Epilepsy MCQs With Answer

As a B.Pharm student, mastering Epilepsy MCQs With Answer sharpens your clinical pharmacology and therapeutics skills. This focused collection covers seizure classification, mechanisms of action of antiseizure drugs, pharmacokinetics, drug interactions, adverse effects, therapeutic drug monitoring and prescribing principles for special populations. Questions range from classic agents (phenytoin, carbamazepine, valproate, phenobarbital) to newer drugs (levetiracetam, lacosamide, perampanel), addressing status epilepticus, pregnancy safety, enzyme induction/inhibition and genetic risks. The concise, keyword-rich format helps you revise for exams and placements efficiently while reinforcing clinical decision-making. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which antiseizure drug is the first-line choice for absence seizures?

• Valproate
• Carbamazepine
• Ethosuximide
• Phenytoin

Correct Answer: Ethosuximide

Q2. What is the primary mechanism of action of sodium valproate in epilepsy?

• AMPA receptor antagonism
• T-type calcium channel blockade and GABA potentiation
• SV2A synaptic vesicle modulation
• Sodium channel slow inactivation

Correct Answer: T-type calcium channel blockade and GABA potentiation

Q3. Which antiseizure drug follows zero-order kinetics at higher concentrations?

• Phenobarbital
• Phenytoin
• Lamotrigine
• Levetiracetam

Correct Answer: Phenytoin

Q4. Levetiracetam primarily exerts its antiseizure effect by binding to which protein?

• NMDA receptor
• SV2A
• GABA-A receptor
• Voltage-gated sodium channel

Correct Answer: SV2A

Q5. Which drug is most associated with the risk of severe rash in HLA-B*1502 positive patients?

• Valproate
• Carbamazepine
• Levetiracetam
• Topiramate

Correct Answer: Carbamazepine

Q6. For acute status epilepticus, the first-line intravenous treatment is:

• IV phenytoin
• IV benzodiazepine (e.g., lorazepam)
• IV valproate
• IV phenobarbital

Correct Answer: IV benzodiazepine (e.g., lorazepam)

Q7. Which antiseizure drug is contraindicated in absence seizures because it may exacerbate them?

• Ethosuximide
• Carbamazepine
• Valproate
• Clobazam

Correct Answer: Carbamazepine

Q8. Which antiseizure medication is most strongly associated with teratogenic risk, including neural tube defects?

• Levetiracetam
• Phenytoin
• Valproate
• Gabapentin

Correct Answer: Valproate

Q9. Which mechanism best describes how benzodiazepines control seizures?

• Blockade of voltage-gated sodium channels
• Enhancement of GABA-A receptor-mediated chloride influx
• Inhibition of glutamate release via NMDA antagonism
• Binding to SV2A proteins

Correct Answer: Enhancement of GABA-A receptor-mediated chloride influx

Q10. Phenytoin primarily reduces neuronal excitability by:

• Enhancing GABAergic transmission
• Blocking voltage-gated sodium channels
• Antagonizing AMPA receptors
• Inhibiting calcium channels T-type

Correct Answer: Blocking voltage-gated sodium channels

Q11. Which antiseizure drug is known for causing hyponatremia via SIADH?

• Oxcarbazepine
• Levetiracetam
• Lacosamide
• Topiramate

Correct Answer: Oxcarbazepine

Q12. Which AED is an AMPA receptor antagonist used for partial-onset seizures and has psychiatric side effects?

• Perampanel
• Lamotrigine
• Ethosuximide
• Carbamazepine

Correct Answer: Perampanel

Q13. Which drug is preferred for infantile spasms and causes potential serious liver toxicity in young children?

• Vigabatrin
• Valproate
• Infantile spasm first-line is ACTH; vigabatrin for tuberous sclerosis
• Lamotrigine

Correct Answer: Infantile spasm first-line is ACTH; vigabatrin for tuberous sclerosis

Q14. Lamotrigine’s primary antiseizure action is through:

• Enhancing GABA synthesis
• Inhibiting voltage-gated sodium channels and reducing glutamate release
• Blocking T-type calcium channels
• Binding to SV2A

Correct Answer: Inhibiting voltage-gated sodium channels and reducing glutamate release

Q15. Which antiseizure drug commonly requires monitoring of serum levels due to narrow therapeutic range?

• Topiramate
• Phenytoin
• Gabapentin
• Levetiracetam

Correct Answer: Phenytoin

Q16. Valproate interaction: co-administration with lamotrigine mainly leads to:

• Increased lamotrigine clearance
• Inhibition of lamotrigine metabolism and increased lamotrigine levels
• No interaction
• Decreased valproate levels

Correct Answer: Inhibition of lamotrigine metabolism and increased lamotrigine levels

Q17. Which AED can cause oligohidrosis, cognitive impairment, and kidney stones?

