Pharmacology - Pharmacology of epilepsies

Question 1

predisposition to generate recurrent unprovoked epileptic seizures ( due to excessive electrical discharges in the brain) and the associated cognitive, psychological and social consequences

Answer 1

epilepsy

Question 2

what percentage of people with epilepsy have pharmacoresistant epilepsy

a.50%
b.20%
c.30%
d.40%

Answer 2

c.30%

Question 3

what are the 3 types of epilepsy

Answer 3

focal onset
generalised onset - absence (rapid blinking, few seconds staring into space)
tonic clonic ( cry out, lose consciousness, muscle jerks and tiredness)
myoclonic (brief muscle spasms)

Question 4

which type of seizure starts in the mesial temporal lobe (limbic region) leading to hallucinations of smell, taste a funny feeling in the tummy, and memory disturbances plus psychiatric dysfunction

a.focal onset
b.generalised onset
c.motor onset

Answer 4

a.focal

Question 5

which type of seizure has electrical misactivity all over the brain

a.focal onset
b.generalised onset
c.motor onset

Answer 5

b.generalised onset

Question 6

what is the key excitatory neurotransmitter

a.dopamine
b.serotonin
c.glutamate
d.GABA
e.Ach

Answer 6

c.glutamate

Question 7

what is the key inhibitory neurotransmitter

a.dopamine
b.serotonin
c.glutamate
d.GABA
e.Ach

Answer 7

d.GABA

Question 8

activation of sodium channels on the presynaptic neuron has what effect on neurotransmitter release

a.increased
b.decreased

Answer 8

a.increased

Question 9

opening of the GABA a receptor allows which substance to move into the post synaptic neuron

a.sodium
b.magnesium
c.potassium
d.chloride

Answer 9

d.chloride

Question 10

what effect does chloride moving into the post synaptic neuron have
..

a.excitation
b.inhibiton

Answer 10

b.inhibiton

Question 11

which group of drugs act on the GABA receptor to promote inhibition (likely question )

a.topiramate, benozodiazepines .valproate

b.phenytoin, carbamazepine, lamotrigine, levetiracetam

Answer 11

a.topiramate, benozodiazepines .valproate

Question 12

which of these groups of drugs reduce excitation by acting on glutamate receptors (likely question)

a.topiramate, benozodiazepines .valproate

b.phenytoin, carbamazepine, lamotrigine, levetiracetam

Answer 12

b.phenytoin, carbamazepine, lamotrigine, levetiracetam

Question 13

what presynaptic channel do carbamazepine and phenytoin work on

a.calcium
b.sodium
c.potassium

Answer 13

b.sodium

Question 14

which of these drugs can exacerbate absence and myoclonic seizures

a.carbamazepine
b.sodium valproate
c.torpiramate
d.lamotrigrine
e.levetiracetam

Answer 14

a.carbamazepine

Question 15

which of these drugs can exacerbate absence and myoclonic seizures

a.phenytoin
b.sodium valproate
c.torpiramate
d.lamotrigrine
e.levetiracetam

Answer 15

a.phenytoin

Question 16

if someone presents with focal/ generalised epilepsy which drug is first choice

a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam

Answer 16

interacts the least and has the least side effects

d.lamotrigine
e.levitiracetam
effective against all seizure types

Question 17

what seizure type is the most effective against generalised seizure types

a.carbamazepine
b.phenytoin
c.sodium valporate
d.lamotrigine
e.leveriracetam

Answer 17

c.sodium valporate

but has side effects so not the best to start with especially for women

Question 18

what is the mode of action of carbamazepine

a.calcium channel blocker
b.sodium channel blocker
c. potassium channel blocker

Answer 18

b.sodium channel blocker

Question 19

what is the main side effect of carbamazepine

a.strong hepatic enzyme disturbance
b.kidney failure
c.nausea

Answer 19

a.strong hepatic enzyme disturbance

so has lots of interactions

and can disturb liver function so has ro be monitored

induces enzymes to metabolise itself over wks / months so may need dose increase

RASH - Steven johnson syndrome

Question 20

what has to be monitored in patients taking carbamazepine

a.wbc
b. fluid levels
c. bilirubin
d.lft
e.thyroid function

Answer 20

d.lft

function can be disturbed
plus major side effect of inducing liver enzymes

Question 21

which side effects of carbamazepine are dose dependent

a.liver enzyme induction
b.diplopia,ataxia, fatigue
c.hyponatraemia
d.bone marrow surpression, hepatic derangement

Answer 21

b.diplopia,ataxia, fatigue
c.hyponatraemia
d.bone marrow surpression, hepatic derangement

Question 22

what effect does carbamazepine have on bone marrow

a.surpression
b.activation

Answer 22

a.surpression

changes in platelet function, anaemia, hb

Question 23

patient has a rash following taking carbamazepine what syndrome does this indicate

a.steven johnson
b.eaton Lambert
c.cushings
d. brown squared

Answer 23

a.steven johnson

organ failure

Question 24

what side effect of carbamazepine should the patient be advised to stop the drug and phone doctor immediately

a.diplopia
b.ataxia
cfatigue
d.rash
e.hyperensitivity

Answer 24

d.rash
Steven johnson syndorome

Question 24

what side effect of carbamazepine should the patient be advised to stop the drug and phone doctor immediately a.diplopia b.ataxia cfatigue d.rash e.hyperensitivity

