of neurons
B) Blockade of Ca++ ion channels and decreased release of the excitatory neurotransmitter glutamate
C) Blockade of the neuronal reuptake of the inhibitory transmitter GABA back into its nerve endings
D) Interference with both Na + and Ca++ ion channel activity to inhibit the high-frequency firing of neurons

Question 31

The primary mechanism of action of gabapentin is _____.

A) increased release of the excitatory neurotransmitter glutamate
B) blockade of Ca++ ion channels
C) inactivation of Na+ ion channels
D) increased reuptake of GABA back into its nerve endings

Question 32

Maria comes in with a complaint of having frequent seizures that do not last for more than a few seconds.Maria says that she would often stare into space or rapidly blink for a few seconds in office and then continue with her regular work as if nothing had happened.Maria is presenting symptoms of _____.

A) absence seizures
B) tonic seizures
C) clonic seizures
D) atonic seizures

Question 33

A series of generalized seizures,particularly tonic-clonic,without cessation is referred to as _____.

A) simple partial seizure
B) status epilepticus
C) complex partial seizure
D) absence seizure

Question 34

William,an 80-year-old epileptic patient,is being treated for absence seizures.When left alone,William often forgets to take his medicine in time or consumes more than the required dosage.To prevent this,William's medicine intake is monitored by his son who has a regular day job.Which of the following drugs would be the most convenient to use?

A) Lorazepam
B) Topiramate
C) Diazepam
D) Ethosuximide

Question 35

Which of the following drugs is rarely prescribed because of the high incidence of adverse effects?

A) Valproic acid
B) Lamotrigine
C) Diazepam
D) Trimethadione