Chapter 45: Antiepileptics

Chapter 45: Antiepileptics

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient who has partial seizures has been taking phenytoin (Dilantin). The patient has recently developed thrombocytopenia. The primary care nurse practitioner (NP) should contact the patient’s neurologist to discuss changing the patient’s medication to:

ANS:  D

Evidence-based recommendations exist showing carbamazepine to be effective as monotherapy for partial seizures. Because this patient has developed a serious side effect of phenytoin, changing to carbamazepine may be a good option. The other three drugs may be added to phenytoin or another first-line drug when drug-resistant seizures occur, but are not recommended as monotherapy.

DIF:    Cognitive Level: Applying (Application)                           REF:   491

2. A patient is newly diagnosed with generalized epilepsy. The primary care NP will refer this patient to a neurologist and should expect this patient to begin taking:

ANS:  A

There is little good-quality evidence to support the use of newer monotherapy over older drugs. Phenytoin is the prototype of many seizure medications and is usually tried first. Other drugs may be used if seizures are resistant to phenytoin or if side effects occur.

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   491

3. A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication. The NP should:

ANS:  A

Discontinuation of AEDs may be considered in patients who have been seizure-free for longer than 2 years. An EEG should be obtained before the medication is withdrawn. The drug should be tapered to prevent status epilepticus, but only after a normal EEG is obtained. AED therapy is not lifelong in all patients. Patients should not stop AED medications abruptly, and these drugs are not used on an as-needed basis.

DIF:    Cognitive Level: Applying (Application)                           REF:   492

4. A 12-month-old child with severe developmental delays was recently treated in an emergency department for a febrile seizure and is seen by the primary care NP for a follow-up visit. The child’s parent asks if it is necessary to continue giving the child phenobarbital. The NP should tell the parent that:

ANS:  D

Although the American Academy of Pediatrics has concluded that the risks of long-term treatment with phenobarbital outweigh the potential benefits in most cases, continued treatment with this drug is used in children at greatest risk for future neurologic problems, including children with febrile seizures before 18 months of age and children with neurologic dysfunction or severe developmental delays.

DIF:    Cognitive Level: Applying (Application)                           REF:   492