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CNS Pharmacology > Epilepsy And Antiepileptic Drugs > Flashcards

Epilepsy And Antiepileptic Drugs Flashcards

1
Q

What is the global ranking of epilepsy among neurologic disorders?
a) First
b) Second
c) Third
d) Fourth

A

c) Third

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2
Q

Which two neurologic disorders are more common than epilepsy globally?
a) Parkinson’s disease and multiple sclerosis
b) Cerebrovascular disease and Alzheimer’s disease
c) Huntington’s disease and amyotrophic lateral sclerosis
d) Migraine and traumatic brain injury

A

b) Cerebrovascular disease and Alzheimer’s disease

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3
Q

Epilepsy is characterized by:
a) Gradual, minimal neuronal activity
b) Sudden, excessive, and asynchronous discharge of cerebral neurons
c) Slow, synchronized activity of brain cells
d) Predictable, rhythmic neuronal firing patterns

A

b) Sudden, excessive, and asynchronous discharge of cerebral neurons

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4
Q

Epilepsy is best described as:
a) A single disorder with uniform symptoms
b) A diverse range of seizure types and syndromes
c) An exclusively genetic disorder
d) Limited to one specific region of the brain

A

b) A diverse range of seizure types and syndromes

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5
Q

What is the common feature among different seizure types and syndromes in epilepsy?
a) Gradual onset
b) Excessive sleepiness
c) Sudden, excessive, and synchronous discharge of cerebral neurons
d) Progressive cognitive decline

A

c) Sudden, excessive, and synchronous discharge of cerebral neurons

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6
Q

The symptoms produced by epilepsy depend on:
a) The age of the patient
b) The type of medication taken
c) The site of origin of the abnormal neuronal firing
d) The patient’s diet

A

c) The site of origin of the abnormal neuronal firing

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7
Q

If the abnormal neuronal firing originates in the motor cortex, what symptom might a patient experience?
a) Loss of consciousness
b) Abnormal movements
c) Visual hallucinations
d) Olfactory hallucinations

A

b) Abnormal movements

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8
Q

Seizures originating in the parietal or occipital lobe may lead to:
a) Loss of consciousness
b) Auditory hallucinations
c) Abnormal movements
d) Visual, auditory, or olfactory hallucinations

A

d) Visual, auditory, or olfactory hallucinations

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9
Q

What is the most widely effective mode of treatment for patients with epilepsy?
a) Surgery
b) Psychotherapy
c) antiepileptic Drug or vagal nerve stimulator therapy
d) Herbal remedies

A

c) antiepileptic Drug or vagal nerve stimulator therapy

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10
Q

Which type of epilepsy is characterized by seizures resulting from an inherited abnormality in the central nervous system?
a) Primary epilepsy
b) Secondary epilepsy
c) Tertiary epilepsy
d) Hereditary epilepsy

A

a) Primary epilepsy

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11
Q

Patients with primary epilepsy are often treated chronically with:
a) Surgery
b) Psychotherapy
c) Antiepileptic drugs or vagal nerve stimulation
d) Herbal remedies

A

c) Antiepileptic drugs or vagal nerve stimulation

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12
Q

What is the most common cause of epilepsy?
a) Primary epilepsy (idiopathic)
b) Secondary epilepsy
c) Trauma
d) Meningitis

A

a) Primary epilepsy (idiopathic)

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13
Q

Which type of epilepsy is associated with local causes such as stroke, trauma, meningitis, and brain tumors?
a) Primary epilepsy
b) Secondary epilepsy
c) Tertiary epilepsy
d) Congenital epilepsy

A

b) Secondary epilepsy

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14
Q

Secondary epilepsy can result from:
a) Inherited abnormalities in the central nervous system
b) Local causes such as stroke, trauma, meningitis, and brain tumor
c) Idiopathic factors
d) Chronic exposure to loud noise

A

b) Local causes such as stroke, trauma, meningitis, and brain tumor

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15
Q

Systemic causes of secondary epilepsy include:
a) Hypertension
b) Hypoglycemia and hypocalcemia
c) Vitamin D deficiency
d) Allergic reactions

A

b) Hypoglycemia and hypocalcemia

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16
Q

Which of the following is NOT a local cause of secondary epilepsy?
a) Stroke
b) Meningitis
c) Hypoglycemia
d) Trauma

A

c) Hypoglycemia

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17
Q

Which type of drugs can contribute to secondary epilepsy?
a) Antibiotics
b) Antipsychotics
c) Tricyclic antidepressants (TCA) and CNS stimulants
d) b&c

A

d) b&c

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18
Q

What distinguishes secondary epilepsy from primary epilepsy?
a) Onset age
b) Inheritance pattern
c) Underlying cause
d) Duration of seizures

A

c) Underlying cause

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19
Q

Classification of Seizures?

A

1-Focal seizures
a) (Simple partial)Focal with preserved awareness.
b)Complex partial(focal with impaired awareness):
c)focal with secondarily generalized convulsion.

2- generalized seizure
A)Tonic-clonic (Grandmal epilepsy);
B) Absence(petit mal epilepsy)
C) Myoclonic
D) Febrile seizures
E)Status epilepticus!

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20
Q

Focal seizures with preserved awareness involve:
a) Loss of consciousness
b) Hyperactive neurons exhibiting abnormal electrical activity
c) Generalized muscle contractions
d) Loss of sensation in the affected limb

A

b) Hyperactive neurons exhibiting abnormal electrical activity

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21
Q

What characterizes the abnormal electrical activity in simple focal seizures?
a) It is confined to a single locus in the brain
b) It spreads rapidly throughout the entire brain
c) It only affects the peripheral nervous system
d) It is synchronized with normal brain activity

A

a) It is confined to a single locus in the brain

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22
Q

Which of the following is may showed by the pts of simple partial seizures?
a) Loss of awareness
b) Involuntary muscle jerks
c) Sensory distortions
d) Profound memory loss

A

c) Sensory distortions

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23
Q

Simple partial seizures may involve abnormal activity in:
a) Multiple brain regions simultaneously
b) Only the left hemisphere of the brain
c) A single limb or muscle group controlled by the affected brain region
d) The brainstem exclusively

A

c) A single limb or muscle group controlled by the affected brain region

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24
Q

At what age may simple partial seizures occur?
a) Only in childhood
b) Only in old age
c) At any age
d) Exclusively during adolescence

