Question 1

A child, Dwayne, has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels may be:

Accepted Answer

Carbamazepine is known to induce its own metabolism over time, which can lead to lower plasma levels despite consistent dosing and adherence. This phenomenon is known as autoinduction.

Question 2

Long-term monitoring of patients who are taking carbamazepine includes:

Accepted Answer

Carbamazepine can cause blood disorders such as leukopenia, aplastic anemia, and agranulocytosis, making regular monitoring of the complete blood count (CBC) every three to four months a necessary precaution to detect these potential adverse effects early.

Question 3

Levetiracetam has known drug interactions with:

Accepted Answer

Levetiracetam is known for having few, if any, significant drug interactions, making it a safer choice in polypharmacy, especially in patients with epilepsy who may be on multiple medications.

Question 4

A 10-year-old child is diagnosed with major depression. The appropriate first-line antidepressant for children is:

Accepted Answer

Fluoxetine is the only antidepressant approved by the FDA for the treatment of major depressive disorder in children aged 8 and older, making it the appropriate first-line choice for a 10-year-old child.

Question 5

A patient is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding them:

Accepted Answer

Abruptly discontinuing levetiracetam can lead to withdrawal seizures, so patients are advised not to stop taking it suddenly without consulting their healthcare provider.

Question 6

A patient has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be:

Accepted Answer

Assessing for suicidal ideation is crucial when a patient reports depression or unusual thoughts, especially when taking medications like gabapentin, which can affect mood and mental health. This step helps ensure patient safety and determines the need for further intervention.

Question 7

A patient is started on paroxetine (Paxil), an SSRI, for depression. Education regarding antidepressants includes:

Accepted Answer

SSRIs, including paroxetine, often take several weeks before their full therapeutic effects are observed. This delay in onset of action is a well-known characteristic of this class of medications.

Question 8

Before prescribing phentermine, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St. John's Wort due to:

Accepted Answer

Phentermine, when used in combination with serotonergic agents such as SSRIs or St. John's Wort, can increase the risk of serotonin syndrome, a potentially life-threatening condition characterized by symptoms such as confusion, hyperthermia, and neuromuscular abnormalities.

Question 9

A patient is taking lamotrigine (Lamictal) for their seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:

Accepted Answer

DCombined oral contraceptives (COCs) can reduce the levels of lamotrigine in the body due to hepatic enzyme induction, potentially decreasing the effectiveness of lamotrigine in controlling seizures. This may necessitate an increase in the lamotrigine dose to maintain therapeutic levels. Additionally, COCs can induce the metabolism of estrogen, which might require prescribing OCs with higher estrogen content to maintain contraceptive efficacy.

Question 10

Monitoring of a patient on gabapentin to treat seizures includes:

Accepted Answer

Gabapentin does not require routine therapeutic drug level monitoring or serum electrolyte testing. Monitoring should focus on seizure frequency, duration, and severity to assess treatment efficacy.

Question 11

A three-year-old child has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for _________ to be used for an episode of status epilepticus.

Accepted Answer

Rectal diazepam (Diastat) is recommended for home management of acute seizure episodes, including status epilepticus, because it can be administered easily and safely by family members.

Question 12

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner (NP) managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):

Accepted Answer

All of the choices are correct regarding the management and understanding of phenelzine and other MAOIs. A) Co-prescription with serotonergic drugs can lead to serotonin syndrome. B) MAOIs interact with tyramine-rich foods, leading to potential hypertensive crises. C) Symptoms of a hypertensive crisis indeed require immediate medical attention.

Question 13

Tricyclic antidepressants should be prescribed cautiously in patients with:

Accepted Answer

Tricyclic antidepressants can have cardiovascular side effects, including arrhythmias and postural hypotension, making them a cautious choice for patients with heart disease.

Question 14

A six-year-old has recently started taking ethosuximide (Zarontin) for seizures. The patient should be monitored for:

Accepted Answer

Ethosuximide, used in the treatment of absence seizures, can cause blood dyscrasias (such as leukopenia, aplastic anemia, agranulocytosis, and pancytopenia), although these side effects are rare. Monitoring blood counts is important during treatment.

Question 15

Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

Accepted Answer

Topiramate can impair the body's ability to sweat and regulate temperature, making it important for individuals on this medication to monitor their temperature and ability to sweat, especially in hot conditions or when engaging in physical activities like sports.

Question 16

Carbamazepine has a black box warning due to life threatening:

Accepted Answer

Carbamazepine has a black box warning for life-threatening dermatologic reactions, including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), which are severe skin reactions that can be fatal.

Question 17

An overweight patient recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be:

Accepted Answer

Topiramate is known to cause weight loss in some patients as a side effect. This is not uncommon and can be considered beneficial for overweight patients, as long as the weight loss is not excessive or rapid. Therefore, reassuring the patient and continuing to monitor her weight is the appropriate action.

Question 18

A patient is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

Accepted Answer

Lamotrigine (Lamictal) can cause serious hypersensitivity reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, which may present with fever and lymphadenopathy. It's crucial to rule out this potentially life-threatening reaction early.

Question 19

A child is prescribed phenytoin for seizures. Monitoring includes assessing:

Accepted Answer

Phenytoin hypersensitivity syndrome is a serious adverse reaction that can occur three to eight weeks after starting treatment with phenytoin, a medication used to control seizures. Monitoring for signs of this syndrome is crucial for patient safety.

Question 20

A 42-year-old female requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

Accepted Answer

Anorexiants like phentermine can lead to tolerance, and their use is generally limited to short-term treatment, typically not exceeding six months, to help jump-start weight loss in conjunction with diet and exercise.

Quiz 12: Drugs Affecting the Central Nervous System