Anticonvulsants Monitoring & Management Quiz

1. Levetiracetam (Keppra) has a unique advantage over older anticonvulsants. Which is it?

Requires frequent drug level monitoring

Minimal drug interactions and no metabolism

Lower cost than other agents

More effective for generalized seizures

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3. A patient on lamotrigine reports mood improvement and reduced seizure frequency. What is the nurse's best action?

Continue monitoring and encourage compliance

Increase the dose for better control

Discontinue after 3 months

Add a second anticonvulsant immediately

4. Carbamazepine can cause hyponatremia due to SIADH. Which symptom should alert the nurse?

Polydipsia and polyuria

Confusion, headache, and muscle cramps

Elevated blood pressure

Increased appetite

5. Which patient assessment finding suggests phenytoin toxicity rather than therapeutic effect?

Improved alertness

Horizontal nystagmus and confusion

Normal gait

Decreased seizure frequency

6. A patient abruptly stops phenobarbital after months of therapy. What is the primary risk?

Rebound hypertension

Status epilepticus or severe rebound seizures

Permanent cognitive impairment

Immediate anaphylaxis

7. Which anticonvulsant requires baseline liver function tests and periodic monitoring due to hepatotoxicity risk?

Levetiracetam

Valproic acid

Gabapentin

Pregabalin

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10. A patient taking gabapentin reports sudden diplopia and ataxia. What is the likely cause?

Therapeutic effect

Toxicity or overdose

Interaction with acetaminophen

Withdrawal syndrome

11. Which anticonvulsant requires the most frequent therapeutic drug level monitoring?

Phenytoin

Levetiracetam

Lamotrigine

Gabapentin

12. A patient on ethosuximide reports dizziness and drowsiness. When should levels be checked?

Immediately

After 5–7 days of therapy

After 7–10 days to reach steady state

Only if symptoms persist beyond 2 weeks

13. Phenobarbital is a long-acting barbiturate anticonvulsant. What is a major disadvantage of chronic use?

Causes hypertension

Tolerance develops, requiring dose escalation

No drug interactions

Cannot be used in children

14. Which anticonvulsant is safest in pregnancy due to minimal teratogenic risk?

Phenytoin

Valproic acid

Levetiracetam

Phenobarbital

15. A patient develops a severe rash after starting lamotrigine. What is the nurse's immediate concern?

Mild allergic reaction that will resolve

Stevens-Johnson syndrome or DRESS syndrome

Normal drug side effect

Indication to increase the dose

16. Carbamazepine is an inducer of CYP3A4. Which medication interaction is most clinically significant?

Increases warfarin metabolism, reducing anticoagulation

Decreases phenytoin levels

Increases digoxin toxicity

Inhibits oral contraceptive metabolism

17. A patient on valproic acid reports persistent nausea and vomiting. What is the priority nursing action?

Administer the dose with food

Check serum valproic acid level immediately

Reduce the dose without consulting the provider

Switch to extended-release formulation

18. Which drug is known to induce the metabolism of phenytoin, potentially lowering its levels?

Cimetidine

Rifampin

Ketoconazole

Fluconazole

19. Phenytoin toxicity typically manifests as ataxia, nystagmus, and confusion. What serum level usually triggers these signs?

Above 20 mcg/mL

Above 30 mcg/mL

Above 40 mcg/mL

Above 50 mcg/mL

20. What is the therapeutic serum level range for phenytoin?

5–10 mcg/mL

10–20 mcg/mL

20–30 mcg/mL

30–40 mcg/mL

Anticonvulsant Quiz: Can You Monitor the Levels?

1. Levetiracetam (Keppra) has a unique advantage over older anticonvulsants. Which is it?

2.

What first name or nickname would you like us to use?

2. Fosphenytoin is preferred over phenytoin in acute settings because it has a ______ onset and fewer infusion complications.

3. A patient on lamotrigine reports mood improvement and reduced seizure frequency. What is the nurse's best action?

4. Carbamazepine can cause hyponatremia due to SIADH. Which symptom should alert the nurse?

5. Which patient assessment finding suggests phenytoin toxicity rather than therapeutic effect?

6. A patient abruptly stops phenobarbital after months of therapy. What is the primary risk?

7. Which anticonvulsant requires baseline liver function tests and periodic monitoring due to hepatotoxicity risk?

8. A patient on valproic acid develops tremor, weight gain, and hair loss. These are classic signs of ______ toxicity.

9. Phenytoin exhibits ______ kinetics at higher serum levels, making dose adjustments unpredictable.

10. A patient taking gabapentin reports sudden diplopia and ataxia. What is the likely cause?

11. Which anticonvulsant requires the most frequent therapeutic drug level monitoring?

12. A patient on ethosuximide reports dizziness and drowsiness. When should levels be checked?

13. Phenobarbital is a long-acting barbiturate anticonvulsant. What is a major disadvantage of chronic use?

14. Which anticonvulsant is safest in pregnancy due to minimal teratogenic risk?

15. A patient develops a severe rash after starting lamotrigine. What is the nurse's immediate concern?

16. Carbamazepine is an inducer of CYP3A4. Which medication interaction is most clinically significant?

17. A patient on valproic acid reports persistent nausea and vomiting. What is the priority nursing action?

18. Which drug is known to induce the metabolism of phenytoin, potentially lowering its levels?

19. Phenytoin toxicity typically manifests as ataxia, nystagmus, and confusion. What serum level usually triggers these signs?

20. What is the therapeutic serum level range for phenytoin?