A

c) At any age

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25
Q

What distinguishes complex partial seizures from simple partial seizures?
a) Loss of consciousness
b) Lack of sensory distortions
c) Involuntary muscle movements
d) Unilateral limb involvement

A

a) Loss of consciousness

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26
Q

Complex partial seizures are characterized by:
a) Simple sensory experiences
b) Loss of consciousness and complex sensory hallucinations
c) Complete absence of motor dysfunction
d) Normal awareness throughout the seizure

A

b) Loss of consciousness and complex sensory hallucinations

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27
Q

Which of the following is a common motor dysfunction observed in complex partial seizures?
a) Rapid eye movements
b) Hand tremors
c) Chewing movements
d) Slurred speech

A

c) Chewing movements

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28
Q

In complex partial seizures, consciousness is:
a) Fully preserved
b) Altered
c) Completely lost
d) Temporarily enhanced

A

b) Altered

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29
Q

Simple partial seizure activity may progress to become complex (impaired awareness) and then spread to become:
a) focal with secondarily generalized convulsion.
b) Generalised tonic-clonic seizures
c) Absence seizures
d) Myoclonic seizures

A

a) focal with secondarily generalized convulsion.

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30
Q

Partial seizures have been observed:
a) Solely in the elderly population
b) Mainly in infants
c) Across all age groups
d) Only in young adults

A

c) Across all age groups

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31
Q

Which of the following motor dysfunctions may be observed during complex partial seizures?
a) Rapid eye movements
b) Chewing movements, diarrhea, and/or urination
c) Flailing of arms and legs
d) Slowed breathing

A

b) Chewing movements, diarrhea, and/or urination

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32
Q

What distinguishes complex partial seizures from simple partial seizures?
a) They involve only one specific area of the brain
b) They are characterized by complete absence of sensory experiences
c) They result in loss of consciousness and complex sensory hallucinations
d) They are restricted to specific age groups

A

c) They result in loss of consciousness and complex sensory hallucinations

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33
Q

Complex partial seizures are characterized by:
a) Loss of sensory experiences
b) Simple motor movements
c) Loss of consciousness, complex sensory hallucinations, and motor dysfunction
d) Normal awareness throughout the seizure

A

c) Loss of consciousness, complex sensory hallucinations, and motor dysfunction

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34
Q

What characterizes generalized seizures?
a) They involve only one hemisphere of the brain
b) They produce abnormal electrical discharges throughout both hemispheres of the brain
c) They are limited to specific age groups

A

b) They produce abnormal electrical discharges throughout both hemispheres of the brain

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35
Q

What distinguishes primary generalized seizures from focal seizures?
a) They involve only one hemisphere of the brain
b) They produce abnormal electrical discharges throughout both hemispheres of the brain
c) They always begin with a loss of consciousness
d) They are characterized by simple sensory experiences

A

b) They produce abnormal electrical discharges throughout both hemispheres of the brain

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36
Q

What are common features of generalized seizures?
a) Convulsive movements only
b) Loss of consciousness and convulsive or nonconvulsive movements
c) Mild sensory distortions
d) Rapid eye movements

A

b) Loss of consciousness and convulsive or nonconvulsive movements

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37
Q

During generalized seizures, what typically happens to the patient’s consciousness?
a) It remains fully preserved
b) usually immediate loss of consciousness
c) It is completely lost
d) It is heightened

A

b) usually immediate loss of consciousness

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38
Q

Tonic-clonic seizures are characterized by:
a) Loss of consciousness, followed by tonic and clonic phases
b) Brief moments of confusion
c) Slow and continuous muscle contractions
d) Absence of post-seizure exhaustion

A

a) Loss of consciousness, followed by tonic and clonic phases

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39
Q

What happens during the tonic phase of a tonic-clonic seizure?
a) Rapid contraction and relaxation of muscles
b) Loss of consciousness
c) Continuous muscle contraction
d) Sudden loss of muscle tone

A

c) Continuous muscle contraction

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40
Q

What characterizes the clonic phase of a tonic-clonic seizure?
a) Continuous muscle contraction
b) Sudden loss of muscle tone
c) Rapid contraction and relaxation of muscles
d) Complete paralysis

A

c) Rapid contraction and relaxation of muscles

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41
Q

After a tonic-clonic seizure, the patient may experience:
a) Heightened alertness
b) A period of confusion and exhaustion
c) Enhanced cognitive abilities
d) No noticeable effects

A

b) A period of confusion and exhaustion

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42
Q

What contributes to the period of confusion and exhaustion following a tonic-clonic seizure?
a) Depletion of glucose and energy stores
b) Release of adrenaline
c) Increased oxygen levels in the brain
d) Normal brain activity

A

a) Depletion of glucose and energy stores

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43
Q

At what age does the onset of absence seizures typically occur?
a) 1 to 2 years
b) 3 to 5 years
c) 6 to 8 years
d) 9 to 12 years

A

b) 3 to 5 years

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44
Q

Which of the following is a characteristic feature of absence seizures?
a) Loss of consciousness for several minutes
b) Slow eye movements
c) Rapid eye blinking
d) Muscle spasms

A

c) Rapid eye blinking

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45
Q

What is the duration of the staring and rapid eye-blinking exhibited during an absence seizure?
a) 1 to 2 seconds
b) 3 to 5 seconds
c) 6 to 8 seconds
d) 9 to 12 seconds

A

b) 3 to 5 seconds

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46
Q

Which pattern is typically seen on electroencephalogram (EEG) during absence seizures?
a) Theta waves
b) Delta waves
c) Alpha waves
d) Three-per-second spike and wave discharge

A

d) Three-per-second spike and wave discharge

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47
Q

Which of the following best describes the characteristic feature of absence seizures?
a) Prolonged loss of consciousness
b) Sudden jerking movements
c) Brief, abrupt loss of consciousness
d) Involuntary vocalizations

A

c) Brief, abrupt loss of consciousness

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48
Q

At what age does the onset of absence seizures typically occur?
a) Newborn to 1 year
b) 1 to 3 years
c) 3 to 5 years
d) 5 to 7 years

A

c) 3 to 5 years

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49
Q

Until when may absence seizures persist?
a) Until age 10
b) Until age 15
c) Until puberty or beyond
d) Until adulthood

A

c) Until puberty or beyond

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50
Q

When do myoclonic seizures typically occur?
a) During sleep
b) After eating
c) After wakinging
d) During physical activity

