Oxazolidine diones, exemplified by paramethadione, are a historically important class of anticonvulsants used in the management of absence (petit mal) seizures. B. Pharm students should grasp paramethadione’s oxazolidinedione core, pharmacodynamics (reduction of thalamocortical rhythmicity and modulation of T‑type calcium currents), hepatic metabolism, distinctive adverse effects (sedation, hepatotoxicity, hematologic changes, and teratogenic risk), and relevant monitoring parameters. This concise overview emphasizes structure‑activity relationships, therapeutic uses, dosing considerations, drug interactions, and safety monitoring to strengthen clinical understanding and exam readiness. ‘Now let’s test your knowledge with 50 MCQs on this topic.’
Q1. Which chemical class does paramethadione belong to?
- Barbiturates
- Sulfonamides
- Oxazolidine diones
- Benzodiazepines
Correct Answer: Oxazolidine diones
Q2. What is the primary clinical indication historically associated with paramethadione?
- Generalized tonic‑clonic seizures
- Absence seizures (petit mal)
- Parkinson’s disease
- Myasthenia gravis
Correct Answer: Absence seizures (petit mal)
Q3. The anticonvulsant action of paramethadione is primarily attributed to modulation of which ion channel type?
- Voltage‑gated sodium channels
- Nicotinic acetylcholine receptors
- T‑type calcium channels
- Potassium leak channels
Correct Answer: T‑type calcium channels
Q4. Which of the following adverse effects is a major concern with paramethadione therapy?
- Hyperglycemia
- Teratogenicity and fetal abnormalities
- Chronic cough
- Hypokalemia
Correct Answer: Teratogenicity and fetal abnormalities
Q5. Compared to modern agents like ethosuximide, paramethadione is best described as:
- More commonly used first‑line today
- An older drug with higher toxicity profile
- Primarily used for status epilepticus
- Non‑sedating and safer in pregnancy
Correct Answer: An older drug with higher toxicity profile
Q6. Which monitoring tests are most important during paramethadione therapy?
- Chest X‑ray and ECG
- Liver function tests and complete blood count
- Serum amylase and lipase
- Thyroid function tests
Correct Answer: Liver function tests and complete blood count
Q7. Paramethadione’s mechanism contributes to seizure control by primarily affecting which brain region circuitry?
- Basal ganglia motor loops
- Thalamocortical circuits
- Hippocampal limbic pathways
- Brainstem respiratory centers
Correct Answer: Thalamocortical circuits
Q8. A significant hematologic adverse effect that may occur with oxazolidine diones is:
- Polycythemia vera
- Agranulocytosis or bone marrow suppression
- Iron deficiency anemia only
- Von Willebrand disease
Correct Answer: Agranulocytosis or bone marrow suppression
Q9. Which statement about paramethadione pharmacokinetics is most accurate?
- It is excreted unchanged primarily via the kidneys
- It undergoes extensive hepatic metabolism
- It is not absorbed orally
- It has no interactions with liver enzymes
Correct Answer: It undergoes extensive hepatic metabolism
Q10. Which drug is considered a safer modern alternative for absence seizures compared to paramethadione?
- Phenobarbital
- Ethosuximide
- Phenytoin
- Levodopa
Correct Answer: Ethosuximide
Q11. Structural activity: the core heterocyclic ring in paramethadione is best described as:
- Oxazolidine dione ring
- Imidazole ring
- Thiophene ring
- Indole ring
Correct Answer: Oxazolidine dione ring
Q12. Which patient group is absolutely contraindicated for paramethadione due to teratogenic risk?
- Postmenopausal women
- Pregnant women
- Male adolescents
- Men over 65
Correct Answer: Pregnant women
Q13. The term “petit mal” refers to which seizure type treated historically by paramethadione?
- Complex partial seizures
- Absence seizures
- Myoclonic seizures
- Focal motor seizures
Correct Answer: Absence seizures
Q14. Which clinical feature is characteristic of absence seizures?
