NURS 3517 Pharmacology Test 2
UPDATED ACTUAL Questions and CORRECT Answers
Question: Brief episode of abnormal electrical activity in nerve cells of the brain, which may or may
not lead to a convulsion
Correct Answer: Seizure
Question: Convulsion
Correct Answer: Involuntary spasmodic contractions of any or all voluntary muscles throughout the
body, including skeletal, facial, and ocular muscles
Question: Epilepsy
Correct Answer: Chronic, recurrent pattern of seizures
Question: Epilepsy: Primary (idiopathic)
Correct Answer: Cause cannot be determined. Roughly 50% of epilepsy cases
Question: Epilepsy: Sec- ondary (sympto- matic)
Correct Answer: Distinct cause is identified (Trauma, infection, cerebrovascular disorder)
Question: Classification of Epilepsy
Correct Answer: Generalized onset seizures - Tonic-clonic seizures - Atonic seizures Focal onset
seizures - Localized or focal region - Simple Complex - Secondary generalized
tonic-clonic Unclassified seizures
Question: Status Epilepti- cus
Correct Answer: - Multiple seizures occur that last 5 minutes or longer of continuous or elec-
trographic seizure activity or recurrent seizure activity without recovery between
seizures Result: hypotension, hypoxia, brain damage, and possibly death *True
medical emergency*
,Question: Antiepileptic Drugs
Correct Answer: - Also known as anticonvulsants Difference between epilepsy and convulsions Goals
of therapy: - To control or prevent seizures while maintaining a reasonable quality of
life - To minimize adverse effects and drug-induced toxicity - Antiepileptic drug
(AED) therapy is usually lifelong - Combination of drugs may be used - Single-drug
therapy is started before multiple-drug therapy is tried. Serum drug concentrations
must be measured: - Therapeutic drug monitoring - Serum concentrations of
phenytoin, phenobarbital, carbamazepine, and prim- idone correlate better with
seizure control and toxicity than do those of valproic acid, ethosuximide, and
clonazepam. Antiepileptic drugs traditionally used to manage seizure disorders
include: - Barbiturates - Hydantoins - Iminostilbenes plus valproic acid - Second- and
third-generation antiepileptics
Question: - Exact mechanism of action is not known. Pharmacological effects: - Reduce nerve's ability
to be stimulated - Suppress transmission of impulses from one nerve to the next - Decrease
speed of nerve impulse conduction within a neuron - Motor cortex of the brain - Abnormal
brain activity in the motor cortex could cause a partial seizure or a generalized seizure
Correct Answer: Mechanism of Action and Drug Effects
Question: Antiepileptic Drugs: Indications
Correct Answer: - Prevention or control of seizure activity - Long-term maintenance therapy for
chronic, recurring seizures - Acute treatment of convulsions and status epilepticus -
Other uses
Question: Antiepileptic Drugs: Adverse Effects
Correct Answer: - Numerous adverse effects; vary per drug - Adverse effects often necessitate a
change in medication. - Long-term therapy with phenytoin (Dilantin®) may cause
gingival hyperplasia, acne, hirsutism, and Dilantin facies. Self care: Self-management
(sleep hygiene, stress/emotions, medication adher- ence, identifying/avoiding, seizure
triggers, listening to anti seizure music) Self care: Self-efficacy (education about
,epilepsy, diagnosis, therapies, psychoso- cial aspects, self control and self esteem,
self monitoring of emotions thoughts and behaviours)
Question: Barbiturates: Phenobarbital and Primidone
Correct Answer: - Primidone is metabolized in the liver to phenobarbital. - Most common adverse
effect is sedation. - Therapeutic effects: serum drug levels of 15 to 40 mcg/mL -
Contraindications: known drug allergy, porphyria, liver or kidney impairment,
respiratory illness - Adverse effects: cardiovascular, central nervous system (CNS),
gastrointestinal (GI), and dermatological reactions
Question: Hydantoins: phenytoin sodium
Correct Answer: - Phenytoin (Dilantin®) has been used as a first-line drug for many years and is the
prototypical drug. - Long-term therapy adverse effects: gingival hyperplasia, acne,
hirsutism, Dilantin facies, and osteoporosis - Therapeutic drug levels are usually 10
to 20 mcg/mL.
