Seizures/Epilepsy

Question 1

A 28 y/o male has been diagnosed with seizures. He continues to have seizures despite receiving multiple antiepileptic drugs. His Dr has prescribed a specific diet that can help reduce seizures in pts who are refractory. Which of the following diets is used for this purpose?

a. Low sodium
b. Mediterranean
c. Low cholesterol
d. Ketogenic
e. High carbohydrate

Answer 1

d

The ketogenic diet is high in fats and low in carbs (4:1 fat to carb+protein) and induces a state of ketosis that can decrease seizure frequency.

Question 2

What is the max infusion rate for fosphenytoin?

a. 50 mg PE/mL
b. 50 mg PE/min
c. 100 mg PE/min
d. 150 mg PE/mL
e. 150 mg PE/min

Answer 2

e

Question 3

HT was in a MVA with a head injury and suffered a seizure in the ER. He has stabilized, and will be released from the hospital on phenytoin 100 mg TID. Discharge counseling on the use of phenytoin should include a discussion of the following symptom of acute drug toxicity:

a. Gingival hyperplasia
b. Osteoporosis
c. GI bleeding
d. Ataxia
e. Malignant HTN

Answer 3

d

Dose-related toxicity: Nystagmus, ataxia, and diplopia
-Nystagmus - involuntary rhythmic side-to-side, up and down, or circular motion of the eyes
-Ataxia - lack of coordination, “walking drunk”
-Diplopia - seeing double

Question 4

Which statements concerning status epilepticus are accurate?

a. This condition is a medical emergency
b. Seizures that last longer than 5 min are considered status epilepticus
c. Pts in status epilepticus should be rolled on their side
d. Something should be placed in the pt’s mouth so they don’t swallow their tongue
e. Lorazepam is a 1st line agent for treating status epilepticus

Answer 4

a, b, c, e

Question 5

RT presents with a new Rx for Lamictal 250 mg BID #60. The pharmacist confirmed that RT has never taken this med before. Choose the correct statements:

a. The pt should be counseled on the risk of serious rash
b. The Rx can’t be filled until the Dr is contacted to correct the dose
c. The generic name is lacosamide
d. Lamictal concentration can become markedly increased if the pt is taking valproate
e. Lamictal has a BBW for agranulocytosis

Answer 5

a, b, d

Lamictal is started at 25 mg daily for the first 2 weeks

Question 6

Which of the following meds are known to cause seizures?

a. Meperidine
b. Ultram
c. Cleocin
d. Imipenem/cilastatin
e. Bupropion

Answer 6

a, b, d, e

Drugs that cause seizures: Bupropion, clozapine, theophylline, varenicline, carbapenems (esp imipenem), lithium, meperidine, penicillin, quinolones, tramadol

• = high doses and renal impairment increase risk

Question 7

Which of the following pairs of terms is not correctly matched?

a. Focal seizures - start on 1 side of the brain
b. Focal aware seizure - previously called generalized partial seizure
c. Focal seizure with impaired awareness - previously called complex partial seizure
d. Generalized seizures - start on both sides of the brain
e. Generalized seizures - loss of consciousness or awareness during the seizure

Answer 7

b

Focal aware seizure is the updated term for what was previously called a simple partial seizure

Question 8

A 42 y/o female pt with partial onset seizures has several other med conditions including GERD, HTN, and T2DM. She’s currently prescribed omeprazole, amlodipine, and metformin. The Dr has begun her on levetiracetam. Choose the correct statement:

a. Levetiracetam has a high risk of DDIs and may pose a problem with the pt’s other meds
b. The brand name of levetiracetam is Trileptal
c. Levetiracetam isn’t indicated for partial seizures
d. Levetiracetam is only available as a tab formulation

Answer 8

c

Question 9

Which of the following anticonvulsants are associated with oligohydrosis?

