MCQ Quiz: Management of Epilepsy

The management of epilepsy, a core module in the Patient Care VII: Brain and Behavior course, requires pharmacists to apply a wide range of clinical skills. This quiz is designed to test your knowledge of managing epilepsy through the Pharmacists’ Patient Care Process (PPCP), from initial drug selection based on seizure type to complex pharmacokinetic monitoring and patient counseling. Questions are based on curriculum topics including the acute management of seizures, care for special populations, and the legal and ethical issues faced by patients with epilepsy.

1. What is the primary goal in the management of epilepsy?

• A. To use the highest number of anti-seizure medications (ASMs) possible.
• B. To achieve a seizure-free state with minimal adverse effects, thereby improving quality of life.
• C. To cure epilepsy within one year of treatment.
• D. To only treat generalized tonic-clonic seizures.

Answer: B. To achieve a seizure-free state with minimal adverse effects, thereby improving quality of life.

2. The initial selection of an anti-seizure medication is most dependent on which factor?

• A. The cost of the medication.
• B. The patient’s preference for a specific brand.
• C. The seizure type and epilepsy syndrome.
• D. The pharmacy’s inventory.

Answer: C. The seizure type and epilepsy syndrome.

3. Which anti-seizure medication is considered a narrow-spectrum agent, primarily effective only for absence seizures?

• A. Valproic acid
• B. Levetiracetam
• C. Ethosuximide
• D. Lamotrigine

Answer: C. Ethosuximide

4. According to the “Acute Management of Epilepsy” unit, what is the first-line class of medication for the emergent treatment of status epilepticus?

• A. Intravenous barbiturates
• B. Intravenous hydantoins
• C. Intravenous benzodiazepines
• D. Intravenous anesthetics

Answer: C. Intravenous benzodiazepines

5. A patient’s phenytoin level is 15 mcg/mL. The dose is increased by 20%, and the new level is 25 mcg/mL. This disproportionate increase is due to phenytoin’s:

• A. Linear pharmacokinetics.
• B. Non-linear (Michaelis-Menten) pharmacokinetics.
• C. Rapid renal clearance.
• D. Low protein binding.

Answer: B. Non-linear (Michaelis-Menten) pharmacokinetics.

6. A pharmacist is counseling a patient of Southeast Asian descent before they start carbamazepine. Management should include a discussion about testing for which allele to prevent a serious adverse reaction?

• A. CYP2C9*3
• B. VKORC1
• C. HLA-B*1502
• D. MTHFR

Answer: C. HLA-B*1502

7. A critical, non-pharmacological counseling point in the management of epilepsy involves discussing:

• A. The patient’s favorite foods.
• B. The importance of medication adherence to maintain seizure control.
• C. The latest trends in fashion.
• D. The benefits of a high-caffeine diet.

Answer: B. The importance of medication adherence to maintain seizure control.

8. Which anti-seizure medication is considered broad-spectrum, making it effective for both focal and multiple types of generalized seizures?

• A. Ethosuximide
• B. Valproic acid
• C. Pregabalin
• D. Lacosamide

Answer: B. Valproic acid

9. Therapeutic drug monitoring is essential in the management of a patient taking phenytoin. What is the standard therapeutic range for total phenytoin concentration?

• A. 1-5 mcg/mL
• B. 50-100 mcg/mL
• C. 5-10 mcg/mL
• D. 10-20 mcg/mL

Answer: D. 10-20 mcg/mL

10. A patient taking an enzyme-inducing ASM like carbamazepine or phenytoin may need a(n) _______ dose of a concurrently administered drug that is a substrate of the induced enzyme.

• A. decreased
• B. identical
• C. increased
• D. weight-based

Answer: C. increased

11. A woman with epilepsy who is of childbearing potential should be counseled that valproic acid carries a high risk of:

• A. Causing weight loss.
• B. Inducing the metabolism of oral contraceptives.
• C. Teratogenicity, including neural tube defects.
• D. Causing kidney stones.

Answer: C. Teratogenicity, including neural tube defects.

12. When initiating lamotrigine, the dose must be titrated slowly to reduce the risk of what potentially life-threatening adverse effect?

