Pharm

Question 1

What is the first-line drug for focal seizures?

Answer 1

Lamotrigine or levetiracetam

Question 2

What are ALL second-line options for focal seizures in the UK?

Answer 2

Carbamazepine, oxcarbazepine, or zonisamide

Question 3

According to UK guidance, what is the first-line treatment for generalised tonic-clonic seizures?

Answer 3

Lamotrigine or levetiracetam

Question 4

When can sodium valproate be used for generalised tonic-clonic seizures in the UK?

Answer 4

Only in males or females where pregnancy risk is not possible (e.g. over 55), due to strict pregnancy prevention regulations

Question 5

What is the second-line treatment for generalised tonic-clonic seizures in the UK?

Answer 5

Topiramate

Question 6

What is the first-line treatment for absence seizures in the UK?

Answer 6

Ethosuximide

Question 7

What is the first-line treatment for myoclonic seizures in the UK?

Answer 7

Levetiracetam

Question 8

When can sodium valproate be used for myoclonic seizures?

Answer 8

When pregnancy is not a concern

Question 9

What is first-line emergency treatment for status epilepticus in the UK?

Answer 9

IV lorazepam

Question 10

What is given if benzodiazepines fail in status epilepticus?

Answer 10

IV levetiracetam (preferred in UK practice) or phenytoin

Question 11

Which antiepileptic drug must not be started in women of childbearing potential unless no alternative works?

Answer 11

Sodium valproate

Question 12

Which epilepsy drug requires slow dose titration due to the risk of Stevens–Johnson syndrome?

Answer 12

Lamotrigine

Question 13

Lamotrigine – main side effect and warning?

Answer 13

Rash → risk of Stevens–Johnson syndrome

= Must titrate slowly

Question 14

Carbamazepine – main side effects and warnings?

Answer 14

Agranulocytosis, aplastic anaemia, hyponatraemia (SIADH), rash.

= Strong enzyme inducer → reduces COCP effectiveness

Question 15

Levetiracetam – main side effect and warning?

Answer 15

Mood changes, irritability, depression

= Use caution in patients with a psychiatric history

Question 16

Topiramate – main side effects and warnings?

Answer 16

Cognitive slowing, weight loss, kidney stones, paraesthesia

= Avoid in pregnancy (risk of cleft lip/palate)

Question 17

When do most neurologists start antiepileptic treatment?

Answer 17

After a second unprovoked seizure

Question 18

Which focal seizure drug is structurally similar to carbamazepine but causes less enzyme induction?

Answer 18

Oxcarbazepine

Question 19

What is the second-line treatment for absence seizures in the UK?

Answer 19

Lamotrigine or levetiracetam

Question 20

What is a key risk of long-term clobazam use?

Answer 20

Sedation and dependence

Question 21

Jane is a 29-year-old woman who is known to have epilepsy. She was diagnosed with this 5 years ago, and she remains stable on carbamazepine. She had recently been pregnant and had just given birth to a baby girl.

While in the hospital, Jane has approached you as she is unsure about breastfeeding. Jane is afraid that the baby will be affected if she continues to breastfeed while on carbamazepine.

What advice would you provide Jane with regards to her antiepileptic and breastfeeding?

Answer 21

Continue carbamazepine, continue breastfeeding

Question 22

A 22-year-old woman attends the family planning clinic enquiring about contraception. She is currently taking carbamazepine for epilepsy, and her BMI is 39 kg/m². She has no other past medical history.

What would be the most suitable contraceptive to offer her?

Answer 22

ANY OF THE 3
1. Copper intrauterine device
2. Progesterone injection = Depo-Provera
3. Mirena intrauterine system

Question 23

A 17-year-old boy has been in status epilepticus for 45 minutes. He is given intravenous lorazepam boluses before being commenced on a phenytoin infusion. He resumes consciousness, and his seizures stop.

How does phenytoin act as an emergency treatment for epilepsy?

Answer 23

Blocks voltage-gated sodium channels

Question 24

What are the teratogenic side effects of phenytoin?

Answer 24

cleft palate and congenital heart disease

Question 25

A 27-year-old female is seen in the epilepsy clinic for follow-up since switching from lamotrigine to carbamazepine for generalised tonic-clonic seizures. What is the mechanism of action of her new drug?

Answer 25

Binds to sodium channels to increase their refractory period

Question 26

A 25-year-old woman was started on carbamazepine by her neurologist for partial seizures. She initially has a good response, but 1 month later, her symptoms return. What is the process through which this medication has lost its effect?

Answer 26

Autoinduction

Question 27

A patient with newly diagnosed Parkinson’s disease is started on levodopa. Why is Levodopa always given with carbidopa?

Answer 27

(1) Carbidopa inhibits peripheral DOPA decarboxylase. (2) This prevents peripheral conversion of Levodopa to dopamine.

Question 28

Which Parkinson’s drug is most associated with hallucinations in elderly patients?

Answer 28

Dopamine agonists and Levodopa

Question 28

Which COMT inhibitor requires liver monitoring?

Answer 28

Tolcapone = hepatotoxicity risk

Question 29

What is the route of administration of most dopaminergic drugs?

Answer 29

Oral (PO)

Question 29

Which drug class provides the greatest improvement in motor symptoms?

Answer 29

Levodopa

Question 30

What are carbamazepine main indications?

Answer 30

First-line treatment to control pain intensity and frequency of attacks in trigeminal neuralgia

Question 31

If a patient with Parkinson's disease cannot take levodopa orally, they can be given a dopamine agonist patch as rescue medication to prevent what?

Answer 31

acute dystonia = sudden, sustained, involuntary muscle contractions causing abnormal postures or twisting movements

Question 32

Which anti-epileptic drug has a rate of elimination independent of concentration in the blood?

Answer 32

Phenytoin = sodium channel blocker

Question 33

What are the side effects of phenytoin?

Answer 33

1. Ataxia 2. Vertigo 3. Gum hypertrophy 4. Hirsutism 5. Megaloblastic anaemia

Question 34

What MAIN neuro drugs cause Ataxia?

Answer 34

1 carbamazepine 2. phenytoin 3. Sodium valproate

Question 35

A 23-year-old man with difficult-to-control epilepsy is reviewed in the clinic, four months after a change in his antiepileptic medication. He has remained seizure-free but has gained 5 kg in weight since his last review. What antiepileptic drug is most associated with weight gain?

Answer 35

Sodium valproate

Question 36

Carbamazepine is a potent what and therefore what does it do?

Answer 36

Cytochrome P450 enzyme inductor = This induction increases the metabolism of warfarin, causing a reduction in its effect,s which subsequently decreases the INR.

Question 37

IV hydrocortisone, IV fluids, glucose, antibiotics

Answer 37

Addisonian crisis

Question 38

Dantrolene and lorazepam

Answer 38

neuroleptic malignant syndrome

Question 39

IV hydrocortisone, propranolol, IV fluids

Answer 39

thyroid storm crisis

Question 40

Plasmapheresis and intravenous immunoglobulin

Answer 40

myasthenic crisis