- Prolonged tonic‑clonic convulsions
- Brief sudden lapses in awareness with staring
- Progressive memory loss over months
- Persistent muscle rigidity
Correct Answer: Brief sudden lapses in awareness with staring
Q15. Which of the following safety counseling points is essential for patients on paramethadione?
- Avoid sudden discontinuation and report signs of infection or bleeding
- Drink grapefruit juice to enhance absorption
- No need for routine blood tests
- Stop all other anticonvulsants immediately
Correct Answer: Avoid sudden discontinuation and report signs of infection or bleeding
Q16. Which of these interactions is most likely with paramethadione?
- Reduced CNS effects when combined with benzodiazepines
- Additive CNS depression with other sedatives
- Complete inactivation by antacids
- No interaction with alcohol
Correct Answer: Additive CNS depression with other sedatives
Q17. Which adverse hepatic manifestation can occur with paramethadione?
- Steatosis without enzyme changes
- Hepatocellular injury with raised transaminases
- Exclusive cholestasis with no ALT rise
- No reported hepatic effects
Correct Answer: Hepatocellular injury with raised transaminases
Q18. In the evaluation of a patient on paramethadione, which baseline tests should be done before starting therapy?
- Urinalysis only
- Liver function tests and complete blood count
- EEG only
- Fasting glucose and lipid profile
Correct Answer: Liver function tests and complete blood count
Q19. Which property describes paramethadione’s use in pediatric patients historically?
- Never used in children
- Used cautiously for childhood absence seizures but with toxicity concerns
- Preferred over ethosuximide in children today
- Stimulates growth and development
Correct Answer: Used cautiously for childhood absence seizures but with toxicity concerns
Q20. Which symptom would most strongly suggest serious bone marrow toxicity from paramethadione?
- Mild headache
- Fever, sore throat, and persistent infections
- Slight insomnia
- Transient rash resolving in 24 hours
Correct Answer: Fever, sore throat, and persistent infections
Q21. The reason oxazolidine diones fell out of favor is primarily due to:
- Superior efficacy compared to other drugs
- High frequency of serious adverse effects and teratogenicity
- Excessive cost only
- Short supply of raw materials
Correct Answer: High frequency of serious adverse effects and teratogenicity
Q22. Which alternative anticonvulsant is considered first‑line for absence seizures in many guidelines?
- Carbamazepine
- Ethosuximide or valproate depending on context
- Phenytoin
- Gabapentin
Correct Answer: Ethosuximide or valproate depending on context
Q23. A pharmacology student asks: paramethadione reduces spike‑and‑wave discharges by acting on which neuronal activity?
- Enhancing excitatory glutamatergic transmission
- Stabilizing thalamic relay neuron firing and reducing burst firing
- Increasing nicotinic receptor activity
- Blocking GABA synthesis
Correct Answer: Stabilizing thalamic relay neuron firing and reducing burst firing
Q24. Which monitoring interval is appropriate for CBC and LFTs after initiating paramethadione?
- No monitoring necessary
- Baseline, then periodic monitoring during therapy
- Only after 5 years of treatment
- Hourly monitoring at home
Correct Answer: Baseline, then periodic monitoring during therapy
Q25. Which patient complaint should prompt immediate evaluation for paramethadione toxicity?
- Mild dry mouth
- Dark urine and jaundice
- Occasional yawning
- Intermittent nasal congestion
Correct Answer: Dark urine and jaundice
Q26. Which of the following best describes paramethadione’s role in modern therapy?
- Widely used first‑line agent
- Largely historical/obsolete due to safety concerns
- Primary treatment for febrile seizures
- Commonly used as an antiarrhythmic
Correct Answer: Largely historical/obsolete due to safety concerns
Q27. Which structural descriptor differentiates oxazolidine diones from barbiturates?
