MCQ Quiz: Epilepsy Patient Care

Epilepsy is a complex neurological disorder characterized by a predisposition to generate seizures, requiring careful, long-term, and highly individualized patient care. For pharmacists, managing epilepsy pharmacotherapy is a significant responsibility that involves deep knowledge of antiepileptic drugs (AEDs), including their mechanisms, side effect profiles, and drug interaction potentials. As outlined in the advanced patient care and skills lab curricula, pharmacists must be adept at applying the Pharmacists’ Patient Care Process (PPCP) to select appropriate therapies, manage acute seizures like status epilepticus, and provide crucial patient education on safety and adherence. This quiz will test your knowledge on the nuanced clinical management of patients with epilepsy.

1. Which of the following best defines epilepsy?

• a) A single, unprovoked seizure event.
• b) A neurological condition characterized by an enduring predisposition to generate epileptic seizures.
• c) Any convulsive movement of the body.
• d) A seizure caused by a reversible metabolic disturbance.

Answer: b) A neurological condition characterized by an enduring predisposition to generate epileptic seizures.

2. A patient experiences a seizure where they lose consciousness and have tonic-clonic movements involving both sides of their body from the start. This is classified as what type of seizure?

• a) Focal aware seizure
• b) Focal to bilateral tonic-clonic seizure
• c) Generalized onset motor seizure
• d) Absence seizure

Answer: c) Generalized onset motor seizure

3. Which of the following antiepileptic drugs (AEDs) is considered broad-spectrum, meaning it is effective for both focal and primary generalized seizures?

• a) Carbamazepine
• b) Oxcarbazepine
• c) Levetiracetam
• d) Phenytoin

Answer: c) Levetiracetam

4. A patient is being initiated on lamotrigine. To reduce the risk of a severe, potentially life-threatening rash (Stevens-Johnson Syndrome), it is critical to:

• a) Administer a large loading dose.
• b) Follow a slow dose titration schedule.
• c) Take the medication with a high-fat meal.
• d) Avoid co-administration with levetiracetam.

Answer: b) Follow a slow dose titration schedule.

5. A patient on chronic phenytoin therapy should be monitored for which of the following long-term adverse effects?

• a) Weight loss
• b) Gingival hyperplasia, hirsutism, and osteoporosis.
• c) Alopecia
• d) Severe hyponatremia

Answer: b) Gingival hyperplasia, hirsutism, and osteoporosis.

6. What is the first-line class of medication for the emergency treatment of status epilepticus?

• a) Barbiturates
• b) Hydantoins
• c) Benzodiazepines (e.g., lorazepam, diazepam)
• d) Broad-spectrum AEDs

Answer: c) Benzodiazepines (e.g., lorazepam, diazepam)

7. A patient is stabilized after receiving IV lorazepam for status epilepticus. What is an appropriate next step to prevent seizure recurrence?

• a) Discharge the patient with no further medication.
• b) Administer an oral dose of a maintenance AED.
• c) Administer a loading dose of a longer-acting, non-benzodiazepine AED like fosphenytoin or levetiracetam.
• d) Start a continuous infusion of lorazepam.

Answer: c) Administer a loading dose of a longer-acting, non-benzodiazepine AED like fosphenytoin or levetiracetam.

8. The primary mechanism of action of phenytoin and carbamazepine is:

• a) Enhancement of GABA-ergic transmission.
• b) Blockade of T-type calcium channels.
• c) Blockade of voltage-gated sodium channels.
• d) Antagonism of AMPA receptors.

Answer: c) Blockade of voltage-gated sodium channels.

9. Carbamazepine is a potent inducer of many CYP enzymes, including its own metabolism. This phenomenon is known as:

• a) Auto-inhibition
• b) Auto-induction
• c) First-pass metabolism
• d) Zero-order kinetics

Answer: b) Auto-induction

10. A patient taking oxcarbazepine should be monitored for which electrolyte abnormality, especially during initiation?

• a) Hyperkalemia
• b) Hypercalcemia
• c) Hyponatremia
• d) Hypermagnesemia

Answer: c) Hyponatremia

11. Valproic acid has a broad spectrum of activity but carries a black box warning for which severe adverse effects?

• a) Severe rash and aseptic meningitis.
• b) Aplastic anemia.
• c) Hepatotoxicity and pancreatitis.
• d) Optic neuritis.

