Miscellaneous anticonvulsants – Felbamate MCQs With Answer

Introduction: Felbamate is a miscellaneous anticonvulsant used as adjunctive therapy for refractory epilepsy, notably Lennox-Gastaut syndrome. B. Pharm students should understand felbamate’s mechanisms (NMDA antagonism, GABA potentiation, sodium channel blockade), hepatic metabolism, therapeutic role, severe adverse effects such as aplastic anemia and hepatic failure, and key drug interactions requiring monitoring. Practical knowledge of dosing principles, baseline and follow-up laboratory tests (CBC, LFTs), contraindications, and patient counseling points is essential for safe use. This focused review and question set will deepen your clinical pharmacology and pharmaceutical care skills. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is a primary pharmacological action of felbamate that contributes to its anticonvulsant effect?

• Potent inhibition of monoamine oxidase
• Antagonism of NMDA (N-methyl-D-aspartate) receptors
• Selective beta-adrenergic blockade
• Inhibition of acetylcholinesterase

Correct Answer: Antagonism of NMDA (N-methyl-D-aspartate) receptors

Q2. Felbamate’s anticonvulsant activity also involves modulation of which inhibitory neurotransmitter system?

• Dopaminergic system
• Serotonergic system
• GABAergic system (positive modulation of GABA-A)
• Histaminergic system

Correct Answer: GABAergic system (positive modulation of GABA-A)

Q3. Which severe hematologic adverse effect is classically associated with felbamate and limits its use?

• Agranulocytosis
• Polycythemia vera
• Aplastic anemia
• Hemolytic anemia

Correct Answer: Aplastic anemia

Q4. Which hepatic complication has been reported with felbamate therapy and requires monitoring?

• Cholestatic jaundice only
• Autoimmune hepatitis exclusively
• Fulminant hepatic failure
• Portal hypertension

Correct Answer: Fulminant hepatic failure

Q5. Before initiating felbamate therapy, which baseline laboratory tests are essential?

• Serum electrolytes and urinalysis only
• Complete blood count (CBC) and liver function tests (LFTs)
• Thyroid function tests only
• Serum amylase and lipase only

Correct Answer: Complete blood count (CBC) and liver function tests (LFTs)

Q6. The main clinical indication for felbamate in modern practice is:

• First-line therapy for generalized tonic-clonic seizures
• Adjunctive treatment for refractory epilepsy such as Lennox-Gastaut syndrome
• Acute management of status epilepticus
• Treatment of absence seizures as monotherapy

Correct Answer: Adjunctive treatment for refractory epilepsy such as Lennox-Gastaut syndrome

Q7. Felbamate’s metabolism primarily occurs in which organ?

• Kidney
• Lung
• Liver
• Skeletal muscle

Correct Answer: Liver

Q8. What monitoring frequency is recommended early after starting felbamate to detect hematologic toxicity?

• Once yearly
• No monitoring required
• Frequent CBC monitoring during initial months
• Only monitor if symptoms occur

Correct Answer: Frequent CBC monitoring during initial months

Q9. Which of the following is a common practical counseling point for patients starting felbamate?

• No need to report fever or sore throat
• Report signs of infection, unexplained bruising, or jaundice immediately
• Stop medication abruptly if feeling drowsy
• Take only on an empty stomach always

Correct Answer: Report signs of infection, unexplained bruising, or jaundice immediately

Q10. Felbamate’s mechanism includes blockade of which ion channel involved in seizure propagation?

• Potassium channels only
• Voltage-gated sodium channels
• Chloride channels solely
• Hyperpolarization-activated cyclic nucleotide channels (HCN) only

Correct Answer: Voltage-gated sodium channels

Q11. Which patient history would be a contraindication to prescribing felbamate?

• History of well-controlled migraines
• History of aplastic anemia
• Seasonal allergic rhinitis
• Mild eczema

Correct Answer: History of aplastic anemia

Q12. Which formulation(s) of felbamate are commonly available for clinical use?

• Intravenous injection only
• Oral tablets and oral suspension
• Topical cream
• Transdermal patch

Correct Answer: Oral tablets and oral suspension

Q13. If a patient on felbamate develops unexplained bruising and pallor, the pharmacist should suspect which condition?