A

c) After wakinging

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51
Q

What is a common age range for the onset of myoclonic seizures?
a) Infancy
b) Early childhood
c) Puberty or early adulthood
d) Middle age

A

c) Puberty or early adulthood
“ But it may occurs at any age “

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52
Q

How long may myoclonic seizures last?
a) Several hours
b) Several days
c) Several seconds
d) Several minutes

A

d) Several minutes

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53
Q

What characterizes myoclonic seizures?
a) Prolonged loss of consciousness
b) Repetitive muscle contractions
c) Uncontrollable laughter
d) Slurred speech

A

b) Repetitive muscle contractions

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54
Q

How are myoclonic seizures manifested?
a) Sudden loss of vision
b) Brief jerks of the limbs
c) Tingling sensation in the fingers
d) Sudden onset of confusion

A

b) Brief jerks of the limbs

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55
Q

For how long may myoclonic seizures reoccur?
a) Several hours
b) Several days
c) Several seconds
d) Several minutes

A

d) Several minutes

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56
Q

What characterizes febrile seizures in young children?
a) Focal motor seizures
b) Absence seizures
c) Generalized tonic-clonic convulsions
d) Absence of convulsions

A

c) Generalized tonic-clonic convulsions

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57
Q

Febrile seizures in young children typically occur:
a) With low-grade fever
b) Without any fever
c) With high fever
d) Only during the night

A

c) With high fever

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58
Q

Febrile seizures may occur in:
a) Isolation
b) Siblings
c) Adults only
d) Without any family history

A

b) Siblings

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59
Q

What is the duration of febrile seizures?
a) Several hours
b) Several days
c) Short duration
d) Indefinite duration

A

c) Short duration

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60
Q

Do febrile seizures necessarily lead to a diagnosis of epilepsy?
a) Yes, always
b) No, never
c) not necessarily
d) Only in adults

A

c) not necessarily

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61
Q

Which type of convulsions are typically seen in febrile seizures?
a) Focal motor seizures
b) Absence seizures
c) Generalized tonic-clonic convulsions
d) Myoclonic seizures

A

c) Generalized tonic-clonic convulsions

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62
Q

What is the age range for the occurrence of febrile seizures?
a) Adolescence
b) young children
c) Middle age
d) Elderly age

A

b) young children

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63
Q

What defines status epilepticus?
a) Single seizure episode with recovery of full consciousness
b) Two or more seizures with complete recovery between them
c) Two or more seizures without recovery of full consciousness between them
d) Seizures occurring only during sleep

A

c) Two or more seizures without recovery of full consciousness between them

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64
Q

Which types of seizures can occur in status epilepticus?
a) Only partial seizures
b) Only generalized tonic-clonic seizures
c) Both convulsive and nonconvulsive seizures
d) Only absence seizures

A

c) Both convulsive and nonconvulsive seizures

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65
Q

What distinguishes status epilepticus from other seizure episodes?
a) Longer duration of seizures
b) Absence of convulsions
c) Immediate recovery of consciousness after each seizure
d) Lack of emergency treatment requirement

A

a) Longer duration of seizures

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66
Q

How many seizures typically characterize status epilepticus?
a) One
b) Two or more
c) Three or more
d) Four or more

A

b) Two or more

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67
Q

Which emergency intervention is required for status epilepticus?
a) Administering antihistamines
b) Providing psychological counseling
c) Immediate administration of antiepileptic drugs
d) Performing surgery

A

c) Immediate administration of antiepileptic drugs

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68
Q

What is the primary characteristic of status epilepticus?
a) Absence of convulsions
b) Recurrent seizures without recovery of consciousness
c) Occurrence only during sleep
d) Occurrence exclusively in children

A

b) Recurrent seizures without recovery of consciousness

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69
Q

In status epilepticus, the seizures may be:
a) Only partial
b) Only primary generalized
c) Partial or primary generalized
d) Absence seizures only

A

c) Partial seizures or
primary generalized

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70
Q

The seizures in status epilepticus can be:
a) Only convulsive
b) Only nonconvulsive
c) Convulsive or nonconvulsive partial “focal” or primary
generalized,
d) Nonconvulsive with absence of convulsions

A

c) Convulsive or nonconvulsive partial “focal” or primary
generalized,

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71
Q

is life-threatening and requires emergency treatment ?

A

Status epilepticus

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72
Q

Which antiepileptic drug facilitates GABA action?
a) Phenytoin
b) Carbamazepine
c) Phenobarbitone
d) Lamotrigine

A

c) Phenobarbitone

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73
Q

Vigabatrin inhibits:
a) GABA reuptake
b) GABA transaminase
c) GABA synthesis
d) GABA degradation

A

b) GABA transaminase

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74
Q

Tiagabine acts by:
a) Facilitating GABA action
b) Inhibiting GABA transaminase
c) Blocking GABA reuptake
d) Blocking Na channels

A

c) Blocking GABA reuptake
الوحيد اللي انذكر في التصنيف انه يشتغل بالطريقة هدي

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75
Q

Phenytoin and carbamazepine exert their antiepileptic effects by blocking:
a) GABA transaminase
b) GABA reuptake
c) Sodium channels
d) T-calcium channels

A

c) Sodium channels

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76
Q

Ethosuximide primarily blocks:
a) Sodium channels
b) T-calcium channels
c) NMDA receptors
d) AMPA receptors

A

b) T-calcium channels

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77
Q

Which of the following drugs facilitates GABA action?
a) Phenobarbitone
b) Vigabatrin
c) Tiagabine
d) Valproate

A

a) Phenobarbitone

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78
Q

Which medication inhibits GABA transaminase?
a) Benzodiazepine
b) Vigabatrin
c) Tiagabine
d) Phenobarbitone

A

b) Vigabatrin

(Vigabatrin, Valproate)

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79
Q

What is the mechanism of action of tiagabine?
a) Facilitates GABA action
b) Inhibits GABA transaminase
c) Inhibits GABA reuptake
d) Blocks GABA receptors

A

c) Inhibits GABA reuptake

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80
Q

Which drug inhibits GABA reuptake?
a) Phenobarbitone
b) Benzodiazepine
c) Vigabatrin
d) Tiagabine

A

d) Tiagabine

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81
Q

Which medications inhibit GABA transaminase?
a) Vigabatrin
b) Valproate
c) Phenobarbitone
d) a&b

A

d) a&b

82
Q

Which medications block T-calcium channels in relay neurons between the thalamus and cerebral cortex?
a) Ethosuximide
b) Valproate
c) Carbamazepine
d)a&b

A

d)a&b

83
Q

Which mechanism is common among most second-generation antiepileptic drugs?
a) Facilitate GABA action
b) Inhibit GABA transaminase
c) Inhibit GABA reuptake
d) Decrease excitatory transmitter release or block excitatory receptors like NMDA or AMPA receptors

A

d) Decrease excitatory transmitter release or block excitatory receptors like NMDA or AMPA receptors

84
Q

Which medications decrease membrane ion permeability by blocking Na channels?
“5”

A

1) Phenytoin
2) Carbamazepine
3) Valproate
4) Topiramate
5) Lamotrigine

85
Q

Classification of antiepileptic
drugs based on the Mechanism of action ?