Answer: c) Hepatotoxicity and pancreatitis.

12. Which AED is known for causing weight loss and cognitive side effects (e.g., word-finding difficulties), sometimes referred to as “Dopamax”?

• a) Valproic acid
• b) Gabapentin
• c) Topiramate
• d) Pregabalin

Answer: c) Topiramate

13. A standard therapeutic range for total phenytoin concentration is 10-20 mcg/mL. However, this level must be corrected for which laboratory value?

• a) Serum creatinine
• b) Serum albumin
• c) Serum potassium
• d) Hemoglobin A1c

Answer: b) Serum albumin

14. A patient has a total phenytoin level of 15 mcg/mL and an albumin of 2.0 g/dL (normal 4.0 g/dL). Their corrected phenytoin level will be:

• a) Lower than 15 mcg/mL.
• b) The same as 15 mcg/mL.
• c) Higher than 15 mcg/mL, indicating potential toxicity.
• d) Impossible to calculate.

Answer: c) Higher than 15 mcg/mL, indicating potential toxicity.

15. Which narrow-spectrum AED should be avoided in a patient with primary generalized epilepsy, as it can worsen absence and myoclonic seizures?

• a) Valproic acid
• b) Lamotrigine
• c) Carbamazepine
• d) Levetiracetam

Answer: c) Carbamazepine

16. The ketogenic diet is a non-pharmacologic option for refractory epilepsy, particularly in children. A pharmacist’s role is to ensure that:

• a) The patient’s medications are available in high-carbohydrate formulations.
• b) All of the patient’s medications (including liquid suspensions) are sugar-free and low in carbohydrates.
• c) The patient eats plenty of bread and pasta.
• d) The diet is only used for one week.

Answer: b) All of the patient’s medications (including liquid suspensions) are sugar-free and low in carbohydrates.

17. Why is patient counseling on adherence particularly critical in epilepsy management?

• a) AEDs are inexpensive.
• b) Suddenly stopping an AED can precipitate seizures or status epilepticus.
• c) Most AEDs can be taken on an as-needed basis.
• d) The medications have no side effects.

Answer: b) Suddenly stopping an AED can precipitate seizures or status epilepticus.

18. A woman of childbearing potential is being managed for epilepsy. Which AED carries the highest risk of major congenital malformations, particularly neural tube defects?

• a) Levetiracetam
• b) Lamotrigine
• c) Valproic acid
• d) Ethosuximide

Answer: c) Valproic acid

19. What is the recommended supplementation for all women of childbearing potential on AEDs?

• a) Vitamin D
• b) Calcium
• c) Folic acid
• d) Iron

Answer: c) Folic acid

20. A patient on an enzyme-inducing AED (e.g., carbamazepine, phenytoin) is prescribed an oral contraceptive. What is the potential interaction?

• a) The AED will increase contraceptive levels, causing toxicity.
• b) The AED will decrease the efficacy of the oral contraceptive, leading to a risk of unplanned pregnancy.
• c) The oral contraceptive will cause the AED level to become subtherapeutic.
• d) There is no interaction.

Answer: b) The AED will decrease the efficacy of the oral contraceptive, leading to a risk of unplanned pregnancy.

21. Ethosuximide is a narrow-spectrum AED used specifically for the treatment of which type of seizure?

• a) Focal to bilateral tonic-clonic seizures
• b) Atonic seizures
• c) Absence seizures
• d) Myoclonic seizures

Answer: c) Absence seizures

22. A patient taking levetiracetam complains of new-onset irritability and mood changes. The pharmacist recognizes this as:

• a) An unexpected reaction.
• b) A common psychiatric side effect of levetiracetam.
• c) A sign of drug-induced lupus.
• d) A symptom of an allergic reaction.

Answer: b) A common psychiatric side effect of levetiracetam.

23. As outlined in the skills lab syllabus, what is a key component of epilepsy patient care provided by a pharmacist?

• a) Performing an EEG to diagnose epilepsy.
• b) Counseling the patient on their treatment plan and medication side effects.
• c) Prescribing the initial AED.
• d) Administering IV medications for status epilepticus.

Answer: b) Counseling the patient on their treatment plan and medication side effects.

24. State laws regarding driving for patients with epilepsy typically require:

• a) That all patients with a history of a single seizure surrender their license permanently.
• b) That a patient be seizure-free for a specific period of time (e.g., 3-12 months).
• c) The pharmacist to report the patient to the DMV.
• d) That patients only drive during daylight hours.