Question: Hydantoins: fos- phenytoin (Cere- byx®)
Correct Answer: - Injectable prodrug of phenytoin - Water-soluble phenytoin derivative that can be
given intramuscularly or in- travenously—by IV push or continuous
infusion—without causing burning on injection associated with phenytoin - Adverse
effects
Question: Carbamazepine (Tegretol®)
Correct Answer: - Second most commonly prescribed antiepileptic drug in Canada after pheny- toin -
Autoinduction of hepatic enzymes Adverse reactions - Drug interactions
Question: Oxcarbazepine (Trileptal®)
Correct Answer: - Chemical analogue of carbamazepine - Precise mechanism of action has not been
identified. - Adverse reactions
, Question: Gabapentin (Neurontin®)
Correct Answer: - Chemical analogue of gamma-aminobutyric acid (GABA), a neurotransmitter that
inhibits brain activity - Believed to work by increasing the synthesis and synaptic
accumulation of GABA between neurons - Contraindication: known drug allergy -
Oral use only
Question: Lamotrigine (Lamictal®)
Correct Answer: - Also used for the treatment of bipolar disorder - Contraindications: drug allergy -
Common adverse effects: relatively minor CNS and GI symptoms and possible
Stevens-Johnson syndrome - Oral use only
Question: Assessment - Health history, including current medications - Drug allergies - Liver function
studies, complete blood count - Baseline vital signs Oral drugs - Take regularly, same time
each day. - Take with meals to reduce GI upset. - Do not crush, chew, or open
extended-release forms. - If patient is to take nothing orally (NPO) before a procedure,
contact the prescriber regarding AED dosage.
Correct Answer: Nursing Implica- tions for Anal- gesics: Assess- ment and Oral
Question: Nursing Implica- tions for Anal- gesics: IV
Correct Answer: IV forms - Follow manufacturer's recommendations for IV delivery (usually given
slowly) - Monitor vital signs during administration - Avoid extravasation of fluids -
Use only normal saline with IV phenytoin (Dilantin).
Question: Teach patients to keep a journal to monitor: - Response to AED - Seizure occurrence and
descriptions - Adverse effects - Instruct patients to wear a medical alert tag or ID. - AEDs
should not be discontinued abruptly. - Instruct patients to follow driving recommendations. -
Teach patients that therapy is long term and possibly lifelong (not a cure). Monitor for
therapeutic effects: - Decreased or absent seizure activity Monitor for adverse effects: -
Mental status changes, mood changes, changes in level of consciousness or sensorium - Eye
problems, visual disorders - Sore throat, fever (blood dyscrasias may occur with hydantoins)
- Many others
UPDATED ACTUAL Questions and CORRECT Answers
Question: Brief episode of abnormal electrical activity in nerve cells of the brain, which may or may
not lead to a convulsion
Correct Answer: Seizure
Question: Convulsion
Correct Answer: Involuntary spasmodic contractions of any or all voluntary muscles throughout the
body, including skeletal, facial, and ocular muscles
Question: Epilepsy
Correct Answer: Chronic, recurrent pattern of seizures
Question: Epilepsy: Primary (idiopathic)
Correct Answer: Cause cannot be determined. Roughly 50% of epilepsy cases
Question: Epilepsy: Sec- ondary (sympto- matic)
Correct Answer: Distinct cause is identified (Trauma, infection, cerebrovascular disorder)
Question: Classification of Epilepsy
Correct Answer: Generalized onset seizures - Tonic-clonic seizures - Atonic seizures Focal onset
seizures - Localized or focal region - Simple Complex - Secondary generalized
tonic-clonic Unclassified seizures
Question: Status Epilepti- cus
Correct Answer: - Multiple seizures occur that last 5 minutes or longer of continuous or elec-
trographic seizure activity or recurrent seizure activity without recovery between
seizures Result: hypotension, hypoxia, brain damage, and possibly death *True
medical emergency*
,Question: Antiepileptic Drugs
Correct Answer: - Also known as anticonvulsants Difference between epilepsy and convulsions Goals
of therapy: - To control or prevent seizures while maintaining a reasonable quality of
life - To minimize adverse effects and drug-induced toxicity - Antiepileptic drug
(AED) therapy is usually lifelong - Combination of drugs may be used - Single-drug
therapy is started before multiple-drug therapy is tried. Serum drug concentrations
must be measured: - Therapeutic drug monitoring - Serum concentrations of
phenytoin, phenobarbital, carbamazepine, and prim- idone correlate better with
seizure control and toxicity than do those of valproic acid, ethosuximide, and
clonazepam. Antiepileptic drugs traditionally used to manage seizure disorders
include: - Barbiturates - Hydantoins - Iminostilbenes plus valproic acid - Second- and
