14 - ANTICONVULSIONS

Item Number: 8227 correct answer: 5 category: Anticonvulsants

1. Drugs most often used in the treatment of petit mal epilepsy include:

1. ethosuximide

2. phenytoin

3. sodium valproate

4. All of the above

5. 1,3

Item Number: 2095 correct answer: 4 category: Anticonvulsants

2. The most specific agent for treatment of petit mal epilepsy is:

1. carbamazepine

2. phenytoin

3. gabapentin

4. ethosuximide

5. primidone

Item Number: 9733 correct answer: 5 category: Anticonvulsants

3. Phenytoin may have adverse effects on the hematopoietic system. All of the

following have been reported EXCEPT:

1. macrocytic anemia

2. hepatosplenomegaly

3. folic acid deficiency

4. lymphadenopathy

5. leukemia

Item Number: 6929 correct answer: 5 category: Anticonvulsants

4. The drug of choice in initiating chronic treatment of grand mal epilepsy is:

1. phenobarbital

2. ethosuximide

3. phenacemide

4. diazepam

5. carbamazepine

Item Number: 4399 correct answer: 2 category: Anticonvulsants

5. Gingival hyperplasia is a common side effect of:

1. procainamide

2. phenytoin

3. digitalis

4. indomethacin

5. guanethidine

Item Number: 9738 correct answer: 1 category: Anticonvulsants

6. Carbamazepine is considered to be a primary drug for treatment of all types of

epilepsy except absence seizures. Its indications and proposed mechanism of

action are most closely related to:

1. phenytoin

2. phenobarbital

3. ethosuximide

4. primidone

5. diazepam

Item Number: 6762 correct answer: 3 category: Anticonvulsants

7. Anticonvulsants which have active metabolites include:

A. phenytoin

B. primidone

C. phenobarbital

D. carbamazepine

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 7646 correct answer: 1 category: Anticonvulsants

8. Carbamazepine toxicities include:

A. water retention

B. dystonia and myoclonus

C. diplopia, blurred vision, and vertigo

D. gingival Hyperplasia

1. A,B,C

2. A,C

3. B,D

4. D only

5. All are correct

Item Number: 6099 correct answer: 4 category: Anticonvulsants

9. Prolonged dilantin use may lead to:

1. vitamin A deficiency

2. hypoglycemia

3. folic acid, iron, and vitamin C deficiency

4. abnormality in folic acid metabolism

5. thiamine deficiency

Item Number: 6903 correct answer: 1 category: Anticonvulsants

10. Visual disturbances (such as "halos" on objects) are a side effect of

which of the following anticonvulsants?

1. trimethadione

2. phenytoin

3. phenacemide

4. phenobarbital

5. ethosuximide

Item Number: 6763 correct answer: 5 category: Anticonvulsants

11. Pharmacokinetic blood level monitoring is apt to be most helpful for

which of the following anticonvulsants?

A. phenytoin

B. primidone

C. phenobarbital

D. carbamazepine

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6386 correct answer: 3 category: Anticonvulsants

12. A patient with pulmonary disease is taking prednisone. You begin her on

phenytoin therapy for a newly diagnosed seizure disorder. Two weeks later the

patient returns to the clinic to see you and complains that her pulmonary

disease has worsened since she began the phenytoin therapy. A likely reason

for this new change is that phenytoin:

1. interferes with absorption of the prednisone

2. stabilizes cell membranes, preventing the prednisone from diffusing to

the site of action

3. accelerates hepatic degradation of the prednisone

4. induce renal excretory pathways, accelerating urinary excretion of the

prednisone

5. activates the asthma directly

Item Number: 6909 correct answer: 3 category: Anticonvulsants

13. Drugs which are effective in the management of petit mal seizures include:

A. phenytoin

B. clonazepam

C. primidone

D. valproate

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6768 correct answer: 1 category: Anticonvulsants

14. Treatment of complex partial (temporal lobe) seizures generally requires the

use of:

A. phenytoin

B. phenobarbital

C. carbamazepine

D. ethosuximide

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6408 correct answer: 3 category: Anticonvulsants

15. Antiarthritic drugs not presently known to interact with phenytoin therapy

include:

A. salicylates

B. cyclophosphamide

C. phenylbutazone

D. gold

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 7425 correct answer: 4 category: Anticonvulsants

16. A 21-year-old male has been brought to the emergency room unconscious three

hours after ingestion of a large dose of barbiturate. The immediate method of

management would be:

1. administer concentrated dextrose intravenously

2. perform hemodialysis immediately with an artificial kidney

3. administer an analeptic drug such as pentylenetetrazol

4. maintain a clear airway and artificially assist ventilation if air

exchange is unsatisfactory

5. perform gastric lavage immediately with warm tap water

Item Number: 10777 correct answer: 1 category: Anticonvulsants

17. The liver function test most frequently elevated in patients taking

phenytoin is:

1. gamma-glutamyl transpeptidase (GGTP)

2. serum glutamic oxaloacetic transaminase (SGOT)

3. serum glutamic pyruvic transaminase (SGPT)

4. lactic acid dehydrogenase (LDH)

5. alkaline phosphatase

Item Number: 6777 correct answer: 3 category: Anticonvulsants

18. Which of the following drugs (including metabolites) would achieve steady

state blood level concentrations earliest assuming a loading dose is not

given?

