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</p> Signup and view all the answers

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

    <p>Pregnancy</p> Signup and view all the answers

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

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

    What is the recommended administration of extended release lamotrigine tablets?

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

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

    <p>Urine protein test</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%.</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</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.</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</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.</p> Signup and view all the answers

    What is the primary metabolic pathway for valproic acid?

    <p>Glucuronidation</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</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</p> Signup and view all the answers

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

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

    What is the mechanism of action of valproic acid?

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

    What is the primary labeled indication for valproic acid use?

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

    What is lamotrigine's mechanism of action?

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

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

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

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

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

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