a. Topiramate
b. Phenytoin
c. Carbamazepine
d. Lamotrigine
e. Lacosamide

Answer 9

a

-Oligohydrosis - decreased sweating
-Most prominent in children

Question 10

A pt who started taking antiepileptic drugs 2 years ago commented to her Dr that she’s seen an increase in body hair. Which antiepileptic drug is associated with this effect?

a. Carbamazepine
b. Lamotrigine
c. Phenobarbital
d. Phenytoin
e. Valproate

Answer 10

d

Long-term complications of phenytoin therapy can include hirsutism (increased hair growth), gingival hyperplasia, osteoporosis, hepatotoxicity, and peripheral neuropathy

Question 11

JC, who has controlled partial seizures, has been experiencing at least 4 headaches per month for the past 4 months. Which of the following anticonvulsants is indicated for migraine prophylaxis?

a. Topamax
b. Klonopin
c. Dilantin
d. Keppra
e. Lyrica

Answer 11

a

Topiramate and divalproex are both indicated for migraine prophylaxis

Question 12

A 12 y/o girl with refractory Lennox-Gastaut syndrome is prescribed febalmate. A medication informed consent needs to be completed before starting therapy. The neurologist asks the pharmacist to educate the pt and her family on the BBWs of felbamate which include:

a. Renal and hepatic failure
b. Serious skin reactions and hepatic failure
c. Pneumonitis and renal failure
d. Hepatic failure and aplastic anemia
e. Pneumonitis and serious skin reactions

Answer 12

d

Question 13

VC is a 34 y/o female who’s admitted to the hospital with seizure activity.

6/17 abnormal labs:
Glucose = 158 (100-125)
AST = 212 (10-40)
ALT = 223 (10-40)
Albumin = 2.5 (3.5-5)

Which of VC’s meds has a BBW related her lab results on 6/17?

a. Tegretol
b. Depakote ER
c. Famotidine
d. Cozaar
e. Metformin

Answer 13

b

Depakote ER has a BBW regarding the risk of heptotoxicity

Question 14

VC is a 34 y/o female who’s admitted to the hospital with seizure activity.

4/14 Abnormal labs:
Na = 129 (135-145)
Glucose = 148 (100-125)
Albumin = 2.2 (3.5-5)
Phenytoin, total = 7.8 mcg/mL

Which of VC’s meds is most likely causing the lab results on 4/14?

a. Tegretol
b. Depakote ER
c. Famotidine
d. Cozaar
e. Metformin

Answer 14

a

Tegretol (carbamazepine) can cause hyponatremia

Question 15

VC is a 34 y/o female who’s admitted to the hospital with seizure activity.

Albumin = 2.2
Phenytoin, total = 7.8 mcg/mL

Based on the lab results on 4/14, what is VC’s corrected phenytoin level?

a. 5.6 mcg/mL
b. 7.8 mcg/mL
c. 10.7 mcg/mL
d. 14.4 mcg/mL
e. 24.4 mcg/mL

Answer 15

d

Total phenytoin / [(0.2 x albumin) + 0.1]

Question 16

What is the therapeutic range for Tegretol?

a. 5-15 mcg/mL
b. 4-8 mcg/mL
c. 4-12 mcg/mL
d. 20-40 mcg/mL
e. 50-100 mcg/mL

Answer 16

c

Question 17

What is the equivalent TDD of Phenytek 300 mg PO daily if given IV?

a. 300 mg
b. 450 mg
c. 600 mg
d. 900 mg
e. 1200 mg

Answer 17

a

Phenytek IV:PO ratio is 1:1

Question 18

What labs should be monitored with Tegretol?

a. CBC with differential
b. PFTs
c. CT scan
d. aPTT
e. Sodium

Answer 18

a, e

CBC with differential should be monitored d/t the risk of aplastic anemia and agranulocytosis. It should be discontinued if significant myelosuppression occurs.