• A. Gingival hyperplasia
• B. Aplastic anemia
• C. Stevens-Johnson Syndrome (SJS).
• D. Pancreatitis

Answer: C. Stevens-Johnson Syndrome (SJS).

13. A patient is being switched from carbamazepine to oxcarbazepine. What is a key management consideration?

• A. The dose of oxcarbazepine should be approximately 50% higher than the carbamazepine dose.
• B. The risk of hyponatremia may be higher with oxcarbazepine.
• C. Oxcarbazepine is less likely to cause a rash.
• D. Both A and B are correct.

Answer: B. The risk of hyponatremia may be higher with oxcarbazepine.

14. What is the purpose of using fosphenytoin in the acute management of seizures?

• A. It is an oral prodrug for long-term management.
• B. It is a water-soluble IV prodrug of phenytoin that allows for faster infusion with fewer infusion-site reactions.
• C. It has a different mechanism of action than phenytoin.
• D. It does not require a loading dose.

Answer: B. It is a water-soluble IV prodrug of phenytoin that allows for faster infusion with fewer infusion-site reactions.

15. A patient on chronic phenytoin therapy should be counseled on maintaining good oral hygiene to mitigate the risk of:

• A. Tooth discoloration.
• B. Gingival hyperplasia.
• C. Dental caries.
• D. Dry mouth.

Answer: B. Gingival hyperplasia.

16. Which of the following is an appropriate initial step in the management of a newly diagnosed adult with focal seizures?

• A. Start with polytherapy using two broad-spectrum ASMs.
• B. Initiate monotherapy with a narrow-spectrum ASM like lamotrigine or levetiracetam.
• C. Recommend a ketogenic diet as first-line therapy.
• D. Immediately start an IV infusion of a benzodiazepine.

Answer: B. Initiate monotherapy with a narrow-spectrum ASM like lamotrigine or levetiracetam.

17. The pharmacist’s “Assess” step in the PPCP for an epilepsy patient involves evaluating:

• A. Only the cost of the medication.
• B. Seizure frequency, medication adherence, and adverse effects.
• C. Only the patient’s diet.
• D. The pharmacy’s inventory levels.

Answer: B. Seizure frequency, medication adherence, and adverse effects.

18. If a patient experiences a breakthrough seizure, what is the most important information to collect first?

• A. The patient’s favorite TV show.
• B. Whether the patient has been adherent to their medication regimen.
• C. The cost of their last refill.
• D. The name of their primary care physician.

Answer: B. Whether the patient has been adherent to their medication regimen.

19. Topiramate is known to cause cognitive side effects. When counseling a patient, this can be described as:

• A. Improved memory.
• B. Word-finding difficulties or “brain fog.”
• C. Increased alertness.
• D. A feeling of euphoria.

Answer: B. Word-finding difficulties or “brain fog.”

20. A patient taking valproic acid should have their liver function tests (LFTs) and complete blood count (CBC) monitored to check for:

• A. Hypernatremia and leukocytosis.
• B. Hepatotoxicity and thrombocytopenia.
• C. Renal failure and thrombocytosis.
• D. Hypokalemia and anemia.

Answer: B. Hepatotoxicity and thrombocytopenia.

21. Abruptly discontinuing a benzodiazepine used for seizure control can precipitate:

• A. A complete cure.
• B. Status epilepticus.
• C. A depressive episode.
• D. A hypertensive crisis.

Answer: B. Status epilepticus.

22. Management of epilepsy in a pediatric patient requires special consideration for:

• A. The potential effects of ASMs on cognitive development and behavior.
• B. The fact that children metabolize all drugs faster than adults.
• C. The preference for using only the oldest available medications.
• D. The assumption that children cannot experience side effects.

Answer: A. The potential effects of ASMs on cognitive development and behavior.

23. Which ASM is also frequently used for the management of bipolar disorder?

• A. Ethosuximide
• B. Levetiracetam
• C. Lamotrigine
• D. Lacosamide

Answer: C. Lamotrigine

24. A patient’s corrected phenytoin level should be calculated if they have:

• A. High serum albumin.
• B. Low serum albumin.
• C. High serum creatinine.
• D. Low serum potassium.

