Antiseizure Medication (ASM) Flashcards
A patient is on antiepileptic drugs (AED) for 2 years. On follow-up, his liver function tests were deranged. AED should be discontinued based on derangement of which parameter?
● A. Fatty liver on USG
● B. Acute decrease in ALT
● C. Decrease in ALT/AST ratio
● D. GGT levels twice the normal
● E. Hyperalbuminemia
D. GGT levels twice the normal
What is the dose adjustment of phenytoin in renal failure?
● A. Continue same dosage
● B. Two-thirds of the previous dosage
● C. Half the previous dose
● D. Double the previous dose
● E. Only give on SOS basis
A. Continue same dosage
What is the parenteral loading dose of phenytoin for adults?
● A. 16 mg/kg
● B. 18 mg/kg
● C. 20 mg/kg
● D. 22 mg/kg
● E. 25 mg/kg
B. 18 mg/kg
What is the most common electrolyte imbalance associated with carbamazepine?
● A. Hypernatremia
● B. Hyponatremia
● C. Hypochloremia
● D. Hyperchloremia
● E. Hypermagnesia
B. Hyponatremia
Carbamazepine should be discontinued when CBC shows a WBC count of what?
● A. < 10,000
● B. < 7000
● C. < 6000
● D. < 5000
● E. < 4000
< 4000
Oxcarbazepine was prescribed to a patient for epilepsy. Which blood tests should be employed to monitor the side effects?
● A. CBC
● B. RFTs
● C. Electrolytes
● D. Urinalysis
● E. No blood tests required
E. No blood tests required
What is the maximum recommended adult dose of valproic acid?
● A. 20 mg/kg/d
● B. 30 mg/kg/d
● C. 40 mg/kg/d
● D. 50 mg/kg/d
● E. 60 mg/kg/d
E. 60 mg/kg/d
What is the therapeutic level of valproic acid?
● A. 5 to 10 μg/mL
● B. 10 to 20 μg/mL
● C. 20 to 30 μg/mL
● D. 30 to 40 μg/mL
● E. 50 to 100 μg/mL
E. 50 to 100 μg/mL
What is the loading dose of phenobarbital in adults?
● A. 10 mg/kg
● B. 12 mg/kg
● C. 15 mg/kg
● D. 18 mg/kg
● E. 20 mg/kg
E. 20 mg/kg
What is the recommended daily dose of ethosuximide in adults?
● A. 500 to 1,500 mg/d
● B. 500 to 1,000 mg/d
● C. 250 to 500 mg/d
● C. 100 to 200 mg/d
● D. 100 to 300 mg/d
A. 500 to 1,500 mg/d
What is the initial dose of levetiracetam in adults?
● A. 500 mg oral twice daily
● B. 400 mg oral twice daily
● C. 300 mg oral twice daily
● D. 250 mg oral twice daily
● E. 100 mg thrice daily
A. 500 mg oral twice daily
What is the maximum daily dose of levetiracetam for adults?
● A. 1,000 mg
● B. 1,500 mg
● C. 2,000 mg
● D. 3,000 mg
● E. 1 g
D. 3,000 mg
When given for epilepsy, what is the usual target dosage of gabapentin?
● A.100 mg/d
● B. 1,000 mg/d
● C. 500 to 1,000 mg/d
● D. 800 to 1,800 mg/d
● E. 5 g/d
D. 800 to 1,800 mg/d
The maximum effect of topiramate for seizures control is observed at what dose?
● A. 100 mg/d
● B. 200 mg/d
● C. 400 mg/d
● D. > 600 mg/d
● E. 1 g/d
D. > 600 mg/d
The anticonvulsant effect of lamotrigine is due to presynaptic inhibition of release of what?
● A. Calcium
● B. Potassium
● C. Albumin
● D. Glutamate
● E. Serotonin
D. Glutamate
Fetal hydantoin syndrome is associated with which of the following?
● A. Valproic acid
● B. Levetiracetam
● C. Lamotrigine
● D. Phenytoin
● E. Benzodiazepines
D. Phenytoin
Ethosuximide is drug of choice for what?
● A. Absence seizures
● B. GTC seizures
● C. Myoclonic seizures
● D. Tonic seizures
● E. Atonic seizures
A. Absence seizures
Aside from some specific agents for some particular seizure types, there is generally no significant difference in efficacy of antiseizure medication. Hence, choices are made on the basis of tolerability, adverse effects, effects on comorbidities, drug–drug interactions, or availability of dosing form. What is the goal of antiseizure medication?