A

a )Action on transmitters
Facilitate GABA action (Phenobarbitone, Benzodiazepine)
Inhibition of GABA transaminase (Vigabatrin,Valproate)
Inhibition of GABA reuptake (Tiagabine)
b) Decrease membrane ion permeability
*block Na channel (Phenytoin, Carbamazepine, Valproate,
Topiramate , lamotrigine)
C) block T-calcium channel in relay neurons between thalamus
and cerebral cortex (ethosuximide, valproate)
d) Decrease the excitatory transmitter release or block
excitatory receptors like NMDA or AMPA receptors (Most of
2nd generation antiepileptics)

86
Q

Which group of antiepileptic drugs is labeled as second generation when compared with older agents?
a) Phenobarbitone, phenytoin, carbamazepine
b) Lamotrigine, topiramate, levetiracetam
c) Ethosuximide, valproic acid

A

b) Lamotrigine, topiramate, levetiracetam

87
Q

What potential advantages do second-generation antiepileptic drugs offer over older agents?
a) Higher risk for drug-drug interactions
b) Greater potential for side effects
c) Improved pharmacokinetics, tolerability, and lesser risk for drug-drug interactions
d) Lower efficacy in controlling seizures

A

c) Improved pharmacokinetics, tolerability, and lesser risk for drug-drug interactions

88
Q

Which group of antiepileptic drugs is considered second generation when compared with older agents?
a) Phenytoin, carbamazepine, ethosuximide
b) Lamotrigine, topiramate, levetiracetam
c)b&d
d) Gabapentin, pregabalin, zonisamide

A

c)b&d

89
Q

Among the listed antiepileptic drugs, which is considered an older agent?
a) Lamotrigine
b) Gabapentin
c) Phenytoin
d) Levetiracetam

A

c) Phenytoin

90
Q

Which characteristic distinguishes second-generation antiepileptic drugs from older agents?
a) Increased risk for drug-drug interactions
b) Greater potential for side effects
c) Improved pharmacokinetics and tolerability
d) Lower efficacy in seizure control

A

c) Improved pharmacokinetics and tolerability

91
Q

second generation antiepileptic drugs ?
“7”

A

lamotrigine,topiramate, levetiracetam,
gabapentin, pregabalin, zonisamide and tiagabine

92
Q

older antiepileptics ?

A

such as phenytoin,carbamazepine, ethosuxemide, valproic acid and
benzodiazepines

93
Q

Which type of seizures is phenytoin effective in treating?
a) Absence seizures
b) Partial seizures
c) Myoclonic seizures
d) Atonic seizures

A

b) Partial seizures

Phenytoin is effective for treatment of
1 partial seizures
2 generalized tonic-clonic seizures
3 status epilepticus .

94
Q

Phenytoin is primarily bound to which plasma protein?
a) Hemoglobin
b) Albumin
c) Globulin
d) Fibrinogen

A

b) Albumin
90%

95
Q

Phenytoin is known to induce which enzyme system?
a) CYP3A4
b) UGT
c) CYP2D6
d) NAT2

A

b) UGT

96
Q

Why can small increases in the daily dose of phenytoin lead to large increases in plasma concentration?
a) Due to decreased binding to plasma proteins
b) Due to increased metabolism by the liver
c) Due to saturation of the drug’s elimination pathways
d) Due to increased absorption in the gastrointestinal tract

A

c) Due to saturation of the drug’s elimination pathways

و د. F قال b.c it is eliminated by zero order elimination pathway

97
Q

Which adverse effect can occur if phenytoin is administered intramuscularly?
a) Renal toxicity
b) Cardiac arrhythmias
c) Tissue damage and necrosis
d) Hepatotoxicity

A

c) Tissue damage and necrosis

98
Q

What is the preferred alternative to phenytoin for intramuscular administration?
a) Levetiracetam
b) Lamotrigine
c) Fosphenytoin
d) Topiramate

A

c) Fosphenytoin

99
Q

Which term describes the ability of phenytoin to increase the activity of certain drug-metabolizing enzymes?
a) Drug facilitator
b) Drug inducer
c) Drug antagonist
d) Drug inhibitor

A

b) Drug inducer

100
Q

G.R
Small increases of phenytion in a daily dose can produce large
increases in the plasma concentration, resulting in
drug-induced toxicity(WHY)?????

A

When the hepatic hydroxylation
system becomes saturated, small
increases in the dose of phenytoin
cause a large increase in the
plasma concentration of the drug.

Dr.F b.c it is eliminated by zero order pathway leads to accumulation of the drug and toxicity

101
Q

G.R
Phenytoin sodium should never be given IM ?

A

because it can cause tissue damage and necrosis Use
(fosphenytoin )

102
Q

PHENYTOIN Side effects ?