• Topiramate
• Carbamazepine
• Levetiracetam
• Ethosuximide

Correct Answer: Topiramate

Q18. Which antiseizure drug is associated with weight gain and sedation and is an irreversible GABA transaminase inhibitor?

• Vigabatrin
• Gabapentin
• Phenobarbital
• Tiagabine

Correct Answer: Vigabatrin

Q19. Which AED is an effective choice for focal seizures and causes PR interval prolongation by enhancing slow inactivation of sodium channels?

• Lacosamide
• Ethosuximide
• Valproate
• Levetiracetam

Correct Answer: Lacosamide

Q20. Which antiseizure drug is an NMDA receptor antagonist used rarely due to risk of aplastic anemia and liver failure?

• Felbamate
• Lamotrigine
• Carbamazepine
• Perampanel

Correct Answer: Felbamate

Q21. Which AED is enzyme-inducing and can reduce effectiveness of oral contraceptives?

• Valproate
• Carbamazepine
• Lamotrigine
• Levetiracetam

Correct Answer: Carbamazepine

Q22. Therapeutic drug monitoring of which AED is usually guided by free (unbound) drug concentration due to protein binding?

• Phenytoin
• Levetiracetam
• Topiramate
• Lacosamide

Correct Answer: Phenytoin

Q23. Which drug is preferred for seizure prophylaxis in brain tumor–related focal seizures?

• Phenytoin routinely for all brain tumor patients
• Levetiracetam due to fewer interactions
• Valproate as first-line for tumor seizures
• Carbamazepine due to potency

Correct Answer: Levetiracetam due to fewer interactions

Q24. What adverse effect is most characteristic of vigabatrin requiring monitoring?

• Hepatotoxicity
• Peripheral visual field defects (irreversible)
• Severe depression
• Neutropenia

Correct Answer: Peripheral visual field defects (irreversible)

Q25. Which antiseizure medication is recommended as first-line for generalized tonic-clonic seizures in women of childbearing potential with lower teratogenic risk?

• Valproate
• Lamotrigine
• Phenobarbital
• Topiramate

Correct Answer: Lamotrigine

Q26. Which antiseizure drug causes gingival hyperplasia and hirsutism as notable adverse effects?

• Ethosuximide
• Phenytoin
• Levetiracetam
• Lamotrigine

Correct Answer: Phenytoin

Q27. Mechanism of action of gabapentin in seizure control is primarily:

• Direct GABA receptor agonism
• Inhibition of presynaptic voltage-gated calcium channels (α2δ subunit)
• Enhancement of sodium channel inactivation
• SV2A binding

Correct Answer: Inhibition of presynaptic voltage-gated calcium channels (α2δ subunit)

Q28. Which AED is known to cause pancreatitis and should be used cautiously?

• Valproate
• Levetiracetam
• Lamotrigine
• Ethosuximide

Correct Answer: Valproate

Q29. Which lab monitoring is most appropriate when initiating carbamazepine therapy?

• Thyroid function tests only
• Liver function tests and complete blood count
• Serum creatinine only
• No monitoring required

Correct Answer: Liver function tests and complete blood count

Q30. A patient on chronic phenytoin therapy presents with ataxia and nystagmus. This most likely indicates:

• Subtherapeutic phenytoin levels
• Phenytoin toxicity
• Nonadherence
• Seizure breakthrough

Correct Answer: Phenytoin toxicity

Q31. Which antiseizure drug is typically preferred in status epilepticus if benzodiazepines fail and has a rapid IV formulation?

• Oral carbamazepine
• IV levetiracetam
• IM phenytoin only
• Oral valproate

Correct Answer: IV levetiracetam

Q32. Which antiseizure medication is commonly used for neuropathic pain as well as seizures?

• Ethosuximide
• Gabapentin
• Valproate
• Perampanel

Correct Answer: Gabapentin

Q33. Which AED is associated with decreased bone mineral density with long-term use?

• Levetiracetam
• Enzyme-inducing drugs like phenytoin and phenobarbital
• Lamotrigine exclusively
• Ethosuximide only

Correct Answer: Enzyme-inducing drugs like phenytoin and phenobarbital

Q34. Which medication is specifically effective for absence seizures and acts predominantly on T-type calcium channels in thalamic neurons?

• Ethosuximide
• Carbamazepine
• Phenytoin
• Topiramate

Correct Answer: Ethosuximide

Q35. Which antiseizure drug can worsen myoclonic seizures and should be used with caution?