- Presence of a five‑membered oxazolidine dione ring versus a pyrimidine‑type ring in barbiturates
- Both have identical ring systems
- Barbiturates contain sulfur which oxazolidine diones lack
- Oxazolidine diones are peptide derivatives
Correct Answer: Presence of a five‑membered oxazolidine dione ring versus a pyrimidine‑type ring in barbiturates
Q28. Which counseling advice is important regarding driving while on paramethadione?
- It has no effect; driving is always safe
- Avoid driving until tolerance and individual response are known due to sedation
- Only avoid driving in the first hour after dosing
- Driving enhances drug efficacy
Correct Answer: Avoid driving until tolerance and individual response are known due to sedation
Q29. Which lab abnormality would indicate hepatic injury from paramethadione?
- Low creatinine kinase only
- Elevated AST and ALT
- Decreased eosinophil count only
- Isolated hypernatremia
Correct Answer: Elevated AST and ALT
Q30. Paramethadione’s teratogenic profile necessitates which precaution in women of childbearing potential?
- No contraception required
- Discuss effective contraception and risks before initiating therapy
- Guaranteed safety in pregnancy
- Only avoid breastfeeding
Correct Answer: Discuss effective contraception and risks before initiating therapy
Q31. Which symptom profile is typical of overdose with oxazolidine diones?
- Excessive stimulation and hyperreflexia only
- Central nervous system depression, respiratory depression, and coma in severe cases
- Isolated skin flushing without systemic effects
- Profound hypertension and tachycardia only
Correct Answer: Central nervous system depression, respiratory depression, and coma in severe cases
Q32. Which of the following drugs has a pharmacological target similar to paramethadione for absence seizures?
- Ethosuximide (acts on T‑type calcium channels)
- Levodopa (acts on dopamine pathways)
- Atenolol (beta‑blocker)
- Metformin (antidiabetic)
Correct Answer: Ethosuximide (acts on T‑type calcium channels)
Q33. Which adverse effect is LEAST likely with paramethadione?
- Memory impairment and cognitive slowing
- Severe hepatotoxicity
- Teratogenicity
- Improved visual acuity
Correct Answer: Improved visual acuity
Q34. Concerning drug interactions, combining paramethadione with which class increases sedation risk?
- Anticholinergic laxatives
- Benzodiazepines and opioids
- Topical nasal decongestants only
- Vitamin supplements
Correct Answer: Benzodiazepines and opioids
Q35. For exam preparation, which topic related to paramethadione is most important to emphasize?
- Structure‑activity relationships, adverse effect profile, and monitoring
- Role as an antibiotic
- Use in heart failure management
- Vitamin content
Correct Answer: Structure‑activity relationships, adverse effect profile, and monitoring
Q36. Which clinical history finding would raise suspicion of paramethadione‑induced bone marrow suppression?
- Frequent bruising, prolonged bleeding and recurrent infections
- Mild seasonal allergies
- Occasional heartburn
- Intermittent joint stiffness
Correct Answer: Frequent bruising, prolonged bleeding and recurrent infections
Q37. Which descriptor fits paramethadione’s absorption when given orally?
- Poorly absorbed and requires IV administration
- Orally absorbed but subject to first‑pass hepatic metabolism
- Completely destroyed by stomach acid
- Only effective as a topical application
Correct Answer: Orally absorbed but subject to first‑pass hepatic metabolism
Q38. Which of the following is a recommended action if a woman becomes pregnant while taking paramethadione?
- Immediately continue therapy without discussion
- Promptly consult prescriber to reassess therapy and risks vs benefits
- Double the dose for better seizure control
- Stop all medications without consulting a physician
Correct Answer: Promptly consult prescriber to reassess therapy and risks vs benefits
Q39. Which is a common CNS adverse effect of paramethadione therapy?
