1. Henry has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: Carbamazepine auto-induces metabolism, leading to ...
1. Henry has recently started on carbamazepine to treat seizures. He comes to see you
and you note that while his carbamazepine levels had been in the therapeutic range,
they are now low. The possible cause for the low carbamazepine levels include:
Carbamazepine auto-induces metabolism, leading to lower levels despite good
compliance.
2. Carbamazepine has a Black Box Warning due to life-threatening:
Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
3. Long-term monitoring of patients who are taking carbamazepine includes:
Complete blood count every 3 to 4 months (can be a decrease in WBC &
platelets)
4. Six-year-old Felisha has recently been started on ethosuximide (Zarontin) for
seizures. She should be monitored for:
Blood dyscrasias, which are uncommon but possible
5. What should families be taught regarding seizure activity monitoring?
Prevention of seizures, patient safety, quality of life issues, reach acceptable goals for
treatment, & do not abruptly stop taking seizure meds
6. What electrolyte imbalance is associated with topiramate?
Decreased sodium bicarb leading to hyperchloremic metabolic acidosis
7. Lisa, who is overweight, recently started taking topiramate for seizures and at her
follow- up visit you note she has lost 4 kg. The appropriate action would be:
Reassure her that this is a normal side effect of topiramate and continue to monitor her
weight.
8. Travis’s seizures are well controlled on topiramate and he wants to start playing
baseball. Education for Travis regarding his topiramate includes:
He should monitor his temperature and ability to sweat in the heat while playing
9. Brandy is taking valproate (Depakote) for seizures and would like to get pregnant.
What advice would you give her?
, 615-PHARM EXAM 2 SUPER-DUPER Q&A 2017
Valproate is a known teratogen, but may be taken after the first trimester if necessary.
Keppra is a better drug to be on until the second trimester, then she can go back to
valproate.
10. What category is
valproate? Category X
11. The tricyclic antidepressants should be prescribed cautiously in patients
with: Heart disease
12. A 64-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit
for recalcitrant depression. The NP managing his primary health care needs to
understand the following regarding phenelzine and other monoamine oxidase
inhibitors (MAOIs):
He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex), MAOIs
interact with many common foods, including yogurt, sour cream, and soy sauce, and
symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate
treatment
13. What are the precautions and contraindications for tricyclic antidepressants?
Side effects are similar to anticholinergic activity such as dry mouth,
sedation,
constipation, increased appetite, blurred vision, tinnitus, euphoria, and mania. Caution
in patients with cardiac disease (terminate ventricular fibrillation, decrease cardiac
contractility, increase collateral blood circulation to ischemic heart muscles).
14. Marla is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI),
for depression. Education regarding her antidepressant includes:
SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
15. What “onset of action” symptoms should be reviewed with patients who have
been newly prescribed a selective serotonin reuptake inhibitor?
They can feel a bit of nausea, but this resolves in a week.
16. Which of the following should not be taken with a selective serotonin
reuptake inhibitor?
Alcohol
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