Question 19

JW comes to pick up her seizure medication, Lamictal. Which of the following statements concerning Lamictal is true?

a. Can cause neuroleptic malignant syndrome
b. Can cause reductions in vit D
c. Requires monthly monitoring of platelet counts
d. Requires a slow dose titration
e. The generic name is levetiracetam

Answer 19

d

Question 20

Which of the following best describes the kinetics of phenytoin?

a. Large dose increases can lead to small increases in serum concentrations
b. Changes in the dose lead to proportional changes in serum concentrations
c. Free phenytoin levels should be corrected in pts with low albumin
d. Small doses increases can lead to larger increases in serum concentrations
e. Kinetics are predictable; drug levels don’t need to be monitored in all pts

Answer 20

d

Question 21

Which anticonvulsant requires genetic testing prior to use in persons of Asian descent?

a. Divalproex sodium
b. Zonisamide
c. Carbamazepine
d. Levetiracetam
e. Gabapentin

Answer 21

c

Question 22

A hospital pharmacist is preparing a phenytoin injection. The pharmacist should use the following diluent:

a. Lactated ringers
b. Sterile water
c. D5W
d. D20W
e. NS

Answer 22

e

Phenytoin should be diluted in NS only. It’s administered in a large vein (extravasation can cause tissue necrosis) with an in-line 0.22 micron filter.

Question 23

DK is a 47 y/o male with epilepsy.

Meds:
Lovastatin 40 mg PO QHS
Altace 10 mg PO daily
Norvasc 10 mg PO daily

Allergies: Bactrim (anaphylaxis)

Which of the following anticonvulsants would be contraindicated in DK?

a. Topiramate
b. Depakene
c. Keppra
d. Lamictal
e. Zonisamide

Answer 23

e

Zonisamide (Zonegran) is contraindicated in patients with a sulfa allergy.

Question 24

PY is a 32 y/o male who is in status epilepticus. Phenytoin is ordered to be given by IV infusion. What is the max infusion rate of phenytoin?

a. 10 mg/min
b. 25 mg/min
c. 50 mg/min
d. 75 mg/min
e. 150 mg/min

Answer 24

c

Phenytoin IV can cause hypotension and arrhythmias if administered too quickly.

Question 25

Which of the following is true of the MOA for antiepileptic drugs?

a. Valproate works by decreasing GABA
b. BZDs work by increasing glutamate
c. Phenytoin is a sodium channel blocker
d. Ethosuximide works on magnesium channels
e. Levetiracetam works by decreasing GABA

Answer 25

c

-Valproate - increases GABA
-BZDs - increases GABA
-Ethosuximide - T-type Ca channel blocker
-Levetiracetam - Ca channel blocker and increases GABA

Question 26

CR recently experienced a seizure and requires an anticonvulsant.

Meds:
MVI 1 tab PO daily
Levothyroxine 75 mcg PO daily
LoEstrin 1/20 1 tab PO daily

Which anticonvulsant would have minimal impact on CR’s current med regimen?

a. Topamax
b. Tegretol
c. Trileptal
d. Dilantin
e. Keppra

Answer 26

e

-All of these except Keppra can decrease the effectiveness of PO contraceptives, requiring the use of an alternative contraceptive
-Tegretol, Trileptal, and Dilantin are significant enzyme inducers that affect serum levels of many meds
-Topamax (esp high doses, >/= 200 mg/day) decreases PO contraceptive effectiveness

Question 27

CB, a 13 y/o Asian female, has been prescribed carbamazepine. Which allele should be tested prior to initiation of therapy?

a. 1502
b. 1503
c. 5701
d. 3103
e. 2C19*2

Answer 27

a

This pt should be tested for the HLA-B*1502 allele. If positive, another drug should be used, d/t the increased risk of severe skin reactions.

Question 28

Side effects of divalproex sodium may include which of the following:

a. Thrombocytopenia
b. Tachypnea
c. Extrapyramidal symptoms
d. Weight gain
e. Hair loss

Answer 28

a, d, e

-Dose-related thrombocytopenia is a warning for valproate products
-Hyperammonemia is also a warning

Question 29

Tonic-clonic seizures

Answer 29

uncontrolled jerking movements