• Dehydration
• Aplastic anemia
• Hypothyroidism
• Essential thrombocythemia

Correct Answer: Aplastic anemia

Q14. Which drug interaction concern is associated with felbamate?

• It has no interactions with other antiepileptics
• Felbamate can alter plasma concentrations of other antiepileptic drugs
• Felbamate universally decreases all other drug levels
• Felbamate only interacts with antibiotics

Correct Answer: Felbamate can alter plasma concentrations of other antiepileptic drugs

Q15. The risk-benefit decision for using felbamate in pregnancy should be:

• Use freely; it is proven safe in pregnancy
• Avoid all antiepileptic drugs including felbamate at all costs
• Use only if potential maternal benefit justifies potential fetal risk
• Prescribe at double the usual dose during pregnancy

Correct Answer: Use only if potential maternal benefit justifies potential fetal risk

Q16. Which adverse effect is NOT typically associated with felbamate?

• Insomnia
• Nausea and vomiting
• Aplastic anemia
• Immediate severe anaphylaxis in all patients

Correct Answer: Immediate severe anaphylaxis in all patients

Q17. In terms of therapeutic positioning, felbamate is best described as:

• First-line monotherapy for all seizure types
• Adjunctive therapy reserved for refractory cases due to safety concerns
• Only used for migraine prophylaxis
• Primary choice for febrile seizures in infants

Correct Answer: Adjunctive therapy reserved for refractory cases due to safety concerns

Q18. Which clinical syndrome is most commonly cited as an indication for felbamate adjunctive therapy?

• Lennox-Gastaut syndrome
• Parkinson’s disease
• Alzheimer’s disease
• Essential tremor

Correct Answer: Lennox-Gastaut syndrome

Q19. Which monitoring parameter helps detect early liver injury in a patient on felbamate?

• Serum creatinine
• Liver function tests (ALT, AST, bilirubin)
• Serum magnesium
• Fasting blood glucose only

Correct Answer: Liver function tests (ALT, AST, bilirubin)

Q20. Which statement about felbamate’s pharmacokinetics is correct?

• Felbamate is excreted unchanged entirely via kidneys
• Felbamate is absorbed orally and extensively metabolized by the liver
• Felbamate has zero hepatic metabolism
• Felbamate is only active as an intravenous prodrug

Correct Answer: Felbamate is absorbed orally and extensively metabolized by the liver

Q21. Which adverse psychiatric or neurological symptom may be associated with felbamate therapy?

• Increased seizure frequency in all patients
• Somnolence, dizziness, and potential cognitive effects
• Guaranteed improvement in mood disorders
• Hyperactivity in elderly only

Correct Answer: Somnolence, dizziness, and potential cognitive effects

Q22. After starting felbamate, when should clinicians be most vigilant for evidence of aplastic anemia?

• During the first few months of therapy
• Only after 10 years of continuous therapy
• It cannot occur after starting therapy
• Only in the first 24 hours

Correct Answer: During the first few months of therapy

Q23. Which action is appropriate if a patient on felbamate shows a falling white blood cell count?

• Ignore and continue therapy if seizures are controlled
• Immediately evaluate, consider drug discontinuation, and consult a specialist
• Double the dose to overcome the laboratory changes
• Switch to topical therapy

Correct Answer: Immediately evaluate, consider drug discontinuation, and consult a specialist

Q24. Which of the following mechanisms does NOT contribute to felbamate’s anticonvulsant action?

• NMDA receptor antagonism
• GABA-A receptor potentiation
• Voltage-gated sodium channel blockade
• Beta-lactamase inhibition

Correct Answer: Beta-lactamase inhibition

Q25. Felbamate therapy requires patient education about which warning sign related to liver toxicity?

• Excessive sweating only
• Onset of jaundice, dark urine, or persistent nausea
• Improved appetite within 24 hours
• Temporary hair growth

Correct Answer: Onset of jaundice, dark urine, or persistent nausea

Q26. Which is an important drug interaction concern when combining felbamate with enzyme-metabolized antiepileptic drugs?