A

1 Neurological diturbance (nystagmus, ataxia, diplopia)
2 Hematological effects (megaloplastic anemia)
3 Metabolic disorders (osteomalasia ➡️due to ⬆️vitamin.D metabolism , hyperglycemia due to inhibition of insulin secretion)
4 Cosmotic disturbances (*gingival hyperplasia,
*hirsutism, and acne) and #Lymphadenopathy
5 GIT(nausea and vomiting)
**6 Teratogenic effect (cleft lip, cleft palate)
7 Skin rash and hepatits are rare

103
Q

Which neurological disturbances are associated with phenytoin use?
a) Tremors and bradykinesia
b) Nystagmus, ataxia, and diplopia
c) Aphasia and dysarthria
d) Seizure exacerbation

A

b) Nystagmus, ataxia, and diplopia

104
Q

Which hematological effect can occur as a result of phenytoin therapy?
a) Thrombocytopenia
b) Megaloblastic anemia
c) Hemolytic anemia
d) Leukopenia

A

b) Megaloblastic anemia

105
Q

What metabolic disorder can be induced by phenytoin, resulting in inhibition of insulin secretion?
a) Hypoglycemia
b) Hyperglycemia
c) Hypocalcemia
d) Hyperkalemia

A

b) Hyperglycemia

106
Q

Cosmotic disturbances associated with phenytoin use include:
a) Jaundice and hepatomegaly
b) Renal calculi
c) Gingival hyperplasia, hirsutism, and acne
d) Xerosis and pruritus

A

c) Gingival hyperplasia, hirsutism, and acne

107
Q

Which gastrointestinal symptoms are commonly observed with phenytoin administration?
a) Constipation and abdominal pain
b) Diarrhea and bloating
c) Nausea and vomiting
d) Rectal bleeding and hemorrhoids

A

c) Nausea and vomiting

108
Q

Phenytoin use during pregnancy is associated with an increased risk of:
a) Preterm labor
b) Gestational diabetes
c) Cleft lip and cleft palate

A

c) Cleft lip and cleft palate

109
Q

Which adverse effects of phenytoin are considered rare?
a) Skin rash and hepatitis
b) Nystagmus and ataxia
c) Hyperglycemia and osteomalacia
d) Gingival hyperplasia and hirsutism

A

a) Skin rash and hepatitis

110
Q

Which statement accurately describes the pharmacological properties of carbamazepine?
a) Carbamazepine exhibits poor oral absorption and requires intravenous administration.
b) Carbamazepine has good oral absorption, but there is significant interpatient variability in its rate of absorption, and an extended-release preparation is available.
c) Carbamazepine is primarily administered via inhalation due to its rapid onset of action.

A

b) Carbamazepine has good oral absorption, but there is significant interpatient variability in its rate of absorption, and an extended-release preparation is available.

111
Q

Carbamazepine induces microsomal enzymes and increases its own hepatic clearance, resulting in:
a) Prolonged half-life
b) Reduced half-life from 30 hours to 15 hours
c) Unchanged half-life
d) Decreased hepatic metabolism

A

b) Reduced half-life from 30 hours to 15 hours

112
Q

Carbamazepine is commonly used to treat:
a) Parkinson’s disease
b) Trigeminal neuralgia and bipolar affective disorder
c) Migraines and fibromyalgia
d) Anxiety disorders and obsessive-compulsive disorder

A

b) Trigeminal neuralgia and bipolar affective disorder

113
Q

Why should carbamazepine not be prescribed for patients with absence seizures?
a) Due to its sedative effects
b) because it may cause an increase in seizures
c) Because it causes renal toxicity
d) Because it interferes with calcium channel function

A

b) because it may cause an increase in seizures

114
Q

What is the term for the process by which carbamazepine increases its own hepatic clearance?
a) Autoinduction
b) Metabolization
c) Inhibition
d) Excretion enhancement

A

a) Autoinduction

115
Q

As a result of inducing microsomal enzymes, what happens to carbamazepine’s hepatic clearance?
a) It decreases
b) It remains unchanged
c) It increases
d) It fluctuates unpredictably

A

c) It increases

116
Q

Why is gradual dosage adjustment required early in carbamazepine therapy?
a) Due to its slow onset of action
b) Due to its potential for inducing microsomal enzymes and increasing hepatic clearance
c) Due to its high risk of drug interactions
d) Due to its narrow therapeutic index

A

b) Due to its potential for inducing microsomal enzymes and increasing hepatic clearance

117
Q

Which of the following conditions is carbamazepine commonly used to treat?
a) Parkinson’s disease
b) Migraines
c) Trigeminal neuralgia
d) Hypertension

A

c) Trigeminal neuralgia

118
Q

Oxcarbazepine is a prodrug whose activity is primarily attributed to:
a) Its parent compound
b) Its 10-hydroxy metabolite
c) Its secondary metabolite, oxcarbazepine sulfate
d) Its interaction with neurotransmitter receptors

A

b) Its 10-hydroxy metabolite

119
Q

Compared to carbamazepine, oxcarbazepine is:
a) A more potent inducer of hepatic microsomal enzymes
b) Equally potent in inducing hepatic microsomal enzymes
c) A less potent inducer of hepatic microsomal enzymes
d) Not associated with any induction of hepatic enzymes

A

c) A less potent inducer of hepatic microsomal enzymes

120
Q

Which adverse effect is common with carbamazepine & oxcarbazepine use?
a) Hypertension and tachycardia
b) Constipation and diarrhea
c) Diplopia and ataxia
d) Hyperglycemia and hypoglycemia

A

c) Diplopia and ataxia

Common: Diplopia and ataxia, Gl disturbances;
sedation at high doses.

121
Q

What is an occasional adverse effect associated with oxcarbazepine use?
a) Hypernatremia
b) Hypokalemia
c) Water retention and hyponatremia
d) Metabolic acidosis

A

c) Water retention and hyponatremia

Occasional: Retention of water and hyponatremia;
rash, agitation in children.

122
Q

Idiosyncratic blood dyscrasias and severe rashes are rare adverse effects associated with the use of:
a) Carbamazepine
b) Oxcarbazepine
c)a&b
d) Lamotrigine

A

c)a&b

123
Q

Which statement accurately reflects the occurrence of idiosyncratic blood dyscrasias and severe rashes with carbamazebine & oxcarbazepine use?
a) They occur in the majority of patients
b) They occur frequently but are easily managed
c) They occur rarely
d) They are a common side effect in pediatric patients

A

c) They occur rarely

124
Q

Which of the following drugs is inhibited in its metabolism by valproic acid?
a) Phenytoin
b) Aspirin
c) Ibuprofen
d) Acetaminophen

A

a) Phenytoin

Valproic acid inhibits the metabolism of other
drugs including phenytoin, carbamazepine,
and ethosuximide.

125
Q

Divalproex sodium (Depakote) is:
a) A faster-absorbed form of valproic acid
b) A 1:1 enteric formulation of valproic acid and valproate sodium
c) An opioid pain reliever
d) An antibiotic

A

b) A 1:1 enteric formulation of valproic acid and valproate sodium

126
Q

What is the significance of the 1:1 enteric formulation of divalproex sodium?
a) It enhances the absorption rate of valproic acid.
b) It reduces the bioavailability of valproic acid.
c) It slows down the absorption of valproic acid and valproate sodium.
d) It eliminates the need for enteric coating.

