40 Questions
What is the approximate free fraction of valproic acid at a concentration of 130 mcg/mL?
15%
In which patient populations is protein binding of valproic acid decreased?
Elderly
What is the primary labeled indication for valproic acid use?
Bipolar disorder
For which condition is lamotrigine used off-label as monotherapy?
Migraine prophylaxis
What is the main contraindication for administering valproic acid to women?
Pregnancy
Which of the following is the primary metabolic pathway for topiramate?
Hydroxylation, hydrolysis, and glucuronidation
What effect do enzyme inducers (e.g. carbamazepine, phenytoin) have on topiramate metabolism?
Increase the percentage of dose metabolized in the liver and clearance
What is a contraindication for the extended-release formulation of topiramate (Trokendi XR)?
Recent alcohol use within 6 hours prior to and 6 hours after administration
What is a labeled indication for topiramate?
Prophylaxis of migraine headache in patients ≥12 years of age
What is a contraindication for the extended-release formulation of topiramate (Qudexy XR)?
Patients with metabolic acidosis who are taking concomitant metformin
Which of the following is a potential central nervous system side effect of immediate release lamotrigine in adolescents and adults?
Dizziness
What is the recommended administration of extended release lamotrigine tablets?
Administer with food
What range of maternal serum concentrations of lamotrigine were observed in the study?
5.4 to 69 mg/L
Which of the following is a potential food interaction with immediate release lamotrigine?
No significant effect on rate or extent of absorption
What type of false positive test result has been reported with lamotrigine?
Urine protein test
Which statement about lamotrigine's pharmacokinetics is correct?
It is rapidly and completely absorbed, with a bioavailability of 97.6%.
Which of the following is NOT a labeled indication for lamotrigine?
Treatment of partial seizures in adults
What is lamotrigine's mechanism of action?
It inhibits the release of glutamate and voltage-sensitive sodium channels, stabilizing neuronal membranes.
Which of the following is a potential contraindication or precaution for lamotrigine use?
History of Stevens-Johnson syndrome or toxic epidermal necrolysis
Which of the following statements about lamotrigine's pharmacodynamics is correct?
It has a weak inhibitory effect on the $5-HT_3$ receptor.
What is the primary metabolic pathway for valproic acid?
Glucuronidation
Which of the following patient populations is at an increased risk of high serum concentrations of lamotrigine due to decreased drug clearance?
Neonates and young infants
Which of the following is a potential adverse effect of lamotrigine that may require close monitoring?
Suicidal ideation
What is the recommended administration of lamotrigine extended-release (XR) tablets?
Administer without regard to meals
What is the mechanism of action of valproic acid?
Potentiation of GABA-mediated neurotransmission
What is the primary labeled indication for valproic acid use?
Treatment of bipolar disorder
Which of the following is the main contraindication for administering valproic acid to women?
Potential for fetal malformations
What is lamotrigine's mechanism of action?
Sodium channel blockade
What type of false positive test result has been reported with lamotrigine?
Serum pregnancy test
What is the recommended approach for monitoring lamotrigine levels in pregnant women with epilepsy?
Measure serum levels once or twice prior to pregnancy and up to once a month during pregnancy
Which factor has NOT been identified as a predictor of the risk of rash caused by lamotrigine?
Coadministration with valproate
What is a recommended precaution for lamotrigine use in pediatric populations to reduce the risk of serious skin rashes?
Gradual tapering over 2 weeks
What is a potential consequence of abruptly discontinuing anticonvulsant therapy like lamotrigine?
Greater risk of increased seizure frequency
Which special population requires caution and possible dosage adjustment when using lamotrigine due to hepatic impairment?
Patients with hepatic impairment
What should be considered when withdrawing lamotrigine therapy to minimize the risk of increased seizure frequency?
Gradual tapering over at least 2 weeks
Which of the following is NOT a recommended monitoring parameter for lamotrigine therapy?
Platelet count
Which of the following statements about valproic acid's mechanism of action is correct?
It enhances GABA-mediated chloride influx at GABA-A receptors
Which of the following is a potential sign or symptom that should prompt discontinuation of lamotrigine?
Skin rash, unless clearly not drug-related
Which of the following adverse effects is specifically mentioned as a reason to assess for suicide ideation during lamotrigine therapy?
Both depression and unusual behavior changes
What is the recommended approach for dosing lamotrigine?
Dose based on therapeutic response rather than serum concentrations
This quiz covers the drugs used for Parkinson's Disease, Huntington Disease, Tourette Syndrome, and Antiseizure medications. Associated readings include Basic & Clinical Pharmacology 15th Edition, chapters 24 and 28. Supplemental resources from Access Pharmacy may also be helpful.
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