● A. Seizure control which is seizure-free time for at least 3 years for an epileptic patient and no or minimum chances of seizure in future
● B. Seizure control which is reduction of seizure frequency and severity to very low
● C. Seizure control which is reduction of seizure frequency and severity so that the patient can live normal life without epilepsy-related limitations
● D. Seizure control which is reduction of seizure frequency and severity so that the patient can live normal life without epilepsy-related limitations with minimal or no drug toxicity
● E. None of above
D. Seizure control which is reduction of seizure frequency and severity so that the patient can live normal life without epilepsy-related limitations with minimal or no drug toxicity
In person with focal onset seizure with or without retained awareness and with or without secondary generalization, the indicated antiseizure medications (ASM) are carbamazepine, phenytoin, phenobarbital, and primidone. Which of the follow-ing is the drug indicated in absence seizure?
● A. Ethosuximide
● B. Valproic acid
● C. Clonazepam
● D. Methsuximide
● E. All of the above
E. All of the above
Valproic acid, lamotrigine, levetiracetam, and zonisamide are considered as broad spectrum ASM. A patient presenting with low platelet counts in neurosurgical OPD with primary generalized tonic clonic seizures is to be started with ASM. Which
ASM is indicated in this patient as first-line medication?
● A. Valproic acid
● B. Phenytoin
● C. Levetiracetam
● D. Phenobarbital
● E. Lamotrigine
A. Valproic acid
Following statements regarding antiseizure medication are true except?
● A. A given medication dose is increased until seizures are controlled or side effects become intolerable
● B. Monotherapy is tried with different drugs before resorting to two drugs together as 80% of epileptics can be controlled with monotherapy
● C. When more than two ASMs are needed, it is considered that the patient is having nonepileptic seizure
● D. An ASM is discontinued if GGT levels exceed normal levels
● E. When first evaluating a patient on multiple drugs, the most sedating ones are withdrawn first
D. An ASM is discontinued if GGT levels exceed normal levels
Oral loading dose of phenytoin is 300 mg every 4 hours until 17 mg/kg is given while IV loading dose is 18 mg/kg slow IV. Maintenance dose in adults is 200 to 500 mg/d and 4 to 7 mg/kg/d in children. It is diluted only in normal saline and given at slow rate of 20 mg/min or maximum up to 40 mg/min because of risk of which following side effect?
● A. Hypotension
● B. Arrythmias
● C. Laryngeal spasm
● D. Acute kidney failure
● E. Both A and B
E. Both A and B
Carbamazepine is indicated for focal onset seizures, generalized tonic clonic seizures with or without secondary generalization, and trigeminal neuralgia. Dosage range in adults is 600 to 2,000 mg/d, while in children it is 20 to 30 kg/mg/d but it is started at low dosage and increased slowly like 200 mg per oral
every day for 1st week, then 200 mg twice a day for next week, then 200 mg thrice a day for next week, and so on. Which test is necessary before starting carbamazepine therapy?
● A. CBC
● B. Platelet count
● C. Serum iron
● D. Liver enzymes
● E. A, B, and C
E. A, B, and C
Levetiracetam is used as an adjunctive therapy for partial onset seizures with secondary generalization in patients 4 years of age and older. It is also used in myoclonic seizure (juvenile myoclonic epilepsy) and generalized tonic clonic seizures. It can cause somnolence, fatigue, dizziness, asthenia, or infection
as side effect. What is the maximum safe recommended dose of this medication per day?
● A. 2,000 mg
● B. 2,500 mg
● C. 3,000 mg
● D. 3,500 mg
● E. 4,000 mg
C. 3,000 mg
What is the most effective ASM for generalized genetic epilepsies with generalized tonic clonic seizures, which is also effective for all focal onset seizures, and generalized onset seizures including absence seizure and myoclonic seizures? (Adult dosage range of this drug is 600 to 3,000 mg/d, while in children it is 15 to 60 mg/kg/d, while it is contraindicated in pregnancy or in patients below 2 years of age.)
● A. Levetiracetam
● B. Valproate
● C. Phenytoin
● D. Phenobarbital
● E. Lamotrigine
B. Valproate
After cessation of ASM, which of the following factors are found to affect the likelihood of relapse after seizure-free interval of 2 years?
● A. Seizure type: more relapse in patients with generalized seizures as compared to partial seizures
● B. More the number of seizures before control is attained, the more the chance of relapse
● C. Use of multiple ASM is related with more chance of relapse
● D. EEG class 4 has worst prognosis for relapse
● E. All of the above
E. All of the above
For most women of child-bearing potential, monotherapy with the lowest dose of carbamazepine is indicated. What is the second indicated drug in such patients if therapy with carbamazepine is ineffective?
● A. Levetiracetam
● B. Valproic acid
● C. Phenytoin
● D. Lamotrigine
● E. Phenobarbital
B. Valproic acid
