Assignment (MM=120)
A 23-year-old graduate male student was studying late at night for an examination. He recalls studying, but his next memory is
being on the floor and aching throughout his body. He was incontinent of urine but not stool and felt slightly confused. No one
was with him, and he did not know what to do. He called his mother, who recommended he go to the local emergency room.
The student was too busy and decided not to go to the hospital. He called the school infirmary the next day, and their physicians
examined him. His vital signs were normal, and the neurologic examination, including motor and sensory evaluation, reflexes,
and cranial nerve function were normal. His entire neurologic and physical examinations were normal. He asked for advice.
1. What is the most likely diagnosis? Marks: 3x12=36
2. What is the next diagnostic step?
3. What is the next step in therapy?
4. List the drugs used for GTC seizures?
5. Why phenytoin is preferred in this particular case over phenobarbitone?
6. What are the general health care instructions do you give to a new epileptic patient?
7. List the seven ADR of phenytoin?
8. Describe the MOA of phenytoin?
9. If you choose to initiate phenytoin in this case; what would be the dosage form and starting
dose?
10. How do you monitor the response in this case?
11. What is the normal therapeutic range of phenytoin and why it need TDM?
12. Why fosphenytoin is not ideal for this case? What are the advantages and disadvantages of
fosphenytoin over phenytoin?
A 23-year-old graduate female student was studying late at night for an examination, talking to his friends. All of a sudden, he
began smacking his lips, stared into space, seemed confused, and kept mumbling the same word repeatedly. This episode lasted
approximately 20 seconds. During the episode, his friends tried to constrain him, but he became combative. Within a few more
seconds, he suddenly became asymptomatic although he seemed slightly confused for 5 to 10 more seconds. His friends wanted to
take him to the emergency room, but he refused.
1. What is the most likely diagnosis?
2. What is the next diagnostic step?
3. What is the next step in therapy?
Marks: 3x12=36
4. What is difference between absence seizure and complex partial seizure?
5. What is difference between simple partial and complex partial seizures?
6. List the drugs used for partial seizures?
7. Describe the MOA of carbamazepine?
8. What are the advantages of oxcarbazepine over carbamazepine?
9. List the seven ADR of carbamazepine?
10. If patient is taking OC pills, what would be the alternative drugs in this case?
11. What is the divalproex? Describe it MOA?
12. What is the difference between monotherapy and adjunctive therapy?
An 18-year-old University student was admitted to the Acute Medical Unit after a tonic-clonic seizure that was
witnessed by his girlfriend. While making breakfast in the kitchen, he was observed to let out a cry and then fall rigid
to the ground, followed by 30 seconds of jerking of the limbs. He bit the side of his tongue. He was unresponsive for
several minutes afterwards. His girlfriend called an ambulance. He had not had a seizure before, but she had noticed
his right arm and head tended to twitch in the mornings, especially when he was tired. He had no past medical or
family history and was not taking any medication.
On examination he was back to normal. The cardiovascular and neurological examination were normal. Bloods and a
12-lead ECG were normal.
What treatment should be offered before discharge from hospital?
MM=1X4=4
1. Carbamazepine
[Link]
3. Levetiracetam
4. No treatment
[Link] valproate
A 50-year-old businessman was admitted following several ‘out of body experiences’ that had concerned him enough to
attend the Emergency Department. He described several episodes of feeling not really there, during which he could not
speak and felt as if he was leaving his own body and observing the room from the outside. His wife noticed he went blank
during these episodes. She also said that he had been under considerable stress with his work since a cycling accident
one year ago during which he sustained a head injury. He had made a full physical recovery but suffered from low mood.
He did not take any regular medication.
On examination he was back to normal. The cardiovascular and neurological examination was normal. Bloods and a 12-
lead ECG were normal. A CT of the head performed in the Emergency Department was unchanged from previous,
showing an abnormality consistent with a previous contusion in the right temporoparietal area.
What is the most appropriate treatment?