• Valproate (may help myoclonic)
• Carbamazepine (can worsen myoclonic and absence)
• Ethosuximide (treats absence)
• Levetiracetam (often helpful)

Correct Answer: Carbamazepine (can worsen myoclonic and absence)

Q36. Which AED is enzyme-inhibiting and can increase levels of other drugs, notably lamotrigine or phenobarbital?

• Valproate
• Carbamazepine
• Phenytoin
• Phenobarbital

Correct Answer: Valproate

Q37. Which antiseizure drug commonly causes sedation, cognitive dulling and is a potent GABA-A receptor agonist used in developing countries?

• Phenobarbital
• Levetiracetam
• Lamotrigine
• Oxcarbazepine

Correct Answer: Phenobarbital

Q38. In hepatic impairment, which AED requires cautious dosing or avoidance due to hepatic metabolism?

• Levetiracetam (primarily renal)
• Valproate (extensive hepatic metabolism)
• Gabapentin (renal excretion)
• Pregabalin (renal excretion)

Correct Answer: Valproate (extensive hepatic metabolism)

Q39. Which antiseizure drug’s abrupt withdrawal can precipitate status epilepticus, so tapering is essential?

• Levetiracetam only
• Benzodiazepines and barbiturates (e.g., phenobarbital)
• Ethosuximide only
• Topiramate only

Correct Answer: Benzodiazepines and barbiturates (e.g., phenobarbital)

Q40. Which AED is associated with metabolic acidosis due to carbonic anhydrase inhibition?

• Topiramate
• Lamotrigine
• Valproate
• Phenytoin

Correct Answer: Topiramate

Q41. Which antiseizure drug is most appropriate for absence seizures in children with the best safety profile?

• Ethosuximide
• Valproate (good efficacy but higher teratogenicity concerns later)
• Carbamazepine
• Phenytoin

Correct Answer: Ethosuximide

Q42. A patient on multiple enzyme-inducing AEDs requires warfarin therapy. The likely effect on warfarin is:

• Increased INR due to inhibition
• Decreased warfarin levels and reduced INR due to induction
• No interaction
• Immediate bleeding risk reduction

Correct Answer: Decreased warfarin levels and reduced INR due to induction

Q43. Which newer AED has a mechanism enhancing slow inactivation of sodium channels and can be given orally or intravenously?

• Lacosamide
• Ethosuximide
• Perampanel
• Vigabatrin

Correct Answer: Lacosamide

Q44. Which AED is associated with polycystic ovary–like endocrine effects and hair loss in some patients?

• Valproate
• Levetiracetam
• Lamotrigine
• Topiramate

Correct Answer: Valproate

Q45. Therapeutic strategy: for a woman with generalized epilepsy planning pregnancy, which is most appropriate?

• Switch abruptly from valproate to valproate plus other drugs
• Preconception counseling and consider switching from valproate to lower-teratogenic AED like lamotrigine when feasible
• Stop all AEDs before conception
• Add enzyme-inducing AED to valproate

Correct Answer: Preconception counseling and consider switching from valproate to lower-teratogenic AED like lamotrigine when feasible

Q46. Which AED enhances potassium channel activity and is useful in generalized epilepsies with both focal and generalized features?

• Ezogabine (retigabine) — potassium channel opener (not widely used)
• Ethosuximide
• Carbamazepine
• Levetiracetam

Correct Answer: Ezogabine (retigabine) — potassium channel opener (not widely used)

Q47. Which antiseizure drug acts primarily by blocking AMPA/kainate glutamate receptors?

• Perampanel
• Lamotrigine
• Valproate
• Phenytoin

Correct Answer: Perampanel

Q48. Which AED is commonly chosen for elderly patients due to minimal drug interactions and renal adjustment?

• Carbamazepine
• Levetiracetam
• Phenobarbital
• Phenytoin

Correct Answer: Levetiracetam

Q49. Which adverse effect requires monitoring when initiating valproate therapy, particularly in children under two?

• Renal failure
• Hepatotoxicity
• Hyperglycemia
• Pulmonary fibrosis

Correct Answer: Hepatotoxicity

Q50. Which statement about therapeutic drug monitoring in epilepsy is correct?

• All AEDs require routine serum level monitoring regardless of clinical response
• Serum levels are useful when efficacy or toxicity is unclear and for drugs with narrow therapeutic index (e.g., phenytoin, valproate)
• Monitoring is only necessary for levetiracetam
• Monitoring replaces clinical assessment entirely

Correct Answer: Serum levels are useful when efficacy or toxicity is unclear and for drugs with narrow therapeutic index (e.g., phenytoin, valproate)

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