- Enhanced alertness and insomnia
- Sedation, dizziness, and cognitive slowing
- Selective enhancement of memory recall
- Hyperactivity and mania
Correct Answer: Sedation, dizziness, and cognitive slowing
Q40. Which guideline‑relevant fact should B. Pharm students remember about paramethadione?
- It is first‑line for status epilepticus
- It is rarely used now owing to safety and replaced by safer agents
- It is the preferred drug in pregnancy for epilepsy
- It has no drug interactions
Correct Answer: It is rarely used now owing to safety and replaced by safer agents
Q41. Which medication class would most likely decrease paramethadione levels by inducing hepatic metabolism?
- CYP enzyme inducers such as rifampicin or carbamazepine
- CYP inhibitors like ketoconazole only
- Proton pump inhibitors only
- Topical steroids
Correct Answer: CYP enzyme inducers such as rifampicin or carbamazepine
Q42. Which embryopathy is classically associated with oxazolidine dione exposure (noting historical reports)?
- Fetal trimethadione syndrome with facial and craniofacial abnormalities
- Neural tube defects only due to folate deficiency
- Isolated cardiac septal defect only
- No congenital abnormalities reported
Correct Answer: Fetal trimethadione syndrome with facial and craniofacial abnormalities
Q43. Which pharmacological property explains why paramethadione may cause daytime drowsiness?
- Its stimulant effect on the cortex
- Central nervous system depressant action
- Diuretic properties leading to dehydration
- Selective serotonin reuptake
Correct Answer: Central nervous system depressant action
Q44. When learning structure‑activity relationships, which modification in oxazolidine diones generally affects potency and toxicity?
- Substitutions on the aromatic or alkyl side chains influencing lipophilicity and metabolism
- Presence of a sulfate group only
- Removal of all hydrogen atoms
- Conversion to a peptide backbone
Correct Answer: Substitutions on the aromatic or alkyl side chains influencing lipophilicity and metabolism
Q45. In acute management of paramethadione overdose, the most appropriate immediate step is:
- Activated charcoal if within ingestion window and supportive care
- Administer aspirin to counteract effects
- Induce vomiting at home
- Give double dose of medication to outcompete overdose
Correct Answer: Activated charcoal if within ingestion window and supportive care
Q46. Which symptom cluster differentiates absence seizures from generalized tonic‑clonic seizures?
- Brief impairment of consciousness with rapid recovery, no convulsive activity
- Prolonged convulsions with loss of consciousness and postictal confusion
- Progressive muscle weakness over days
- Fever and focal neurological deficits
Correct Answer: Brief impairment of consciousness with rapid recovery, no convulsive activity
Q47. Which teaching point about drug storage is appropriate for paramethadione tablets?
- Store in a cool, dry place away from direct sunlight
- Store in the freezer for long‑term stability
- Keep tablets in open air to ‘breathe’
- Storage conditions are irrelevant
Correct Answer: Store in a cool, dry place away from direct sunlight
Q48. Which of the following best summarizes the risk‑benefit consideration for using paramethadione today?
- High benefit with minimal risks for all patients
- Potential benefit in refractory absence epilepsy but significant safety concerns limit use
- Always preferred over ethosuximide
- No need to consider risks in women of childbearing age
Correct Answer: Potential benefit in refractory absence epilepsy but significant safety concerns limit use
Q49. Which pharmacological effect is NOT associated with paramethadione?
- Depression of thalamic burst activity
- Enhancement of T‑type calcium channel conductance
- Central nervous system depression
- Potential hepatotoxicity
Correct Answer: Enhancement of T‑type calcium channel conductance
Q50. For exam answers, which concise statement accurately reflects paramethadione?
- An oxazolidine dione anticonvulsant mainly for absence seizures, now rarely used due to toxicity
- A modern first‑line antipsychotic
- An antihypertensive commonly prescribed today
- A broad‑spectrum antibiotic
Correct Answer: An oxazolidine dione anticonvulsant mainly for absence seizures, now rarely used due to toxicity
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com