Chapter 15. Drugs Affecting the Central Nervous System
____ 1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of
phentermine is prescribed. Prescribing precautions include:
1. Understanding that obesity is a contraindication to prescribing phentermine
2. Anorexiants may cause tolerance and should only be prescribed for 6 months
3. Patients should be monitored for postural hypotension
4. Renal function should be monitored closely while on anorexiants
____ 2. Before prescribing phentermine to Sarah, a thorough drug history should be taken including
assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs)
and St John’s wort due to:
1. Additive respiratory depression risk
2. Additive effects affecting liver function
3. The risk of serotonin syndrome
4. The risk of altered cognitive functioning
____ 3. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine
antiseizure medication, she should also have a home prescription for_________ to be used for an
episode of status epilepticus.
1. IV phenobarbital
2. Rectal diazepam (Diastat)
3. IV phenytoin (Dilantin)
4. Oral carbamazepine (Tegretol)
____ 4. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
1. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
2. For pedal edema throughout therapy
3. Heart rate at each visit and consider altering therapy if heart rate is less than 60
bpm
4. For vision changes, such as red-green blindness, at least annually
____ 5. Dwayne 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:
1. Dwayne hasn’t been taking his carbamazepine because it causes insomnia.
2. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good
compliance.
3. Dwayne was not originally prescribed the correct amount of carbamazepine.
4. Carbamazepine is probably not the right antiseizure medication for Dwayne.
____ 6. Carbamazepine has a Black Box Warning due to life-threatening:
1. Renal toxicity, leading to renal failure
2. Hepatotoxicity, leading to liver failure
, 3. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
4. Cardiac effects, including supraventricular tachycardia
____ 7. Long-term monitoring of patients who are taking carbamazepine includes:
1. Routine troponin levels to assess for cardiac damage
2. Annual eye examinations to assess for cataract development
3. Monthly pregnancy tests for all women of childbearing age
4. Complete blood count every 3 to 4 months
____ 8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be
monitored for:
1. Increased seizure activity, as this drug may auto-induce seizures
2. Altered renal function, including renal failure
3. Blood dyscrasias, which are uncommon but possible
4. Central nervous system excitement, leading to insomnia
____ 9. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling
depressed and having “strange” thoughts. The appropriate initial action would be:
1. Increase her dose
2. Assess for suicidal ideation
3. Discontinue the medication immediately
4. Decrease her dose to half then slowly titrate up the dose
____ 10. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit
you note she has lost 3 kg. The appropriate action would be:
1. Tell her to increase her caloric intake to counter the effects of the topiramate.
2. Consult with a neurologist, as this is not a common adverse effect of topiramate.
3. Decrease her dose of topiramate.
4. Reassure her that this is a normal side effect of topiramate and continue to monitor
her weight.
____ 11. Monitoring of a patient on gabapentin to treat seizures includes:
1. Routine therapeutic drug levels every 3 to 4 months
2. Assessing for dermatologic reactions, including Steven’s Johnson
3. Routine serum electrolytes, especially in hot weather
4. Recording seizure frequency, duration, and severity
____ 12. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education
for Scott regarding his topiramate includes:
1. He should not play sports due to the risk of increased seizures
2. He should monitor his temperature and ability to sweat in the heat while playing
3. Reminding him that he may need higher dosages of topiramate when exercising
4. Encouraging him to use sunscreen due to photosensitivity from topiramate
____ 13. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes
reminding her:
1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
2. To wear sunscreen due to photosensitivity from levetiracetam
3. To get an annual eye exam while on levetiracetam
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