A

c) It slows down the absorption of valproic acid and valproate sodium.

127
Q

Which of the following is NOT a proposed mechanism of action of Valproic Acid?
a) Sodium channel blockade
b) Blockade of GABA transaminase
c) Action at the NMDA receptors
d) Action at the T-type calcium channels

A

c) Action at the NMDA receptors

128
Q

Valproic Acid’s broad spectrum of activity against seizures is attributed to:
a) Its ability to increase glutamate levels
b) Blockade of sodium channels only
c) Multiple proposed mechanisms of action
d) Inhibition of acetylcholinesterase activity

A

c) Multiple proposed mechanisms of action

129
Q

GABA is an important neurotransmitter known for its:
a) Excitatory effects on the brain
b) Inhibition of neuronal activity
c) Role in promoting seizure activity
d) Regulation of dopamine release

A

b) Inhibition of neuronal activity

130
Q

The broad spectrum of activity of Valproic Acid means that it:
a) Is only effective against specific seizure types
b) Is ineffective for generalized seizures
c) Can be effective against a wide range of seizure types
d) Is primarily used for absence seizures only

A

c) Can be effective against a wide range of seizure types

131
Q

Clinical use of Valproic acid

A

-Generalized tonic clonic convulsion
-partial seizure ,
bipolar disorder and
migraine prophylaxis.

+++absense seizures أهم حاجة يسألوا فيها ف الأورال
في الحالة هدي مع الDOC ethosuximide

132
Q

G.R
all women of child-bearing age should be placed on other
therapies other than valproic acid ?

A

B.c Teratogenicity is of great concern and counseled about the potential for birth
defects, including neural tube defects.

133
Q

Which of the following conditions is NOT commonly treated with Valproic Acid?
a) Generalized tonic-clonic convulsion
b) Partial seizure
c) Bipolar disorder
d) Parkinson’s disease

A

d) Parkinson’s disease

134
Q

Valproic Acid is primarily metabolized in the body through:
a) Glucuronidation
b) Hydrolysis
c) Oxidation and conjugation
d) Methylation

A

c) Oxidation and conjugation

80% oxidized and 20% by conjugation. Highly protein
bound

135
Q

What percentage of Valproic Acid is oxidized in the body?
a) 50%
b) 80%
c) 20%
d) 100%

A

b) 80%

136
Q

Why is teratogenicity a concern with Valproic Acid use?
a) It can lead to liver toxicity
b) It can cause gastrointestinal bleeding
c) It is associated with neural tube defects
d) It increases the risk of cardiovascular events

A

c) It is associated with neural tube defects

137
Q

Women of childbearing age who are prescribed Valproic Acid should:
a) Be advised to avoid any medication
b) Be placed on other therapies and counseled about potential birth defects
c) Not be informed about the teratogenic risks
d) Only use Valproic Acid during the first trimester of pregnancy

A

b) Be placed on other therapies and counseled about potential birth defects

138
Q

Which of the following processes is affected by Valproic Acid’s enzyme inhibition?
a) DNA replication
b) Protein synthesis
c) Drug metabolism
d) Cell membrane permeability

A

c) Drug metabolism

139
Q

Valproic Acid acts as an enzyme inhibitor primarily by inhibiting:
a) Cytochrome P450 enzymes
b) Glutathione S-transferase
c) Monoamine oxidase
d) Alcohol dehydrogenase

A

a) Cytochrome P450 enzymes
لم تذكر في الملزمة ولكن مفهومة ✨

140
Q

The enzyme inhibition property of Valproic Acid contributes to:
a) Decreased drug-drug interactions
b) Increased efficacy of other medications
c) Delayed onset of action
d) Enhanced metabolism of toxins

A

b) Increased efficacy of other medications
بالفهم لأنها اتنقص metabolism of drugs

141
Q

Valproic Acid’s inhibition of enzymes leads to:
a) Faster drug clearance from the body
b) Prolonged duration of action of certain drugs
c) Reduced drug absorption
d) Increased drug sensitivity

A

b) Prolonged duration of action of certain drugs
بالفهم

142
Q

Which of the following statements regarding Valproic Acid’s enzyme inhibition is true?
a) It primarily inhibits renal enzymes
b) It has no effect on drug metabolism
c) It may lead to decreased metabolism of certain drugs
d) It enhances the breakdown of medications

A

c) It may lead to decreased metabolism of certain drugs

143
Q

Which of the following side effects is NOT commonly associated with Valproic Acid use?
a) Diplopia
b) Increased appetite and weight gain
c) Rash
d) Hair loss

A

c) Rash

side effects
nystagmus,Diplopia, Ataxia, Hair loss,
Leukopenia low WBC, increase appetite
weight gain ,GIT disturbance, sedation ataxia
Idisoyncratic hepatotoxicity and pancreatitis
Highly teratogenic effect

144
Q

Valproic Acid can lead to leukopenia, which refers to:
a) Low white blood cell count
b) High white blood cell count
c) Low red blood cell count
d) Elevated platelet count

A

a) Low white blood cell count

145
Q

What is a common gastrointestinal (GIT) disturbance associated with Valproic Acid use?
a) Constipation
b) Acid reflux
c) Diarrhea
d) Gallstones

A

c) Diarrhea
سؤال chat GPT مش محددين في الشيت
مكتوب GIT disturbance وخلاص

146
Q

Which of the following conditions is a serious idiosyncratic reaction associated with Valproic Acid use?
a) Hypertension
b) Hypoglycemia
c) Hepatotoxicity
d) Hypokalemia

A

c) Hepatotoxicity

147
Q

Valproic Acid’s highly teratogenic effect makes it:
a) Safe to use during pregnancy
b) Dangerous for the fetus, potentially causing birth defects
c) Suitable for pregnant women with epilepsy
d) Effective for preventing birth defects

A

b) Dangerous for the fetus, potentially causing birth defects

148
Q

Weight gain associated with Valproic Acid use is primarily due to:
a) Increased metabolism
b)increased the appetite
c) Fluid retention
d) Enhanced fat breakdown

A

b)increased the appetite

149
Q

Valproic acid side effects ?