Answer: B. Low serum albumin.

25. A key educational point for a patient starting any new ASM is to:

• A. Stop the medication if they have one breakthrough seizure.
• B. Avoid driving until they know how the medication affects them.
• C. Take the medication only when they feel a seizure coming on.
• D. Double the dose if one is missed.

Answer: B. Avoid driving until they know how the medication affects them.

26. The “Plan” step of the PPCP involves creating patient-centered goals. For an epilepsy patient, a goal might be:

• A. “The patient will be seizure-free.”
• B. “The patient will be seizure-free within the next 6 months with no more than one tolerable side effect.”
• C. “The patient will take their medication.”
• D. “The pharmacist will monitor drug levels.”

Answer: B. “The patient will be seizure-free within the next 6 months with no more than one tolerable side effect.”

27. Which of the following is NOT a primary mechanism of action for currently available ASMs?

• A. Enhancement of GABA-mediated inhibition
• B. Modulation of voltage-gated ion channels (Na+, Ca2+)
• C. Binding to the synaptic vesicle protein SV2A
• D. Agonism at the dopamine D2 receptor

Answer: D. Agonism at the dopamine D2 receptor

28. If a patient has failed two appropriate monotherapy trials, the next step in management is often:

• A. To discontinue all medications.
• B. To consider rational polytherapy (combination therapy).
• C. To recommend surgery immediately.
• D. To switch to an herbal supplement.

Answer: B. To consider rational polytherapy (combination therapy).

29. The management of an ASM overdose would fall under which Patient Care course?

• A. Patient Care VI: Skin and Musculoskeletal Disorders
• B. Patient Care VII: Brain and Behavior
• C. Patient Care IV: Gastrointestinal and Renal Disorders
• D. Patient Care V: Endocrinology and Women’s and Men’s Health

Answer: B. Patient Care VII: Brain and Behavior

30. The “Follow-up: Monitor and Evaluate” step of the PPCP is a continuous process in epilepsy management that includes:

• A. A single phone call after one year.
• B. Regular assessment of seizure control, side effects, and adherence.
• C. Only checking lab values.
• D. Only checking refill history.

Answer: B. Regular assessment of seizure control, side effects, and adherence.

31. A patient with a history of kidney stones should be monitored carefully if started on which ASM?

• A. Levetiracetam
• B. Lamotrigine
• C. Topiramate
• D. Phenobarbital

Answer: C. Topiramate

32. The primary goal of using a loading dose of an ASM in an acute setting is to:

• A. Test for an allergic reaction.
• B. Quickly achieve a therapeutic concentration.
• C. Minimize side effects.
• D. Induce its own metabolism.

Answer: B. Quickly achieve a therapeutic concentration.

33. Which ASM is also commonly used for migraine prophylaxis?

• A. Phenytoin
• B. Ethosuximide
• C. Topiramate
• D. Carbamazepine

Answer: C. Topiramate

34. The “Implement” step of the PPCP for an epilepsy patient includes educating the patient on their care plan and:

• A. Documenting all actions and communications.
• B. Formulating a problem list.
• C. Collecting subjective information.
• D. Assessing medication appropriateness.

Answer: A. Documenting all actions and communications.

35. A patient taking carbamazepine should be counseled to report any signs of fever, sore throat, or unusual bleeding, which could indicate:

• A. A common CNS side effect.
• B. A serious hematologic adverse reaction like aplastic anemia.
• C. Hyponatremia.
• D. An interaction with their diet.

Answer: B. A serious hematologic adverse reaction like aplastic anemia.

36. For most patients, the goal of epilepsy management is to control seizures while allowing the patient to:

• A. Avoid all social activities.
• B. Maintain a normal and productive life.
• C. Sleep for most of the day.
• D. Stop working or attending school.

Answer: B. Maintain a normal and productive life.

37. Which of the following is an example of rational polytherapy?

• A. Combining two drugs with the exact same mechanism of action.
• B. Combining two drugs with different, complementary mechanisms of action.
• C. Combining two drugs that are both potent enzyme inducers.
• D. Combining three or more ASMs at the same time.

Answer: B. Combining two drugs with different, complementary mechanisms of action.

