NUR909 Module 9a (Pharmaceutical Agents for
CNS Disorders) Exam
What is the goal with antiepileptic treatment? - Answer Limit seizure activity & minimize
side effects
True or false: Most AEDs are NOT benign & come with several side effects - Answer
True
What do the side effects of antiepileptic drugs contribute to? - Answer Non-adherence
of AED regimens
True or False: Most seizure activity responds to single drug treatment, however some do
not. The biggest challenge with adding additional antiepileptic drugs are the increased
side effects - Answer True
-Treat with as few drugs as possible
There has been a long-standing concern regarding the use of AED during __ - Answer
Pregnancy
What generation AEDs are associated with the highest incidence of fetal anomalies,
intrauterine growth retardation, & neural tube defects? - Answer First generation AEDs
The overall risk of major congenital malformations is with __ trimester AED exposure -
Answer First trimester
What drug has the highest risk for congenital malformations during pregnancy? -
Answer Valproate (Depakote)
,-AVOID during pregnancy
The risk of congenital malformation increases with what? - Answer Higher doses
-Risk increases in a dose dependent manner
In addition to directly causing anomalies, many AEDs interfere with the absorption &
metabolism of what? - Answer Folate
What does an interference with folate absoprtion & metabolsim lead to? - Answer Neural
tube defects
In addition to Valproate, first generation AEDs include a group of drugs called what? -
Answer Hydantoins
What are some first generation AEDs (hydantoins)? (6) - Answer 1. Phenytoin (Dilantin)
2. Fosphentoin (Cerebrex)
3. Mephentoin (Mesantoin)
4. Valproic acid (Depakote)
5. Carbamazepine (Tegretol)
6. Phenobarbital
First generation AEDs (hydantoins) are associated with a pattern of defects collectively
called? - Answer Fetal hydantoin syndrome
What is fetal hydantoin syndrome characterized by? (4) - Answer 1. Hypoplasia &
ossification of distal phalanges
2. Craniofacial abnormalities (microcephaly)
, 3. Cleft lip or palate
4. Mental delays
What are some "tell-tale" symptoms of fetal hydantoin syndrome? (4) - Answer 1.
Hypertelorism-widespaced eyes & flat/broad nasal bridge
2. Short upturned nose, long philtrum & thin upper lip
3. Stiff tapered fingers w/ hypoplastic fingernails
4. Hypoplastic toenails & digitalized great toe-toes that take on the appearance of
fingers
So what are all the first generation drugs (that we mentioned) associated with? - Answer
Congenital anomalies
True or false: For many years, most practitioners thought that the second generation
AED drugs were safer in pregnancy. However, it is too limited of a database to conclude
these drugs are safer - Answer True
Which defect are some second generation AEDs associated with? - Answer Oral clefts
Several registries have demonstrated a significantly increased risk of isolated,
non-syndrome related oral clefts following first trimester exposure to many of these
drugs even with folate supplementation
True or false: There are many different types of oral clefts - Answer True
1. Unilateral cleft lip
2. Bilateral cleft lip
3. Unilateral cleft lip & palate
4. Bilateral cleft lip & palate
5. Cleft palate
CNS Disorders) Exam
What is the goal with antiepileptic treatment? - Answer Limit seizure activity & minimize
side effects
True or false: Most AEDs are NOT benign & come with several side effects - Answer
True
What do the side effects of antiepileptic drugs contribute to? - Answer Non-adherence
of AED regimens
True or False: Most seizure activity responds to single drug treatment, however some do
not. The biggest challenge with adding additional antiepileptic drugs are the increased
side effects - Answer True
-Treat with as few drugs as possible
There has been a long-standing concern regarding the use of AED during __ - Answer
Pregnancy
What generation AEDs are associated with the highest incidence of fetal anomalies,
intrauterine growth retardation, & neural tube defects? - Answer First generation AEDs
The overall risk of major congenital malformations is with __ trimester AED exposure -
Answer First trimester
What drug has the highest risk for congenital malformations during pregnancy? -
Answer Valproate (Depakote)
,-AVOID during pregnancy
The risk of congenital malformation increases with what? - Answer Higher doses
-Risk increases in a dose dependent manner
In addition to directly causing anomalies, many AEDs interfere with the absorption &
metabolism of what? - Answer Folate
What does an interference with folate absoprtion & metabolsim lead to? - Answer Neural
tube defects
In addition to Valproate, first generation AEDs include a group of drugs called what? -
Answer Hydantoins
What are some first generation AEDs (hydantoins)? (6) - Answer 1. Phenytoin (Dilantin)
2. Fosphentoin (Cerebrex)
3. Mephentoin (Mesantoin)
4. Valproic acid (Depakote)
5. Carbamazepine (Tegretol)
6. Phenobarbital
First generation AEDs (hydantoins) are associated with a pattern of defects collectively
called? - Answer Fetal hydantoin syndrome
What is fetal hydantoin syndrome characterized by? (4) - Answer 1. Hypoplasia &
ossification of distal phalanges
2. Craniofacial abnormalities (microcephaly)
, 3. Cleft lip or palate
4. Mental delays
What are some "tell-tale" symptoms of fetal hydantoin syndrome? (4) - Answer 1.
Hypertelorism-widespaced eyes & flat/broad nasal bridge
2. Short upturned nose, long philtrum & thin upper lip
3. Stiff tapered fingers w/ hypoplastic fingernails
4. Hypoplastic toenails & digitalized great toe-toes that take on the appearance of
fingers
So what are all the first generation drugs (that we mentioned) associated with? - Answer
Congenital anomalies
True or false: For many years, most practitioners thought that the second generation
AED drugs were safer in pregnancy. However, it is too limited of a database to conclude
these drugs are safer - Answer True
Which defect are some second generation AEDs associated with? - Answer Oral clefts
Several registries have demonstrated a significantly increased risk of isolated,
non-syndrome related oral clefts following first trimester exposure to many of these
drugs even with folate supplementation
True or false: There are many different types of oral clefts - Answer True
1. Unilateral cleft lip
2. Bilateral cleft lip
3. Unilateral cleft lip & palate
4. Bilateral cleft lip & palate
5. Cleft palate
