A 27-year-old man with new-onset focal aware seizures needs first-line monotherapy. Normal LFTs/renal panel. Which is most appropriate?
A. Carbamazepine
B. Ethosuximide
C. Clonazepam
D. Vigabatrin
A.
CBZ is first-line for focal seizures; ethosuximide is for absence; clonazepam/vigabatrin not first-line for focal.
A 19-year-old woman has absence seizures. Best first-line agent?
A. Carbamazepine
B. Ethosuximide
C. Phenytoin
D. Gabapentin
B.
Ethosuximide targets T-type Ca²⁺ channels—drug of choice in absence.
A 22-year-old male with juvenile myoclonic epilepsy has morning myoclonic jerks and occasional GTCS. Which drug is best?
A. Valproate
B. Carbamazepine
C. Phenytoin
D. Gabapentin
A.
Valproate is best for JME; CBZ/PHT can worsen myoclonus.
A 30-year-old female teacher with focal seizures asks about pregnancy plans within a year. Which initial therapy balances efficacy and lowest teratogenic risk?
A. Valproate
B. Levetiracetam
C. Topiramate
D. Phenobarbital
B.
Levetiracetam (or lamotrigine) preferred in women planning pregnancy; avoid valproate/topiramate if possible.
A patient on carbamazepine develops a generalized rash with mucosal involvement 2 weeks after initiation. He is Han Chinese. Which baseline test could have reduced this risk?
A. HLA-B1502 genotyping
B. HLA-B5701
C. TPMT activity
D. G6PD level
A.
HLA-B*1502 screening reduces SJS/TEN risk with CBZ in many Asian populations.
A 66-year-old with hyponatremia (Na 124) on an antiseizure drug for focal seizures; otherwise well. Which drug is the likely cause?
A. Levetiracetam
B. Carbamazepine
C. Lamotrigine
D. Topiramate
B.
CBZ → SIADH → hyponatremia.
Status epilepticus in ED: after IV lorazepam x2, seizures persist. Next best step?
A. IV levetiracetam 60 mg/kg (max 4500 mg)
B. Oral phenytoin 300 mg
C. PR diazepam 10 mg
D. Start propofol infusion immediately
A.
After benzos, give a weight-based second-line (LEV/VPA/PHT). Levetiracetam 60 mg/kg (max 4.5 g) is guideline-consistent.
You’re preparing IV phenytoin loading (70-kg adult). Which is correct?
A. Dilute in D5W; infuse ≤100 mg/min
B. Dilute in NS; infuse ≤50 mg/min with inline filter
C. Give IM to avoid arrhythmias
D. Mix with WFI; bolus push
B.
Phenytoin: NS only, ≤50 mg/min, inline filter, large vein.
A 54-year-old on phenytoin 300 mg nocte has a total level of 7 μg/mL with hypoalbuminemia (albumin 25 g/L). He is seizure-free. Best interpretation?
A. Increase dose immediately
B. Likely therapeutic free level; interpret cautiously
C. Toxicity imminent
D. Stop drug
B.
Total level is low because albumin is low; free level may be therapeutic—dose cautiously.
Which pair is contraindicated/avoided in absence or myoclonic seizures due to potential worsening?
A. Lamotrigine and levetiracetam
B. Carbamazepine and phenytoin
C. Valproate and topiramate
D. Clonazepam and ethosuximide
B.
CBZ/PHT may worsen absence and myoclonic seizures.
A 76-year-old with dementia has recurrent GTCS. Which agent has the fewest interactions and simple kinetics (no levels)?
A. Levetiracetam
B. Valproate
C. Phenytoin
D. Carbamazepine
A.
LEV has minimal interactions, renal clearance, no level monitoring.
A 24-year-old pregnant woman (8 weeks) with generalized tonic-clonic epilepsy is stable on valproate. What is the best immediate action?
A. Abruptly stop valproate today
B. Switch to carbamazepine immediately
C. Urgent neuro review to consider switch to levetiracetam/lamotrigine + high-dose folate, risk–benefit discussion
D. Add topiramate
C.
Do not abruptly stop; urgent review to consider safer agent + high-dose folate; valproate has high teratogenicity.
Lamotrigine is started while a patient is already on valproate. What’s the safest starting plan?
A. 25 mg once daily
B. 25 mg every other day with very slow titration
C. 50 mg once daily
D. 100 mg once daily
B.
VPA inhibits LTG metabolism—halve starting dose (e.g., 25 mg alt-day), titrate slowly.