1. phenytoin

2. primidone

3. valproate

4. phenobarbital

5. ethosuximide

Item Number: 6936 correct answer: 4 category: Anticonvulsants

19. The administration of one drug may stimulate the metabolism of another drug

(enzyme induction). Phenobarbital is an example of such an enzyme inducer.

The metabolism of which of the following drugs may be affected by

phenobarbital administration?

1. warfarin

2. phenytoin

3. digitoxin

4. All of the above

5. 1,2

Item Number: 6418 correct answer: 4 category: Anticonvulsants

20. A patient you are following in the hospital is not responding to appropriate

doses of phenytoin therapy (blood level 1.8 mg/dl). The decision is made to

begin phenobarbital therapy immediately. The docent requests that you suggest

a loading regimen for this 70-kg male patient to achieve a blood level of 2.0

mg/dl within 24 hours (volume of distribution of phenobarbital = 0.75 l/kg).

Your suggestion would be:

1. 15 mg

2. 150 mg

3. 1.5 mg/kg

4. 1000 mg

5. It is not possible to calculate regimen without additional data

Item Number: 7963 correct answer: 4 category: Anticonvulsants

21. In the differential diagnosis of hirsutism, drug-induced hirsutism must be

considered. A drug which is known to include hirsutism as a side- effect is:

1. thallium

2. heparin

3. cephalosporins

4. phenytoin

5. diazepam

Item Number: 10780 correct answer: 5 category: Anticonvulsants

22. Drugs known to be effective for generalized tonic-clonic seizures include:

A. phenytoin

B. primidone

C. carbamazepine

D. valproic acid

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6781 correct answer: 3 category: Anticonvulsants

23. Drugs which have been shown to be effective for the chronic management

of absence seizures include:

A. phenytoin

B. valproate

C. primidone

D. ethosuximide

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6423 correct answer: 3 category: Anticonvulsants

24. A Patient you began on carbamazepine recently has returned to your office

complaining of headache, vomiting, and dizziness. The patient is mildly

confused. Laboratory data were: sodium 112 mEq/L, potassium 3.9 mEq/L,

chloride 90 mEq/L, BUN 12 mg/dl and albumin 3.2 G/dl (normal values for lab:

sodium 135-148, potassium 3.0-5.3, chloride 96-107, BUN 7-22, albumin

3.8-4.8). Which of the following best explains this patient's symptomatology?

A. carbamazepine-Induced megaloblastic anemia

B. carbamazepine-Induced hyponatremia

C. carbamazepine-Induced cerebellar degeneration

D. carbamazepine-Induced central nervous system toxicity (blood level

related)

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6880 correct answer: 5 category: Anticonvulsants

25. Grand mal epilepsy can be effectively treated in some patients with:

A. phenytoin

B. carbamazepine

C. phenobarbital

D. valproate

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 10786 correct answer: 4 category: Anticonvulsants

26. Drugs known to increase the concentration of phenytoin when given

concomitantly include:

A. carbamazepine

B. enteral feedings

C. quinidine gluconate

D. disulfiram

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6790 correct answer: 3 category: Anticonvulsants

27. Which of the following anticonvulsants is (are) administered as a single daily

dose?

A. valproic acid

B. phenobarbital

C. carbamazepine

D. phenytoin

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6447 correct answer: 2 category: Anticonvulsants

28. A 26-Year-old female suffering from complex partial seizures is receiving

treatment with phenytoin 400 mg (blood level 11 mg/L), and carbamazepine 600

mg/day (blood level 5.3 mg/L). She currently reports having two or three

seizures every three to four months. Despite treatment with lo/Ovral

(norgestrel 0.3 mg with ethinyl estradiol 30 mcg), she has learned that she is

pregnant. Possible reasons for this complication include:

A. poor compliance with the lo/Ovral

B. increased pituitary gonadotropin secretion secondary to phenytoin

C. anticonvulsant induced microsomal enzyme induction, causing more

rapid metabolism of the lo/Ovral

D. increased pituitary gonadotropin secretion secondary to

carbamazepine

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6890 correct answer: 1 category: Anticonvulsants

29. Phenytoin is hydroxylated by liver microsomes. The amount of drug oxidized

is:

A. increased by chronic administration of carbamazepine

B. decreased by simultaneous administration of isoniazid

C. decreased by concurrent administration of disulfiram

D. increased by simultaneous administration of chloramphenicol

1. A,B,C

2. A,C

3. B,D

4. D only

5. None of the above

Item Number: 10787 correct answer: 3 category: Anticonvulsants

30. Your patient is a 35-year-old epileptic who takes phenytoin 300 mg daily and

primidone 500 mg every eight hours daily. He visits you in clinic complaining

of a recent (Past 1-2 days) increase in seizure frequency. He claims to be

very compliant with his medicine and states that he took his last dose 1.5

hours prior to his clinic visit. Following chart review you request stat drug

levels. These are reported back to you as phenobarbital=12 mcg/mL (15-40),

primidone=0 (5-12), and phenytoin=5 mcg/mL (10-20). Statements which could

explain the drug levels observed include:

A. an unusually high degree of hepatic microsomal enzyme induction

B. compliance is questionable...you strongly suspect that he has

taken no medicine for the past two days

C. the patient did take both of his seizure medicines 1.5 hours

before his clinic visit; however, he probably did not take any for

3-4 days before that time

D. the patient may have been compliant with phenytoin recently (past

1-2 days), but not with his primidone

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6799 correct answer: 3 category: Anticonvulsants

31. Variability in absorption represents one potential source for variation in

steady state blood levels. Anticonvulsants associated with variable

absorption include:

A. primidone

B. phenytoin

C. ethosuximide

D. carbamazepine

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 10704 correct answer: 1 category: Anticonvulsants

32. The most appropriate drug for treatment of generalized tonic-clonic (grand

mal) is:

1. valproate

2. methylphenidate

3. ethosuximide

4. diazepam

5. trimethadione

Item Number: 6796 correct answer: 1 category: Anticonvulsants

33. Since it's introduction in 1938, Phenytoin has been a major anticonvulsant

drug in the treatment of epilepsy. Phenytoin therapy has been shown to be of

value for which of the following seizure types?

A. complex partial seizures (psychomotor)

B. generalized tonic clonic

C. elementary partial (focal)

D. absences

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6888 correct answer: 5 category: Anticonvulsants

34. Drugs useful in the management of temporal-lobe epilepsy include:

1. trimethadione

2. carbamazepine

3. phenytoin

4. diazepam

5. 2,3

Item Number: 12915 correct answer: 1 category: Anticonvulsants

35. A patient comes to the office complaining of sore, enlarged gums. She is

currently taking medication for hypertension and phenobarbital and phenytoin

for seizures. The fibrous hyperplasia is most probably due to:

1. phenytoin

2. excessive brushing of teeth

3. propranolol

4. staphylococci infection of gums

5. phenobarbital

Item Number: 6451 correct answer: 2 category: Anticonvulsants

36. Which of the following anticonvulsants can be administered as a drug and is

also a metabolite of one of the other agents?

1. phenytoin

2. phenobarbital

3. primidone

4. carbamazepine

5. ethosuximide

Item Number: 7665 correct answer: 5 category: Anticonvulsants

37. Correct statements concerning valproic acid toxicity include:

A. VPA has been associated with thinning of the hair

B. VPA has been associated with benign essential tremor

C. VPA has been associated with thrombocytopenia

D. VPA has been associated with hepatitis, which usually occurs

within the initial six months of therapy

1. A,B,C

2. A,C

3. B,D

4. D only

5. All are correct

Item Number: 9595 correct answer: 4 category: Anticonvulsants

38. The generic anticonvulsant diphenylhydantoin is now officially called

phenytoin. Common adverse effects of chronic phenytoin therapy include all of

the following EXCEPT:

1. gingival hyperplasia

2. morbilliform skin rash

3. hirsutism

4. hypoglycemia

5. ataxia

Item Number: 12984 correct answer: 4 category: Anticonvulsants

39. Phenytoin toxicity can cause:

1. behavioral changes

2. increased frequency of seizures

3. gingival hyperplasia

4. All of the above

5. 1,3

Item Number: 6471 correct answer: 1 category: Anticonvulsants

40. Correct statements concerning the use of diazepam for the emergency management

of status epilepticus include:

A. diazepam should be given intravenously to ensure a rapid onset of

action

B. diazepam should be given slowly to minimize the potential

cardiovascular and respiratory complications (Max OF 5 mg/min)

C. diazepam should not be expected to provide long-term control in

status epilepticus because serum levels of the drug fall secondary

to its extensive distribution in the body

D. diazepam should be used only for status epilepticus of the tonic-

clonic (grand mal) type

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 1602 correct answer: 5 category: Anticonvulsants

41. You prescribe phenytoin for a young girl with epilepsy. Her mother calls one

month later to inquire about possible side effects. All of the following may

be side effects EXCEPT:

1. nystagmus

2. ophthalmoplegia

3. gingival hyperplasia

4. ataxia

5. None of the above; all are possible side effects