A

nystagmus,Diplopia, Ataxia, sedation
*Hair loss,
*Leukopenia low WBC,
*increase appetite &weight gain ,GIT disturbance,
Idisoyncratic hepatotoxicity and pancreatitis
Highly teratogenic effect

150
Q

Which type of seizures is ethosuximide most effective in treating?
a) Focal seizures
b) Primary generalized absence seizures only
c) Secondary generalized tonic-clonic seizures
d) Myoclonic seizures

A

b) Primary generalized absence seizures only

151
Q

What is the primary mechanism of action of ethosuximide?
a) Inhibition of sodium channels
b) Inhibition of T-type calcium channels
c) Enhancement of GABAergic transmission
d) Blockade of glutamatergic receptors

A

b) Inhibition of T-type calcium channels

152
Q

What is the approximate half-life of ethosuximide?
a) 6 hours
b) 12 hours
c) 24 hours
d) 40 hours

A

d) 40 hours

153
Q

What are the most common side effects associated with ethosuximide?
a) Rash and fever
b) Hepatotoxicity and jaundice
c) Gastrointestinal disorders and headache
d) Dizziness and blurred vision

A

c) Gastrointestinal disorders and headache

That’s it

154
Q

G.R

Ethosuxamide Must be given with caution if given with valproic acid?

A

B.c it inhibits the metabolism of Ethosuxamide

155
Q

Which of the following benzodiazepines is highly effective in the short-term treatment of status epilepticus?
a) Diazepam
b) Clonazepam
c) Lorazepam
d)a&c

A

d)a&c

156
Q

Which benzodiazepine is particularly effective for treating absence seizures?
a) Diazepam
b) Clonazepam
c) Lorazepam
d) Clorazepate

A

b) Clonazepam

157
Q

What is the primary side effect associated with benzodiazepines when used for tretment of epilepsy ?
a) Hypertension
b) Sedation
c) Hyperactivity
d) Respiratory depression

A

b) Sedation

158
Q

Benzodiazepines used for t. Of epilepsy ?
“4”

A

Benzodiazepines: diazepam, lorazepam,
clonazepam, and clorazepate

  1. Diazepam and lorazepam are highly effective
    in short-term treatment of status epilepticus.
    ( في شيت S &H هما الاتنين
    are DOC in ttt grand mal epilepsy/tonic clonic seizures)
    ➕dr.K diazepam ➡️febrile seizures
  2. Clonazepam is effective for the treatment of
    absence seizures( petit mal epilepsy )
159
Q

Which of the following statements regarding phenobarbital and primidone is true?

A) Phenobarbital was synthesized in 1912 by Bayer.
B) Phenobarbital is primarily metabolized by cytochrome P450 enzymes as an inhibitor.
C) Primidone has two active metabolites, phenobarbital and phenylethylmalonamide, with shorter half-lives than the parent drug.
D) Phenobarbital should be considered for chronic therapy as a first-line treatment for epilepsy.
E) Due to long-term adverse effects, phenobarbital and primidone should be reserved for patients with refractory epilepsy only

A

E) Due to long-term adverse effects, phenobarbital and primidone should be reserved for patients with refractory epilepsy only

160
Q

Which of the following adverse effects is associated with phenobarbital?
A) Hypertension
B) Osteoporosis
C) Hyperglycemia
D) Bronchospasm
E) Bradycardia

A

B) Osteoporosis

161
Q

What is the primary reason for considering phenobarbital and primidone only for patients with refractory epilepsy?
A) They have a rapid onset of action.
B) They are highly selective for specific seizure types.
C) They have fewer adverse effects compared to other antiepileptic drugs.
D) They are metabolized primarily by cytochrome P450 enzymes.
E) They carry a high risk of long-term adverse effects.

A

E) They carry a high risk of long-term adverse effects.

162
Q

Which enzyme system does phenobarbital primarily interact with as an inducer?
A) Cytochrome P450
B) Acetylcholinesterase
C) Monoamine oxidase
D) Glutamate decarboxylase
E) Tyrosine kinase

A

A) Cytochrome P450

163
Q

Which of the following are active metabolites of primidone?
A) Phenobarbital and phenytoin
B) Phenobarbital and phenylethylmalonamide
C) Phenylethylmalonamide and carbamazepine
D) Gabapentin and phenytoin
E) Lamotrigine and topiramate

A

B) Phenobarbital and phenylethylmalonamide

164
Q

What distinguishes phenobarbital and phenylethylmalonamide from the parent drug primidone?
A) They have shorter half-lives.
B) They are less effective in controlling seizures.
C) They are metabolized by different enzymes.
D) They have longer half-lives.
E) They have fewer adverse effects.

A

D) They have longer half-lives.

165
Q

Which of the following best describes the pharmacokinetic profile of phenobarbital and phenylethylmalonamide compared to primidone?
A) They are rapidly excreted unchanged in the urine.
B) They undergo extensive metabolism by glucuronidation.
C) They have similar half-lives to the parent drug.
D) They have longer half-lives than the parent drug.
E) They are primarily excreted in feces.

A

D) They have longer half-lives than the parent drug.

166
Q

What is the significance of having active metabolites with longer half-lives in the context of antiepileptic therapy?
A) It allows for more frequent dosing.
B) It reduces the risk of drug interactions.
C) It enhances drug efficacy.
D) It may lead to accumulation and prolonged therapeutic effects.
E) It decreases the likelihood of adverse effects.

A

D) It may lead to accumulation and prolonged therapeutic effects.
Chat GPT

167
Q

What is the mechanism of action of lamotrigine1990?
a) Blocking calcium channels
b) Blocking sodium channels and decreasing glutamate release
c) Increasing GABA release
d) Blocking potassium channels

A

b) Blocking sodium channels and decreasing glutamate release

168
Q

Lamotrigine is primarily used as monotherapy for which type of seizures?
a) Generalized tonic-clonic seizures
b) Absence seizures
c) Partial seizures
d) Myoclonic seizures

A

c) Partial seizures

It is also used for
absence seizures and myoclonic seizures

169
Q

Which of the following medications can decrease the half-life of lamotrigine?
a) Phenytoin and carbamazepine
b) Valproic acid
c) Phenobarbital
d) Ethosuximide

A

a) Phenytoin and carbamazepine

b.c they are microsomal enzyme inducers

170
Q

Lamotrigine is considered safe for use during pregnancy. (True/False)

A

True

171
Q

Which of the following adverse effects is associated with lamotrigine, particularly in children, and can be life-threatening?
a) Nausea and vomiting
b) Headache and dizziness
c) Rash including Stevens-Johnson syndrome
d) Insomnia and anxiety

A

c) Rash including Stevens-Johnson syndrome

172
Q

Lamotrigine is primarily used as for which type of seizures?

a) Absence seizures
b) Partial seizures
c) Myoclonic seizures
d) All of the above

A

d) All of the above

173
Q

Which of the following medications can
Increase the half-life of lamotrigine?
a) Phenytoin
b) Carbamazepine
c) Valproic acid
d) Phenobarbital

A

c) Valproic acid

b.c it is microsmal enzyme inhibitor

174
Q

Lamotrigine(1990) Mechanism —

A

block Na channels
and decrease glutamate release.