• Felbamate universally neutralizes other drugs
• Felbamate may alter levels of concomitant antiepileptics leading to toxicity or loss of efficacy
• Felbamate reduces absorption of all coadministered drugs
• Felbamate enhances renal clearance of all drugs

Correct Answer: Felbamate may alter levels of concomitant antiepileptics leading to toxicity or loss of efficacy

Q27. Which population requires particularly careful assessment before prescribing felbamate?

• Patients with history of seizure disorder only
• Patients with prior hepatic disease or blood dyscrasias
• All athletes
• Patients with seasonal allergies

Correct Answer: Patients with prior hepatic disease or blood dyscrasias

Q28. Which clinical outcome makes felbamate a considered option despite its risks?

• Mild, easily controlled seizures
• Refractory seizures not responsive to other agents
• Non-epileptic psychogenic events
• Tension-type headache

Correct Answer: Refractory seizures not responsive to other agents

Q29. Which adverse laboratory finding should prompt immediate discontinuation of felbamate?

• Isolated mild hyperglycemia
• Marked drop in hemoglobin and platelets consistent with marrow failure
• Transient mild elevation of creatine kinase after exercise
• Asymptomatic mild electrolyte change

Correct Answer: Marked drop in hemoglobin and platelets consistent with marrow failure

Q30. Which one best describes felbamate’s place in therapy for pediatric patients?

• First-line agent for febrile seizures
• Used cautiously as adjunctive therapy in severe, refractory pediatric epilepsy
• Not used in children under any circumstances
• Primary therapy for ADHD in children

Correct Answer: Used cautiously as adjunctive therapy in severe, refractory pediatric epilepsy

Q31. In counselling a caregiver, which instruction about missed doses of felbamate is appropriate?

• Double the next dose to make up
• Skip the missed dose and continue the regular schedule; consult prescriber for guidance
• Stop medication permanently
• Take ten times the next dose

Correct Answer: Skip the missed dose and continue the regular schedule; consult prescriber for guidance

Q32. Which adverse effect profile makes felbamate less favorable compared to many other antiepileptics?

• Mild headache and transient dizziness only
• Risk of life-threatening aplastic anemia and hepatic failure
• No drug interactions
• Guaranteed weight loss in all patients

Correct Answer: Risk of life-threatening aplastic anemia and hepatic failure

Q33. Which of the following monitoring strategies is most appropriate for a patient on ongoing felbamate therapy?

• No monitoring is necessary after baseline tests
• Periodic CBC and LFT monitoring during treatment
• Only monitor blood pressure monthly
• Only monitor serum sodium levels

Correct Answer: Periodic CBC and LFT monitoring during treatment

Q34. Felbamate is often reserved as adjunct therapy after failure of which approach?

• Nonpharmacologic therapy only
• Standard antiepileptic drug regimens due to its safety profile
• Immediate surgical intervention
• Herbal supplements exclusively

Correct Answer: Standard antiepileptic drug regimens due to its safety profile

Q35. Which patient report should prompt urgent laboratory evaluation while on felbamate?

• New rash with fever or mucosal ulcers
• Improved seizure control
• Slight appetite increase
• Temporary mild cough

Correct Answer: New rash with fever or mucosal ulcers

Q36. Compared to many antiepileptics, felbamate’s major limitation is primarily due to:

• Extremely short half-life
• Serious idiosyncratic toxicities affecting bone marrow and liver
• Inability to be formulated as a tablet
• Lack of oral bioavailability

Correct Answer: Serious idiosyncratic toxicities affecting bone marrow and liver

Q37. Which clinical scenario best justifies careful use of felbamate?

• Patient with newly diagnosed, easily controlled epilepsy
• Patient with severe refractory seizures who has failed multiple other agents
• Patient with only occasional syncope
• Patient with mild anxiety disorder

Correct Answer: Patient with severe refractory seizures who has failed multiple other agents

Q38. Which of the following statements about dose titration of felbamate is true?

• Start at very high doses immediately to achieve rapid control
• Start lower and titrate cautiously while monitoring for toxicity
• Do not adjust dosing based on clinical response
• Discontinue if any minor side effect occurs without assessment

Correct Answer: Start lower and titrate cautiously while monitoring for toxicity

Q39. Which feature in a patient’s lab results would directly indicate bone marrow suppression on felbamate?