Answer: b) That a patient be seizure-free for a specific period of time (e.g., 3-12 months).

25. A patient stabilized on phenytoin is started on trimethoprim-sulfamethoxazole for an infection. The pharmacist should be concerned about:

• a) The antibiotic decreasing phenytoin levels.
• b) The antibiotic inhibiting the metabolism of phenytoin, leading to toxicity.
• c) Phenytoin deactivating the antibiotic.
• d) The combination causing a severe rash.

Answer: b) The antibiotic inhibiting the metabolism of phenytoin, leading to toxicity.

26. Phenobarbital, an older AED, enhances the effect of which neurotransmitter?

• a) Dopamine
• b) Serotonin
• c) Acetylcholine
• d) GABA

Answer: d) GABA

27. What is a primary goal when selecting an AED for an elderly patient?

• a) To choose the most potent enzyme inducer.
• b) To select an agent with the fewest cognitive side effects and drug interactions.
• c) To use the highest possible starting dose.
• d) To choose an agent that requires frequent monitoring.

Answer: b) To select an agent with the fewest cognitive side effects and drug interactions.

28. A patient is transitioning from carbamazepine to oxcarbazepine. What is an advantage of oxcarbazepine?

• a) It is a more potent enzyme inducer.
• b) It does not cause auto-induction and generally has fewer drug interactions.
• c) It has a lower risk of hyponatremia.
• d) It is dosed once weekly.

Answer: b) It does not cause auto-induction and generally has fewer drug interactions.

29. The concept of “rational polytherapy” in epilepsy management means:

• a) Using as many AEDs as possible.
• b) Combining two AEDs with different, complementary mechanisms of action after monotherapy has failed.
• c) Combining two AEDs from the same exact class.
• d) Adding a new AED without a clear rationale.

Answer: b) Combining two AEDs with different, complementary mechanisms of action after monotherapy has failed.

30. Which AED has a unique mechanism of action involving binding to the synaptic vesicle protein SV2A?

• a) Phenytoin
• b) Carbamazepine
• c) Levetiracetam
• d) Valproic acid

Answer: c) Levetiracetam

31. When should therapeutic drug monitoring for an AED be considered?

• a) For every patient on every AED at every visit.
• b) When there is suspicion of toxicity, documented non-adherence, or a change in clinical status.
• c) Only for generic medications.
• d) It is no longer considered a useful tool.

Answer: b) When there is suspicion of toxicity, documented non-adherence, or a change in clinical status.

32. The “honeymoon effect” in epilepsy treatment refers to:

• a) An excellent initial response to a new AED followed by a return of seizures.
• b) The period before a patient is diagnosed with epilepsy.
• c) The side effects experienced when starting a new AED.
• d) The successful discontinuation of all AEDs.

Answer: a) An excellent initial response to a new AED followed by a return of seizures.

33. For a patient with epilepsy and a comorbid migraine headache disorder, which AED would be a logical choice to treat both conditions?

• a) Phenytoin
• b) Ethosuximide
• c) Topiramate or Valproic Acid
• d) Pregabalin

Answer: c) Topiramate or Valproic Acid

34. Fosphenytoin is a prodrug of phenytoin. What is the primary advantage of using fosphenytoin for IV administration?

• a) It is less expensive.
• b) It can be administered more rapidly and is less likely to cause hypotension and arrhythmias than IV phenytoin.
• c) It does not require a loading dose.
• d) It can be administered orally.

Answer: b) It can be administered more rapidly and is less likely to cause hypotension and arrhythmias than IV phenytoin.

35. A patient taking carbamazepine should be screened for which allele, particularly if they are of Asian descent, due to a high risk of SJS/TEN?

• a) HLA-B*5701
• b) HLA-B*1502
• c) CYP3A5*3
• d) TPMT

Answer: b) HLA-B*1502

36. A patient is considered to have drug-resistant epilepsy if they have failed to achieve sustained seizure freedom with:

• a) One adequate trial of an AED.
• b) Two adequate trials of tolerated and appropriately chosen AEDs (monotherapy or in combination).
• c) A non-pharmacologic therapy.
• d) Any AED, regardless of dose or duration.

Answer: b) Two adequate trials of tolerated and appropriately chosen AEDs (monotherapy or in combination).