Answer 24

d.rash Steven johnson syndorome

Question 25

what contraception does carbamazepine interact with a.progesterone only b.combined

Answer 25

a.progesterone only

Question 26

key drugs that carbamazepine interacts with

Answer 26

CARDIAC ANTIBIOTICS STEROIDS

Question 27

which age group should not be prescribed carbamazepine a.young adults b.elderly

Answer 27

b.elderly bone effects

Question 28

what IS THE MECHANISM OF ACTION OF PHENYTOIN a.calcium channel blocker b.sodium channel blocker c. potassium channel blocker

Answer 28

b.sodium channel blocker

Question 29

dizziness, fatigue, diplopia, nystagmus , rash and sedation teratogens effects are acute side effects of which drug a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam

Answer 29

b.phenytoin

Question 30

what is important to monitor when giving a loading dose of phenytoin a.lft b.thyroid c.cardiac d.resp rate

Answer 30

c.cardiac can cause arrhythmias

Question 31

gum thickening, coarse face, bone thinning, low folate and peripheral neuropathy FEVER, RASH, LYMPAHDENOPATHY are side effects of which drug over decades a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam

Answer 31

b.phenytoin stop drug is idiosyncratic reaction suspected

Question 32

in compliance checking / ICU the closer the therapeutic range of phenytoin is to ......... the more effective it is a.10 ug b.20 ug c.30 ug d.40 ug

Answer 32

b.20 ug

Question 33

the elimination of phenytoin goes from ............. to .......... a.first to second order b.first to zero order c.zero order to first order

Answer 33

b.first to zero order pharmacokinetics

Question 34

phenytoin is a hepatic enzyme...... a.inhibitor b.inducer

Answer 34

b.inducer

Question 35

which drug can increase the phenytoin level a.valproate b.lamotrigrine c.carbamazepine

Answer 35

a.valproate

Question 36

which of these drugs acts on sodium channels and GABA and glutamate receptors a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam

Answer 36

c.sodium valproate

Question 37

what is the major issue of valproate a.rash b.cardiac arrhythmias c. teratogenic

Answer 37

c. teratogenic DO NOT START DRUG ON YOUNG WOMEN - LEGALLY

Question 38

what effect does valproate have on lamotrigine a.increase dose b.decreases dose

Answer 38

a.increase dose

Question 39

which drug has few side effects and no significant interactions a.carbamzepine b.phenytoin c.valproate d. levetiracetam

Answer 39

d. levetiracetam

Question 40

what is the main side effect of levetiraceteam a. irritability b. rash c. gum thickening d.heart arrhythmias e.teratogenic

Answer 40

a. irritability rarely psychosis one of the safest in terms of teratogens

Question 41

which drug acts via the sv2a ligand to block synaptic vesicle release a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam

Answer 41

e.levitiracetam

Question 42

what does lamotrigine work on a.sodium channel b.potassium channel c.gaba and glutamate receptors d.sv2a ligand

Answer 42

a.sodium channel

Question 43

which drugs are the safest in terms of teratogenicity

Answer 43

2 Ls lamotrigine leviteraciteam

Question 44

which syndrome that needs emergency treatment can be caused by lamotrigine a.agranulocytosis b.brown sequard c.guillian barre d.steven johnson

Answer 44

d.steven johnson idiosyncratic rash must call and stop drug same day drug built up slowly

Question 45

which drug is a mood stabilising drug so a good option for someone with depression a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam

Answer 45

d.lamotrigine

Question 46

which 2 drugs can cause Steven johnson syndrome a.carbamezipine and phenytoin b.carbamazepine and lamotrigine c.lamotrigine and leviteracetam

Answer 46

b.carbamazepine and lamotrigine

Question 47

lamotrigine interacts with which contraception a.pop b.combined

Answer 47

b.combined cause lamotrigine levels to drop and seizure risk to increase

Question 48

which other anti epileptic does lamotrigine interact with a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam

Answer 48

c.sodium valproate

Question 49

which drug has multiple modes of action and is helpful for migraine a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam f.toparimate

Answer 49

f.toparimate

Question 50

sedation and weight loss are the key side effects of which drug a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam f.toparimate

Answer 50

f.toparimate

Question 51

torparimate should be avoided in... a.elderly b. young women

Answer 51

b. young women

Question 52

comorbidities

Answer 52

mental health weight gain bone health - co prescribe vitamin d with carbamazepine

Question 53

which vitamin should be co prescribed with carbamazepine a.vit a b.vit b12 c.vit c d.vit d

Answer 53

d.vit d

Question 54

which drug that is used for neuropathic pain can be abused a.carbamazepine b.gabapentin c.pregablin

Answer 54

c.pregablin

Question 55

what drugs are particular good for bipolar

Answer 55

cccarbamazepine lamotrigine

Question 56

what drugs can be used in migraine first line a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam f.toparimate

Answer 56

f.toparimate

Question 57

what is the first line treatment for trigeminal neuralgia a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam f.toparimate

Answer 57

a.carbamazepine

Question 58

what is the anti epileptic used in obesity a.carbamazepine b.phenytoin c.sodium valproate d.lamotrigine e.levitiracetam f.toparimate

Answer 58

f.toparimate