Antiepileptic Drugs

Front 1

1. A 72-year-old female with a long history of anxiety treated with diazepam decides to triple her dose because of increasing fearfulness about“environmental noises.” Several days after her attempt at self-prescribing,her neighbor finds her to be extremely lethargic and nonresponsive. On examination, she is found to be stuporous and have diminished reaction to pain and decreased reflexes. Her respiratory rate is 8 breaths per minute(BPM), and she has shallow respirations. Which antidote could be given toreverse these findings?

a. Naltrexone

b. Physostigmine

c. Pralidoxime

d. Flumazenil

Back 1

d.flumazenil is an antidote for benzodiazepine overdose

Front 2

Which of the following is described as a competitive benzodiazepinereceptor antagonist?

a. Ketamine

b. Chlordiazepoxide

c. Flumazenil

d. Midazolam

e. Triazolam

Back 2

flumazenil

Front 3

. The preferred treatment of status epilepticus is intravenous administration is

a. Chlorpromazine

b. Diazepam

c. Succinylcholine

d. Tranylcypromine

e. Ethosuximide

Back 3

diazepam

Front 4

Which of the following may cause nephrogenic diabetes insipidus?

a. Fluoxetine

b. Haloperidol

c. Lithium

d. Phenytoin

e. Diazepam

Back 4

C

Front 5

For each patient, select the drug of choice:

Back 5

a. Midazolam

b. Diazepam

c. Alprazolam

d. Ethosuximide

e. Oxazepam

Front 6

. A 38-year-old male with a 15-year history of grand mal seizures is brought to the ED with generalized tonic-clonic seizures that are unremittent.

Back 6

Diazepam

Front 7

A 16-year-old female is brought to the ED by her mother, who has observed that her daughter has abruptly experienced an impairment of consciousness associated with clonic jerking of the eyelids and staring into space lasting approximately 30 s

Back 7

Ethosuximide

Front 8

A 48-year-old female has had difficulty swallowing for six months.She is premedicated for an endoscopic examination.

Back 8

Midazolam

Front 9

. A 12-year-old boy develops uncontrollable panic while camping with his parents in the Mojave Desert.

Back 9

Alprazolam is mostly used in panic and agoraphobia

Front 10

20-year-old male with absence seizures is treated with ethosuximide.What is the principal mechanism of action of ethosuximide?

a. Sodium channel blockade

b. Increase in the frequency of the chloride channel opening

c. Increase in GABA

d. Calcium channel blockade

e. Increased potassium channel permeability

f. NMDA receptor blockade

Back 10

D

Front 11

A 30-year-old female with partial seizures is treated with vigabatrin.What is the principal mechanism of action of vigabatrin?

a. Sodium channel blockade

b. Increase in frequency of chloride channel opening

c. Increase in GABA

d. Calcium channel blockade

e. Increased potassium channel permeability

f. NMDA receptor blockade

Back 11

C

Front 12

The mechanism of action of antiseizure drugs is:

a) Enhancement of GABAergic (inhibitory) transmission

b) Diminution of excitatory (usually glutamatergic) transmission

c) Modification of ionic conductance

d) All of the above mechanism

Back 12

D

Front 13

. Which of the following antiseizure drugs produces enhancement of GABA-mediated inhibition?

a) Ethosuximide

b) Carbamazepine

c) Phenobarbital

d) Lamotrigine

Back 13

C

Front 14

Indicate an antiseizure drug, which has an impotent effect on the T-type calcium channels in thalamic neurons?

a) Carbamazepin

b) Lamotrigine

c) Ethosuximide

d) Phenytoin

Back 14

C

Front 15

Which of the following antiseizure drugs produces a voltage-dependent inactivation of sodium channels?

a) Lamotrigine

b) Carbamazepin

c) Phenytoin

d) All of the above

Back 15

D

Front 16

Indicate an antiseizure drug, inhibiting central effects of excitatory amino acids:

a) Ethosuximide

b) Lamotrigine

c) Diazepam

d) Tiagabine

Back 16

B

Front 17

The drug for partial and generalized tonic-clonic seizures is:

a) Carbamazepine

b) Valproate

c) Phenytoin

d) All of the above

Back 17

D

Front 18

Indicate an anti-absence drug:

a) Valproate

b) Phenobarbital

c) Carbamazepin

d) Phenytoin

Back 18

A

Front 19

. The drug against myoclonic seizures is:

a) Primidone

b) Carbamazepine

c) Clonazepam

d) Phenytoin

Back 19

C

Front 20

The most effective drug for stopping generalized tonic-clonic status epilepticus in adults is:

a) Lamotrigine

b) Ethosuximide

c) Diazepam

d) Zonisamide

Back 20

C

Front 21

select the appropriate consideration for phenytoin:

a) It blocks sodium channels

b) It binds to an allosteric regulatory site on the GABA-BZ receptor and prolongs the openings of the Cl channels

c) It effects on Ca2+ currents, reducing the low-threshold (T-type) current

d) It inhibits GABA-transaminase, which catalyzes the breakdown of GABA

Back 21

A

Front 22

Phenytoin is used in the treatment of:

a) Petit mal epilepsy

b) Grand mal epilepsy

c) Myoclonic seizures

d) All of the above

Back 22

B

Front 23

Dose-related adverse effect caused by phenytoin is:

a) Physical and psychological dependence

b) Exacerbated grand mal epilepsy

c) Gingival hyperplasia

d) Extrapyramidal symptoms

Back 23

C

Front 24

Granulocytopenia, gastrointestinal irritation, gingival hyperplasia, and facial hirsutism are possible adverse effects of:

a) Phenobarbital

b) Carbamazepin

c) Valproate

d) Phenytoin

Back 24

D

Front 25

The antiseizure drug, which induces hepatic microsomal enzymes, is:

a) Lamotrigine

b) Phenytoin

c) Valproate

d) None of the above

Back 25

B

Front 26

The drug of choice for partial seizures is:

a) Carbamazepine

b) Ethosuximide

c) Diazepam

d) Lamotrigine

Back 26

A

Front 27

The mechanism of action of carbamazepine appears to be similar to that of:

a) Benzodiazepines

b) Valproate

c) Phenytoin

d) Ethosuximide

Back 27

c

Front 28

Neural tube defects may occur with which of the following antiseizuredrugs?

a. Ethosuximide

b. Vigabratin

c. Phenobarbital

d. Valproic acid

e. Primidone

Back 28

D

Front 29

Which of the following antiseizure drugs is also effective in treating trigeminal neuralgia? a) Primidone b) Topiramat c) Carbamazepine d) Lamotrigine

Back 29

C

Front 30

The most common dose-related adverse effects of carbamazepine are:

a) Diplopia, ataxia, and nausea

b) Gingival hyperplasia, hirsutism

c) Sedation, physical and psychological dependence

d) Hemeralopia, myasthenic syndrome

Back 30

A

Front 31

Indicate the drug of choice for status epilepticus in infants and children:

a) Phenobarbital sodium

b) Clonazepam

c) Ethosuximide

d) Phenytoin

Back 31

A

Front 32

. Indicate an irreversible inhibitor of GABA aminotransferase (GABA-T):

a) Diazepam

b) Phenobarbital

c) Vigabatrin

d) Felbamate

Back 32

C

Front 33

The reason for preferring ethosuximide to valproate for uncomplicated absence seizures is:

a) More effective

b) Valproate′s idiosyncratic hepatotoxicity

c) Greater CNS depressant activity

d) All of the above

Back 33

B

Front 34

The mechanism of valproate action is:

a) Facilitation glutamic acid decarboxylase, the enzyme responsible for GABA synthesis and inhibition of GABAaminotransferase,the enzyme responsible for the breakdown of GABA (enhance GABA accumulation)

b) Inhibition of voltage sensitive Na+channels

c) Inhibition of low threshold (T-type) Ca2+ channels

d) All of the above

Back 34

D

Front 35

Indicate the antiseizure drug, which is a sulfonamide derivative, blocking Na+channels and having additional ability to inhibit T-type Ca2+ channels:

a) Tiagabine

b) Zonisamide

c) Ethosuximide

d)primidone

Back 35

B

Front 36

Indicate the antiseizure drug – a benzodiazepine receptor agonist:

a) Phenobarbital

b) Phenytoin

c) Carbamazepine

d) Lorazepam

Back 36

D

Front 37

Which of the following antiseizure drugs may produce teratogenicity?

a) Phenytoin

b) Valproate

c) Topiramate

d) All of the above

Back 37

D

Front 38

The proposed mechanism of action for Levetiracetam is:

A) Modifi es synaptic release of glutamate and GABA through action on vesicular function

B) Enhances slow inactivation of voltage-gated Sodium Channels

C) Inhibits Carbonic Anhydrase

D) Irreversibly inhibits GABA aminotransferase

Back 38

A

Front 39

Ethosuximide is indicated for treatment of:

A) Focal epilepsy

B) Generalized tonic-clonic seizures

C) Generalized non-motor (absence) seizures

D) Unclassified epilepsy

Back 39

C

Front 40

SECTION 2

Back 40

ANSWER TRUE OR FALSE

Front 41

levetiracetam mode of action is by binding to SV2A docking protein

Back 41

TRUE

Front 42

vigabatrin mode of action is by inhibiting glutamate release

Back 42

FALSE

Front 43

valproate is used in all type of seizure

Back 43

TRUE

Front 44

mostly of type l calcium blocker are used to treate abscence seizures

Back 44

FALSE

Front 45

phenytoin is structurally related to benzodiazepine

Back 45

FALSE

Front 46

SECTION 3

Back 46

CASES

Front 47

A.AMINA a pregnant women was incorrectly given a certain medication of epilepsy by her doctor 8 month later after delivery the child was seen to have cleft palate which medication of epilepsy accounted for such congenital abnormality

Back 47

phenytoin

Front 48

one week after delivery AMINA read a magazine which explained that the cause of cleft palate was phenytoin he went to her doctor and her doctor apologized to her and told her i could have given you sodium volproate

was the doctor correct

Back 48

no volproate could also cause neurotube disorders like spinal bifida

Front 49

WHAT SHOULD WE CALL THIS KIND OF DOCTOR

Back 49

DOCTOR WA MICHONGOOOO

Front 50

. A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5–10 min. Electroencephalogram (EEG) studies reveal brief 3-Hz spike and wave discharges appearing synchronouslyin all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development?

(A) Clonazepam

(B) Ethosuximide

(C) Gabapentin

(D) Felbamate

(E) Phenobarbital

Back 50

Ethosuximide

Front 51

Which statement concerning the proposed mechanisms of action of anticonvulsant drugs is inaccurate?

(A) Diazepam facilitates GABA-mediated inhibitory actions

(B) Ethosuximide selectively blocks potassium ion (K+) channelsin thalamic neurons

(C) Phenobarbital has multiple actions, including enhancementof the effects of GABA, antagonism of glutamate receptors, and blockade of sodium ion (Na+) channels

(D) Phenytoin prolongs the inactivated state of the Na+channel

(E) Zonisamide blocks voltage-gated Na+channels

Back 51

B

Front 52

Which drug used in management of seizure disorders is most likely to elevate the plasma concentration of other drugs administered concomitantly?

(A) Carbamazepine

(B) Clonazepam

(C) Gabapentin

(D) Valproic acid

(E) Vigabatrin

Back 52

Valproic acid

Front 53

A young female patient suffers from absence seizures. Which of the following statements about her proposed drug managementis NOT accurate?

(A) Ethosuximide and valproic acid are preferred drugs

(B) Gastrointestinal side effects are common with ethosuximide

(C) She should be examined every 2 or 3 mo for deep tendon reflex activity

(D) The use of valproic acid in pregnancy may cause congenitalmalformations

(E) Weight gain is common in patients on valproic acid

Back 53

C

Front 54

With chronic use in seizure states, the adverse effects of this drug include coarsening of facial features, hirsutism, and gingivalhyperplasia.

(A) Carbamazepine

(B) Felbamate

(C) Phenytoin

(D) Phenobarbital

(E) Valproic acid

Back 54

C

Front 55

. Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity. Withdrawal is most easily accomplished if the patient is being treated with

(A) Carbamazepine

(B) Diazepam

(C) Ethosuximide

(D) Phenobarbital

(E) Phenytoin

Back 55

C

Front 56

he mechanism of antiseizure activity of carbamazepine is

(A) Block of sodium ion channels

(B) Block of calcium ion channels

(C) Facilitation of GABA actions on chloride ion channels

(D) Glutamate receptor antagonism

(E) Inhibition of GABA transaminase

Back 56

A

Front 57

Which statement about phenytoin is accurate?

(A) Displaces sulfonamides from plasma proteins

(B) Drug of choice in myoclonic seizures

(C) Half-life is increased if used with phenobarbital

(D) Isoniazid (INH) decreases steady-state blood levels of phenytoin

(E) Toxic effects may occur with only small increments in dose

Back 57

E

Front 58

young male patient suffers from a seizure disorder characterizedby tonic rigidity of the extremities followed in 15–30 s of tremor progressing to massive jerking of the body. This clonic phase lasts for 1 or 2 min, leaving the patient in a stuporous state. Of the following drugs, which is most suitable for longtermmanagement of this patient?

(A) Carbamazepine

(B) Clonazepam

(C) Ethosuximide

(D) Felbamate

(E) Tiagabine

Back 58

A