Clinical Pharmacology III: Week 3
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Questions and Answers

What is the approximate free fraction of valproic acid at a concentration of 130 mcg/mL?

  • 5%
  • 15% (correct)
  • 10%
  • 20%

In which patient populations is protein binding of valproic acid decreased?

  • Elderly (correct)
  • Children
  • Adolescents
  • Adults

What is the primary labeled indication for valproic acid use?

  • Bipolar disorder (correct)
  • Anxiety disorders
  • Depression
  • Schizophrenia

For which condition is lamotrigine used off-label as monotherapy?

<p>Migraine prophylaxis (B)</p> Signup and view all the answers

What is the main contraindication for administering valproic acid to women?

<p>Pregnancy (C)</p> Signup and view all the answers

Which of the following is the primary metabolic pathway for topiramate?

<p>Hydroxylation, hydrolysis, and glucuronidation (B)</p> Signup and view all the answers

What effect do enzyme inducers (e.g. carbamazepine, phenytoin) have on topiramate metabolism?

<p>Increase the percentage of dose metabolized in the liver and clearance (B)</p> Signup and view all the answers

What is a contraindication for the extended-release formulation of topiramate (Trokendi XR)?

<p>Recent alcohol use within 6 hours prior to and 6 hours after administration (A)</p> Signup and view all the answers

What is a labeled indication for topiramate?

<p>Prophylaxis of migraine headache in patients ≥12 years of age (A)</p> Signup and view all the answers

What is a contraindication for the extended-release formulation of topiramate (Qudexy XR)?

<p>Patients with metabolic acidosis who are taking concomitant metformin (B)</p> Signup and view all the answers

Which of the following is a potential central nervous system side effect of immediate release lamotrigine in adolescents and adults?

<p>Dizziness (C)</p> Signup and view all the answers

What is the recommended administration of extended release lamotrigine tablets?

<p>Administer with food (C)</p> Signup and view all the answers

What range of maternal serum concentrations of lamotrigine were observed in the study?

<p>5.4 to 69 mg/L (B)</p> Signup and view all the answers

Which of the following is a potential food interaction with immediate release lamotrigine?

<p>No significant effect on rate or extent of absorption (D)</p> Signup and view all the answers

What type of false positive test result has been reported with lamotrigine?

<p>Urine protein test (B)</p> Signup and view all the answers

Which statement about lamotrigine's pharmacokinetics is correct?

<p>It is rapidly and completely absorbed, with a bioavailability of 97.6%. (B)</p> Signup and view all the answers

Which of the following is NOT a labeled indication for lamotrigine?

<p>Treatment of partial seizures in adults (B)</p> Signup and view all the answers

What is lamotrigine's mechanism of action?

<p>It inhibits the release of glutamate and voltage-sensitive sodium channels, stabilizing neuronal membranes. (C)</p> Signup and view all the answers

Which of the following is a potential contraindication or precaution for lamotrigine use?

<p>History of Stevens-Johnson syndrome or toxic epidermal necrolysis (D)</p> Signup and view all the answers

Which of the following statements about lamotrigine's pharmacodynamics is correct?

<p>It has a weak inhibitory effect on the $5-HT_3$ receptor. (D)</p> Signup and view all the answers

What is the primary metabolic pathway for valproic acid?

<p>Glucuronidation (C)</p> Signup and view all the answers

Which of the following patient populations is at an increased risk of high serum concentrations of lamotrigine due to decreased drug clearance?

<p>Neonates and young infants (A)</p> Signup and view all the answers

Which of the following is a potential adverse effect of lamotrigine that may require close monitoring?

<p>Suicidal ideation (B)</p> Signup and view all the answers

What is the recommended administration of lamotrigine extended-release (XR) tablets?

<p>Administer without regard to meals (A)</p> Signup and view all the answers

What is the mechanism of action of valproic acid?

<p>Potentiation of GABA-mediated neurotransmission (D)</p> Signup and view all the answers

What is the primary labeled indication for valproic acid use?

<p>Treatment of bipolar disorder (A)</p> Signup and view all the answers

Which of the following is the main contraindication for administering valproic acid to women?

<p>Potential for fetal malformations (B)</p> Signup and view all the answers

What is lamotrigine's mechanism of action?

<p>Sodium channel blockade (D)</p> Signup and view all the answers

What type of false positive test result has been reported with lamotrigine?

<p>Serum pregnancy test (B)</p> Signup and view all the answers

What is the recommended approach for monitoring lamotrigine levels in pregnant women with epilepsy?

<p>Measure serum levels once or twice prior to pregnancy and up to once a month during pregnancy (A)</p> Signup and view all the answers

Which factor has NOT been identified as a predictor of the risk of rash caused by lamotrigine?

<p>Coadministration with valproate (C)</p> Signup and view all the answers

What is a recommended precaution for lamotrigine use in pediatric populations to reduce the risk of serious skin rashes?

<p>Gradual tapering over 2 weeks (D)</p> Signup and view all the answers

What is a potential consequence of abruptly discontinuing anticonvulsant therapy like lamotrigine?

<p>Greater risk of increased seizure frequency (A)</p> Signup and view all the answers

Which special population requires caution and possible dosage adjustment when using lamotrigine due to hepatic impairment?

<p>Patients with hepatic impairment (B)</p> Signup and view all the answers

What should be considered when withdrawing lamotrigine therapy to minimize the risk of increased seizure frequency?

<p>Gradual tapering over at least 2 weeks (C)</p> Signup and view all the answers

Which of the following is NOT a recommended monitoring parameter for lamotrigine therapy?

<p>Platelet count (A)</p> Signup and view all the answers

Which of the following statements about valproic acid's mechanism of action is correct?

<p>It enhances GABA-mediated chloride influx at GABA-A receptors (C)</p> Signup and view all the answers

Which of the following is a potential sign or symptom that should prompt discontinuation of lamotrigine?

<p>Skin rash, unless clearly not drug-related (A)</p> Signup and view all the answers

Which of the following adverse effects is specifically mentioned as a reason to assess for suicide ideation during lamotrigine therapy?

<p>Both depression and unusual behavior changes (C)</p> Signup and view all the answers

What is the recommended approach for dosing lamotrigine?

<p>Dose based on therapeutic response rather than serum concentrations (D)</p> Signup and view all the answers

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