37. Which of the following is a non-pharmacologic treatment option for drug-resistant epilepsy?

• a) Vagus nerve stimulation (VNS)
• b) Resective surgery
• c) Ketogenic diet
• d) All of the above

Answer: d) All of the above

38. When discontinuing an AED, the dose should be:

• a) Stopped abruptly.
• b) Tapered slowly over weeks to months to minimize the risk of withdrawal seizures.
• c) Doubled for one week before stopping.
• d) Cut in half for one day before stopping.

Answer: b) Tapered slowly over weeks to months to minimize the risk of withdrawal seizures.

39. A key patient education point regarding epilepsy is:

• a) The importance of a consistent sleep schedule.
• b) Avoiding known seizure triggers.
• c) The importance of medication adherence.
• d) All of the above.

Answer: d) All of the above.

40. A patient on phenytoin is tube fed. The pharmacist should recommend that the tube feeds be held for 1-2 hours before and after the phenytoin dose because:

• a) Phenytoin tastes bad when mixed with feeds.
• b) Enteral feeding products can significantly decrease the absorption of phenytoin.
• c) Phenytoin can clog the feeding tube.
• d) This increases the risk of side effects.

Answer: b) Enteral feeding products can significantly decrease the absorption of phenytoin.

41. Which AED is also commonly used for neuropathic pain?

• a) Ethosuximide
• b) Felbamate
• c) Gabapentin and Pregabalin
• d) Zonisamide

Answer: c) Gabapentin and Pregabalin

42. A patient with absence seizures presents with a brief period of staring and unresponsiveness, often with eyelid fluttering. This type of seizure is a:

• a) Generalized motor seizure
• b) Focal aware seizure
• c) Generalized non-motor seizure
• d) Myoclonic seizure

Answer: c) Generalized non-motor seizure

43. A common drug-disease interaction is that some AEDs can worsen:

• a) Hypertension
• b) Bone mineral density, leading to osteopenia or osteoporosis.
• c) Asthma
• d) Gout

Answer: b) Bone mineral density, leading to osteopenia or osteoporosis.

44. What is the role of a pharmacist in the PPCP for an epilepsy patient?

• a) To collect a thorough seizure history and medication history.
• b) To assess for drug therapy problems (e.g., wrong drug, side effects, interactions).
• c) To develop a care plan that includes medication adjustments and patient education.
• d) All of the above.

Answer: d) All of the above.

45. Which of the following AEDs is available as an auto-injector for the acute treatment of seizure clusters by a caregiver outside the hospital?

• a) Phenytoin
• b) Levetiracetam
• c) Diazepam rectal gel or midazolam nasal spray
• d) Valproic acid

Answer: c) Diazepam rectal gel or midazolam nasal spray

46. “Pseudo-resistance” in epilepsy refers to:

• a) The development of true pharmacologic resistance.
• b) Apparent treatment failure that is actually due to patient non-adherence.
• c) A seizure that is not epileptic in origin.
• d) The honeymoon effect.

Answer: b) Apparent treatment failure that is actually due to patient non-adherence.

47. A patient with epilepsy and a history of kidney stones should use which AED with caution?

• a) Levetiracetam
• b) Valproic acid
• c) Topiramate or Zonisamide
• d) Lamotrigine

Answer: c) Topiramate or Zonisamide

48. The primary goal of epilepsy therapy is:

• a) To cure the epilepsy.
• b) To achieve a “no seizures, no side effects” balance for the patient.
• c) To use the highest possible dose of medication.
• d) To prevent the patient from ever driving again.

Answer: b) To achieve a “no seizures, no side effects” balance for the patient.

49. For a patient with focal seizures, which AED is a reasonable first-line choice?

• a) Ethosuximide
• b) Lamotrigine, Levetiracetam, or Carbamazepine
• c) Valproic acid is the only option.
• d) Phenobarbital

Answer: b) Lamotrigine, Levetiracetam, or Carbamazepine

50. An important ethical issue in epilepsy care that a pharmacist may encounter is:

• a) Deciding which brand of medication to dispense.
• b) Balancing patient autonomy with public safety, particularly regarding issues like driving.
• c) Choosing the color of the tablets.
• d) The cost of EEG monitoring.

Answer: b) Balancing patient autonomy with public safety, particularly regarding issues like driving.