A 40-year-old develops restlessness, tremor, tinnitus during a peripheral nerve block with lidocaine with adrenaline (dentistry). What toxicity is this and first step?
A. Cardiac toxicity; give IV lipid emulsion
B. Early CNS toxicity; stop injection, airway/oxygen, monitor
C. Malignant hyperthermia; give dantrolene
D. Anaphylaxis; give IM adrenaline
B.
Early CNS toxicity from lidocaine; stop drug, airway/oxygen, monitor.
After rapid IV phenytoin in ED, the patient becomes hypotensive with bradyarrhythmia. Main mechanism?
A. Histamine release
B. Negative inotropy and sodium channel block in myocardium + propylene glycol effects
C. Cholinergic excess
D. Serotonin syndrome
B.
Cardiodepression from Na⁺–channel effects and solvent (propylene glycol).
Which antiseizure drug inhibits T-type Ca²⁺ channels in thalamus?
A. Ethosuximide
B. Levetiracetam
C. Perampanel
D. Gabapentin
A.
Ethosuximide blocks T-type channels in thalamus.
A 5-year-old boy with infantile spasms: first-line choice?
A. Vigabatrin
B. Clobazam
C. Carbamazepine
D. Phenytoin
A.
Vigabatrin is first-line for infantile spasms (esp. tuberous sclerosis).
A renal patient (eGFR 25 mL/min) needs adjunct therapy for focal seizures. Which requires dose adjustment for renal clearance and is otherwise interaction-light?
A. Levetiracetam
B. Carbamazepine
C. Valproate
D. Lamotrigine
A.
LEV is renally cleared—dose adjust; few interactions.
A 33-year-old on topiramate presents with flank pain; urinalysis shows crystals; he also reports reduced sweating during spin class. Which advice is most appropriate?
A. This is unrelated to topiramate
B. Encourage hydration; consider drug change due to renal stones and oligohidrosis risk
C. Add acetazolamide
D. Increase dose for better control
B.
Topiramate → renal stones and oligohidrosis/hyperthermia; advise hydration/consider switch.
A 26-year-old with focal seizures is started on carbamazepine. Two months later she has unplanned pregnancy. Which statement is true?
A. Highest neural tube defect risk among ASMs is with carbamazepine
B. Valproate carries higher teratogenic risk than carbamazepine
C. Stop carbamazepine immediately
D. Switch to valproate
B.
Valproate has higher teratogenic risk than CBZ. Do not abruptly stop; involve specialist.
Benzodiazepines in status: which is true?
A. Diazepam IV lasts longest in the brain
B. Lorazepam has longer CNS action than diazepam despite similar half-life
C. Midazolam should not be used IM
D. All require serum level monitoring
B.
Lorazepam remains longer in CNS; midazolam can be given IM/IN; no level monitoring.
A patient on phenytoin develops gingival hypertrophy, ataxia and osteomalacia. The last complication is due to:
A. Folate inhibition
B. Vitamin D metabolism induction
C. GABA agonism
D. SIADH
B.
Phenytoin induces vitamin D metabolism → osteomalacia/rickets.
A 48-year-old with focal seizures on carbamazepine has new oral contraceptive failure. Mechanism?
A. CBZ inhibits CYP3A4
B. CBZ induces CYP3A4 → ↑ estrogen metabolism
C. CBZ inhibits UGT
D. CBZ displaces estrogen from albumin
B.
CBZ is a CYP3A4 inducer, reducing OCP efficacy.
A 32-year-old man with GTCS is on valproate. His ammonia is elevated with lethargy. Best management?
A. Give lactulose and continue VPA
B. Stop VPA; consider L-carnitine and alternative ASM
C. Start steroids
D. Add topiramate
B.
VPA can cause hyperammonemia; stop/switch; consider L-carnitine.
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Cell Membrane and Transport7
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Pharmacokinetics48
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Pharmacodynamics25
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Medical Microbiology10
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Beta-lactam Antibiotics18
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Non-Beta Lactam Antibiotics15
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Gastroenteritis14
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Gastrointestinal Infections7
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Liver Diseases27
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Alcohol Withdrawal15
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Adverse Drug Reactions14
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Drug Interactions5
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Pharmacogenomics6
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Epilepsy40
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Anxiety and Depression26
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Insomnia10
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AKI CKD20
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BPH and Urinary Incontinence35
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Opioids (Add on)25
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LA/GA Short Answer Questions15