third-generation antiepileptics
Question: - Exact mechanism of action is not known. Pharmacological effects: - Reduce nerve's ability
to be stimulated - Suppress transmission of impulses from one nerve to the next - Decrease
speed of nerve impulse conduction within a neuron - Motor cortex of the brain - Abnormal
brain activity in the motor cortex could cause a partial seizure or a generalized seizure
Correct Answer: Mechanism of Action and Drug Effects
Question: Antiepileptic Drugs: Indications
Correct Answer: - Prevention or control of seizure activity - Long-term maintenance therapy for
chronic, recurring seizures - Acute treatment of convulsions and status epilepticus -
Other uses
Question: Antiepileptic Drugs: Adverse Effects
Correct Answer: - Numerous adverse effects; vary per drug - Adverse effects often necessitate a
change in medication. - Long-term therapy with phenytoin (Dilantin®) may cause
gingival hyperplasia, acne, hirsutism, and Dilantin facies. Self care: Self-management
(sleep hygiene, stress/emotions, medication adher- ence, identifying/avoiding, seizure
triggers, listening to anti seizure music) Self care: Self-efficacy (education about
,epilepsy, diagnosis, therapies, psychoso- cial aspects, self control and self esteem,
self monitoring of emotions thoughts and behaviours)
Question: Barbiturates: Phenobarbital and Primidone
Correct Answer: - Primidone is metabolized in the liver to phenobarbital. - Most common adverse
effect is sedation. - Therapeutic effects: serum drug levels of 15 to 40 mcg/mL -
Contraindications: known drug allergy, porphyria, liver or kidney impairment,
respiratory illness - Adverse effects: cardiovascular, central nervous system (CNS),
gastrointestinal (GI), and dermatological reactions
Question: Hydantoins: phenytoin sodium
Correct Answer: - Phenytoin (Dilantin®) has been used as a first-line drug for many years and is the
prototypical drug. - Long-term therapy adverse effects: gingival hyperplasia, acne,
hirsutism, Dilantin facies, and osteoporosis - Therapeutic drug levels are usually 10
to 20 mcg/mL.
Question: Hydantoins: fos- phenytoin (Cere- byx®)
Correct Answer: - Injectable prodrug of phenytoin - Water-soluble phenytoin derivative that can be
given intramuscularly or in- travenously—by IV push or continuous
infusion—without causing burning on injection associated with phenytoin - Adverse
effects
Question: Carbamazepine (Tegretol®)
Correct Answer: - Second most commonly prescribed antiepileptic drug in Canada after pheny- toin -
Autoinduction of hepatic enzymes Adverse reactions - Drug interactions
Question: Oxcarbazepine (Trileptal®)
Correct Answer: - Chemical analogue of carbamazepine - Precise mechanism of action has not been
identified. - Adverse reactions
, Question: Gabapentin (Neurontin®)
Correct Answer: - Chemical analogue of gamma-aminobutyric acid (GABA), a neurotransmitter that
inhibits brain activity - Believed to work by increasing the synthesis and synaptic
accumulation of GABA between neurons - Contraindication: known drug allergy -
Oral use only
Question: Lamotrigine (Lamictal®)
Correct Answer: - Also used for the treatment of bipolar disorder - Contraindications: drug allergy -
Common adverse effects: relatively minor CNS and GI symptoms and possible
Stevens-Johnson syndrome - Oral use only
Question: Assessment - Health history, including current medications - Drug allergies - Liver function
studies, complete blood count - Baseline vital signs Oral drugs - Take regularly, same time
each day. - Take with meals to reduce GI upset. - Do not crush, chew, or open
extended-release forms. - If patient is to take nothing orally (NPO) before a procedure,
contact the prescriber regarding AED dosage.
Correct Answer: Nursing Implica- tions for Anal- gesics: Assess- ment and Oral
Question: Nursing Implica- tions for Anal- gesics: IV
Correct Answer: IV forms - Follow manufacturer's recommendations for IV delivery (usually given
slowly) - Monitor vital signs during administration - Avoid extravasation of fluids -
Use only normal saline with IV phenytoin (Dilantin).
Question: Teach patients to keep a journal to monitor: - Response to AED - Seizure occurrence and
descriptions - Adverse effects - Instruct patients to wear a medical alert tag or ID. - AEDs
should not be discontinued abruptly. - Instruct patients to follow driving recommendations. -
Teach patients that therapy is long term and possibly lifelong (not a cure). Monitor for
therapeutic effects: - Decreased or absent seizure activity Monitor for adverse effects: -
Mental status changes, mood changes, changes in level of consciousness or sensorium - Eye
problems, visual disorders - Sore throat, fever (blood dyscrasias may occur with hydantoins)
- Many others