• Low hemoglobin, leukopenia, and thrombocytopenia
• Elevated serum creatinine only
• Isolated mild hypernatremia
• Low urine specific gravity only

Correct Answer: Low hemoglobin, leukopenia, and thrombocytopenia

Q40. Which statement reflects the appropriate pharmacist action when dispensing felbamate?

• Advise no monitoring is required
• Counsel about signs of infection, bleeding, and jaundice and recommend regular CBC and LFTs
• Tell patients it cures epilepsy permanently
• Recommend over-the-counter supplements to avoid monitoring

Correct Answer: Counsel about signs of infection, bleeding, and jaundice and recommend regular CBC and LFTs

Q41. Which type of seizure is felbamate particularly effective against when used as adjunctive therapy?

• Psychogenic non-epileptic seizures
• Seizures in Lennox-Gastaut syndrome including drop attacks
• Only peripheral neuropathy-related twitching
• Isolated transient ischemic attacks

Correct Answer: Seizures in Lennox-Gastaut syndrome including drop attacks

Q42. Felbamate’s safety concerns led to which clinical approach regarding its use?

• Routine first-line prescribing for all patients
• Restricted or cautious use, with informed consent and close monitoring
• Complete ban in all countries
• Use only in topical dermatology

Correct Answer: Restricted or cautious use, with informed consent and close monitoring

Q43. Which symptom is NOT a typical early warning sign of serious felbamate toxicity?

• Fever and sore throat
• Easy bruising or mucosal bleeding
• Jaundice and right upper quadrant pain
• Immediate and complete resolution of seizures

Correct Answer: Immediate and complete resolution of seizures

Q44. In drug interaction management, pharmacists should be aware that felbamate can:

• Never affect drug levels of other medications
• Alter plasma concentrations of some antiepileptics requiring dosage adjustments
• Always neutralize the effect of antibiotics
• Only interact with vitamins

Correct Answer: Alter plasma concentrations of some antiepileptics requiring dosage adjustments

Q45. When considering discontinuation, felbamate should be stopped how?

• Abruptly in all cases
• Tapered gradually under medical supervision to reduce seizure risk
• Switched overnight to an alternative without supervision
• Stopped only if the patient demands it

Correct Answer: Tapered gradually under medical supervision to reduce seizure risk

Q46. Which clinical documentation is important when initiating felbamate in a patient?

• No documentation is required
• Informed discussion of risks and benefits, baseline CBC and LFTs, and monitoring plan
• Only document the tablet color
• Only document the patient’s shoe size

Correct Answer: Informed discussion of risks and benefits, baseline CBC and LFTs, and monitoring plan

Q47. Which describes the nature of felbamate-induced liver injury?

• Mild, transient, and clinically insignificant always
• Can be idiosyncratic and severe, potentially fulminant
• Only occurs with massive overdose
• Always predictable by dose

Correct Answer: Can be idiosyncratic and severe, potentially fulminant

Q48. For a B. Pharm student counseling a patient, which statement about felbamate efficacy is balanced and appropriate?

• Felbamate cures epilepsy with no risks
• Felbamate can reduce seizures in refractory cases but carries rare serious risks that require monitoring
• Felbamate is only for headaches
• Felbamate must be taken only once a month

Correct Answer: Felbamate can reduce seizures in refractory cases but carries rare serious risks that require monitoring

Q49. Which action should be taken if significant LFT elevations occur in a patient on felbamate?

• Continue treatment and ignore results
• Evaluate for hepatic injury and consider discontinuation of felbamate
• Increase dose to overcome lab abnormalities
• Switch to topical therapy

Correct Answer: Evaluate for hepatic injury and consider discontinuation of felbamate

Q50. Which general principle best guides the clinical use of felbamate in pharmacy practice?

• Use broad-spectrum in all new seizure patients without monitoring
• Reserve for refractory cases, ensure informed consent, and monitor CBC and LFTs regularly
• Prescribe freely with no follow-up
• Recommend felbamate to treat bacterial infections

Correct Answer: Reserve for refractory cases, ensure informed consent, and monitor CBC and LFTs regularly

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