38. The management of epilepsy in women is a special consideration due to:

• A. The teratogenicity of some ASMs.
• B. The effect of enzyme-inducing ASMs on hormonal contraception.
• C. Changes in seizure frequency during the menstrual cycle.
• D. All of the above.

Answer: D. All of the above.

39. A patient is considered to have drug-resistant epilepsy if they have failed adequate trials of:

• A. One anti-seizure medication.
• B. Two tolerated and appropriately chosen and used anti-seizure medications.
• C. Three or more anti-seizure medications.
• D. Any anti-seizure medication.

Answer: B. Two tolerated and appropriately chosen and used anti-seizure medications.

40. A key aspect of managing epilepsy is patient empowerment, which includes:

• A. Making all decisions for the patient.
• B. Educating the patient so they can be an active participant in their own care.
• C. Withholding information about side effects.
• D. Discouraging the patient from asking questions.

Answer: B. Educating the patient so they can be an active participant in their own care.

41. Which dosage form might be considered for a pediatric epilepsy patient who cannot swallow tablets?

• A. An injectable formulation only.
• B. An oral solution, sprinkle capsule, or chewable tablet.
• C. An inhaled formulation.
• D. A transdermal patch.

Answer: B. An oral solution, sprinkle capsule, or chewable tablet.

42. When a patient switches from carbamazepine to another ASM that is not an auto-inducer, the doses of other drugs they are taking may need to be:

• A. Increased.
• B. Decreased.
• C. Kept the same.
• D. Discontinued.

Answer: B. Decreased.

43. The therapeutic plan for an epilepsy patient should always be:

• A. Rigid and unchangeable.
• B. Individualized to the patient’s needs and reassessed regularly.
• C. Based on a single drug level.
• D. The same for every patient with the same seizure type.

Answer: B. Individualized to the patient’s needs and reassessed regularly.

44. After an initial IV benzodiazepine in status epilepticus, a second, longer-acting agent is given to:

• A. Reverse the sedation.
• B. Prevent immediate seizure recurrence.
• C. Treat the underlying cause.
• D. Lower blood pressure.

Answer: B. Prevent immediate seizure recurrence.

45. Which of the following is a “narrow-spectrum” ASM?

• A. Valproic Acid
• B. Levetiracetam
• C. Lamotrigine
• D. Ethosuximide

Answer: D. Ethosuximide

46. Patient education on adherence is part of which Entrustable Professional Activity (EPA)?

• A. Fulfilling a medication order.
• B. Collaborating as a member of an interprofessional team.
• C. Educating the patient and others trusted by the patient regarding the appropriate use of a medication.
• D. Answering medication-related questions using scientific literature.

Answer: C. Educating the patient and others trusted by the patient regarding the appropriate use of a medication.

47. The management of seizure “clusters” or acute repetitive seizures in the outpatient setting may involve the use of a:

• A. Rectal diazepam gel or intranasal midazolam spray.
• B. Daily high-dose oral phenobarbital.
• C. A single dose of IV phenytoin.
• D. An oral antibiotic.

Answer: A. Rectal diazepam gel or intranasal midazolam spray.

48. Why is it important to differentiate between a seizure and epilepsy in management?

• A. It is not important; the treatment is the same.
• B. A single, provoked seizure may not require long-term ASM therapy, whereas epilepsy does.
• C. All seizures lead to a diagnosis of epilepsy.
• D. Epilepsy is easier to treat than a single seizure.

Answer: B. A single, provoked seizure may not require long-term ASM therapy, whereas epilepsy does.

49. In the management of epilepsy, the pharmacist plays a key role in identifying and resolving:

• A. Only insurance issues.
• B. Medication therapy problems.
• C. Only social problems.
• D. Only diagnostic dilemmas.

Answer: B. Medication therapy problems.

50. A successful management plan for epilepsy results in:

• A. The patient never having to see a doctor again.
• B. A partnership between the patient and the healthcare team to achieve the best possible outcomes.
• C. The patient taking at least four different ASMs.
• D. The complete elimination of all side effects.

Answer: B. A partnership between the patient and the healthcare team to achieve the best possible outcomes. Sources

Generate Audio Overview