[Link] MM=1X4=4
[Link]
[Link]
[Link]
[Link] treatment
A 26-year-old woman discovered she was unexpectedly pregnant. She had been taking regularly an oral
contraceptive medication for several years. Two months ago she was diagnosed with complex partial
seizures and started the prescribed therapy. Which of the following drugs was she most likely taking?
a. Lamotrigine
b. Valproic acid
c. Clonazepam
d. Gabapentin
e. Levetiracetam
f. Carbamazepine
A 45-year-old man visited his physician office for consultation regarding his antimigraine medication. The
man had one month history of disabling migraine headache occurring two three times weekly. About 70% of
his headache attacks had been aborted with one sumatriptan tablet and rest. The patient had been suffering
from idiopathic second degree AV block diagnosed three years ago and from open angle glaucoma for four
years. The physician decided to initiate a prophylactic treatment to reduce the frequency of the migraine
attacks. Which of the following drugs was most likely prescribed?
a. Metoprolol
b. Verapamil
c. Amitriptyline MM=2X5=10
d. Lamotrigine
e. Valproic acid
f. Topiramate
A 12-year-old girl was admitted to the hospital because of vomiting, drowsiness, lethargy and jaundice of six
hours duration. The girl had a long history of refractory absence seizure and had been receiving several drugs
during the last two years. She was presently treated with two antiseizure agents and had no absence seizures
for five weeks. Physical examination showed a patient in obvious distress with extensive jaundice on the skin
and sclerae. Significant lab results on admission were: alanine aminotransferase 400 U/L, total bilirubin 4
mg/L. ammonia 190 mcg/dL (normal for children 36-85). Which of the following drugs most likely caused the
patients symptoms and signs?
a. Ethosuximide
b. Valproic acid MM=1X4=4
c. Lamotigrine
d. Tiagabine
e. Levetiracetam
f. Zonisamide
g. Clonazepam
A 44-year-old man complained to his physician of burning and tickling in his hands and feet. The man
was diagnosed with tonic-clonic seizures three years ago and has been receiving high dose of an
antiseizure drug since then. Physical examination disclosed large inguinal lymph nodes and reflex
testing showed lack of knee and ankle tendon reflexes. Further lab exams showed megaloblastic
anemia. Which of the following drugs most likely caused the patient's symptoms and signs?
a. Gabapentin
b. Lamotigrine
c. Clonazepam
d. Phenytoin
e. Levetiracetam
f. Tiagabine
A 36-year-old woman recently diagnosed with simple partial seizures started a therapy with lamotrigine,
two tablet daily. Which of the following adverse effects could most likely occur during the therapy?
a. Macrocytic anemia
b. Hallucinations
c. Liver cirrhosis
d. Pancreatitis
e. Lupoid syndrome
f. Erythematous skin rash MM=2X5=10
The antiepileptic drug, which produce inhibition of the central effects of
excitatory amino acids is :
a)Ethosuximide MM=2X3=6
b)Lamotrigine
c)Diazepam
d)Tiagabine
The drug which is not used for partial and generalized tonic-clonic
seizures is :
a)Carbamazepine
b)Valproate
c)Phenytoin
d)Vigabatrine
22 year-old suma, with a history of epilepsy is undergoing the pre-anaesthetic review. The use of which inhalational agent is
contraindicated in this patient?
a. Halothane
b. Isoflurane
c. Enflurane
d. Sevoflurane
You are a consultant for a long-term care skilled nursing facility. During one of your visits, you are
approached by one of the local internists. He is caring for LK, an 80-year-old man who has developed
secondarily generalized tonic-clonic seizures after suffering a stroke. This patient has a history of
depression, for which he is currently receiving amitriptylline. The physician wants to start an
antiepileptic drug but is worried about causing any pharmacokinetic drug interactions. Which of the
following medication options is least likely to cause a drug-drug interaction?
MM=2X2=4
a. Carbamazepine
b. Lamotrigine
c. Phenytoin
d. Oxcarbazepine
e. none of the above
BT is a 19-year-old with a history of myoclonic seizures. She is new to your pharmacy and presents
with complaints of excessive weight gain and tremor. She also reports that she has noticed some hair
thinning. You try to obtain a medication history from this patient, but she is unable to recall what
medication her neurologist recently started. Based on her presentation, her medication likely is
a. Valproic acid
b. Ethosuximide
c. Lamotrigine
d. Gabapentin
e. None of the above
which of the following has an important effect on the T-type calcium channels in thalamic neurons?
a)Carbamazepine
b)Lamotrigine
c)Ethosuximide MM=2X3=6
d)Phenytoin
The drug which does not produce a voltage-dependent inactivation of sodium channels is :
a)Lamotrigine
b)Carbamazepine
c)Phenytoin
d)Vigabatrin
A 6-year-old girl was diagnosed with myoclonic seizures. A brain MRI showed no overt neurologic
deficit. Her past medical history was negative for epileptic seizures. Which of the following drugs
would be appropriate for this patient?
a. Carbamazepine
b. Haloperidol
c. Phenobarbital
d. Phenytoin
e. Fluoxetine
f. Clonazepam