175
Q

Lamotrigine (1990) uses

A

It is used as
monotherapy for *partial seizures. It is also used for
*absence seizures and *myoclonic seizures.

176
Q

Lamotrigine(1990) A/E?

A

Adverse effects include
( headache, ataxia, dizziness )
and
(rarely) a rash that may be life-threatening
*(Steven Johnson syndrome), particularly in children

177
Q

What is the mechanism of action of vigabatrin?
a) Blocking sodium channels
b) Inhibiting GABA transaminase
c) Increasing glutamate release
d) Blocking calcium channels

A

b) Inhibiting GABA transaminase

178
Q

Vigabatrin is primarily used to treat which types of epilepsy?
a) Generalized tonic-clonic seizures
b) Absence seizures
c) Focal epilepsy and West syndrome
d) Myoclonic seizures

A

c) Focal epilepsy and West syndrome

179
Q

Which of the following is a significant side effect associated with vigabatrin?
a) Irreversible visual field loss
b) Rash, including Stevens-Johnson syndrome
c) Headache and dizziness
d) Nausea and vomiting

A

a) Irreversible visual field loss

180
Q

Vigabatrin S/E

A

Irreversible Visual field loss

181
Q

What is the mechanism of action of topiramate?
a) Blocking sodium channels
b) Blocking AMPA receptors
c) Increasing GABA activity
d) All of the above

A

d) All of the above

182
Q

Topiramate is effective in treating which types of seizures?
a) Generalized tonic-clonic seizures
b) Absence seizures
c) Focal seizures
d) All types of seizures

A

d) All types of seizures

183
Q

Which adverse effect is associated with topiramate and can lead to an increased risk of glaucoma?
a) Weight gain
b) Increase in intraocular pressure (IOP)
c) Renal stones
d) Teratogenic effects (cleft lip)

A

b) Increase in intraocular pressure (IOP)

184
Q

What is a notable adverse effect of topiramate?
a) Weight gain
b) Weight loss
c) Hyperglycemia
d) Hypothyroidism

A

b) Weight loss

185
Q

Topiramate 1995 mechanism of action?

A

Block Na and block AMPA receptors and
increases GABA activity

186
Q

Topiramate 1995 Adverse effects?

“4”

A

1 Increase IO “ intraocular pressure”
2 Weight loss
3 Renal stone
4 Teratogenic(cleft lip)

187
Q

Levetiracetam is approved for adjunct therapy in which types of seizures?
a) Generalized tonic-clonic seizures only
b) Partial onset seizures only
c) Myoclonic seizures only
d) Partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures

A

d) Partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures

188
Q

The mechanism of anticonvulsant action of levetiracetam is believed to involve high affinity for which synaptic vesicle protein?
a) SV1A
b) SV2A
c) SV3A
d) SV4A

A

b) SV2A

189
Q

Levetiracetam is primarily used as adjunct therapy, meaning it is typically used:
a) Alone as the sole treatment for seizures
b) In combination with other antiepileptic drugs
c) After other drugs have failed to control seizures
d) Only in pediatric patients

A

b) In combination with other antiepileptic drugs

190
Q

Which of the following types of seizures is NOT approved for adjunct therapy with levetiracetam?
a) Simple partial seizures
b) Absence seizures
c) Myoclonic seizures
d) Primary generalized tonic-clonic seizures

A

b) Absence seizures

191
Q

Levetiracetam is approved for use in which age groups?
a) Adults only
b) Children only
c) Both adults and children
d) Elderly patients only

A

c) Both adults and children

192
Q

mechanism of action of Levetiracetam ?

A

The exact mechanism of
anticonvulsant action is unknown. It
demonstrates high affinity for a synaptic vesicle
protein (SV2A)

193
Q

Levetiracetam is approved for adjunct therapy
of ……

A

*partial onset seizures, *myoclonic seizures, and
*primary generalized tonic-clonic seizures in
adults and children

194
Q

Gabapentin and pregabalin are used as adjuvant therapy in the treatment of which type of seizures?
a) Absence seizures
b) Generalized tonic-clonic seizures
c) Focal seizures
d) Myoclonic seizures

A

c) Focal seizures

195
Q

Tiagabine exerts its pharmacological effect by:
a) Blocking sodium channels
b) Blocking calcium channels
c) Inhibiting GABA reuptake
d) Increasing glutamate release

A

c) Inhibiting GABA reuptake

196
Q

What is the mechanism of action of gabapentin and pregabalin?
a) Blocking sodium channels
b) Blocking P/Q type calcium channels and binding to α2δ subunit of calcium channels and decrease glutamate release
c) Enhancing GABA release

A

b) Blocking P/Q type calcium channels and binding to α2δ subunit of calcium channels and decrease glutamate release

197
Q

Besides their use in adjuvant therapy for focal seizures, gabapentin and pregabalin are also commonly prescribed for:
a) Generalized tonic-clonic seizures
b) Absence seizures
c) Neuropathic pain
d) Myoclonic seizures

A

c) Neuropathic pain

198
Q

What is the specific mechanism of action of Tiagabine?
a) Blocking sodium channels
b) Blocking calcium channels
c) Inhibiting glutamate release
d) Inhibiting GABA reuptake

A

d) Inhibiting GABA reuptake

199
Q

Gabapentine and pregabaline 2005 uses
“2”

A

Used as adjuvant therapy of *focal seizures and
used in treatment of * neuropathic pain

200
Q

Dr.K Absence seizure =>

A

1- ethosuximide (DOC)
2- valproic acid
3- topiramate
4- lamotrigine
5- clonazepam

CNS Pharmacology (7 decks)

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