AGNP Board Exam – Neurology Assessment
1. Question:
Which of the following medications is NOT a serotonin 5-HT1 receptor
agonist?
Axert.
Fioricet. Correct
Maxalt.
Zomig.
Explanation:
Fioricet is a combination of butalbital, acetaminophen and caffeine. Axert
(almotriptan), Maxalt (rizatriptan), Zomig (zolmitriptan) are all classified as
serotonin 5-HT1 receptor agonists, or triptans.
2. Question:
A patient presenting with a transient ischemic attack (TIA) is taking
nifedipine (Adalat CC) for hypertension. Pharmacokinetics of nifedipine may
be altered in patients with:
renal insufficiency.
hepatic impairment. Correct
irritable bowel disease.
G6PD deficiency.
Explanation:
Since hepatic biotransformation is the predominant route for the disposition
of nifedipine, the pharmacokinetics may be altered in patients with chronic
liver disease. Patients with hepatic impairment have a longer disposition
half-life and higher bioavailability of nifedipine than healthy volunteers.
3. Question:
Oxcarbazepine (Trileptal) is structurally similar to:
carbamazepine (Tegretol). Correct
divalproex sodium (Depakote).
lamotrigine (Lamictal).
topiramate (Topamax).
Explanation:
As the name suggests, oxcarbazepine (Trileptal) is related to carbamazepine
(Tegretol, Carbatrol) and appears to be similarly effective for controlling
complex partial seizures and primary and secondary generalized tonic-clonic
seizures. It seems to cause fewer unwanted side effects in many (but not all)
patients. Oxcarbazepine is not effective against absence or myoclonic
seizures.
, 4. Question:
Patients who experience greater than 7 to 9 tension-type headaches per
month may be considered for maintenance therapy including:
anticonvulsants and tricyclic antidepressants.
antidepressants and beta-blockers.
anticonvulsants and muscle relaxants.
muscle relaxants and tricyclic antidepressants. Correct
Explanation:
Patients who experience greater than 7 to 9 tension-type headaches per
month may be considered for maintenance therapy including muscle
relaxants (i.e., tizanidine) and tricyclic antidepressants (i.e., amitriptyline).
Muscle relaxants are considered second-line therapy to be added to TCAs if
inadequate in reducing headache episodes. Antiepileptics and beta-blockers
may be indicated for the prophylactic treatment of migraines. There is more
evidence of effectiveness with amitriptyline than doxepin, or with other
antidepressants such as venlafaxine and mirtazapine. Doses used are
generally low and not in the range used to treat depression. The need for
continued chronic treatment of tension-type headaches should be reviewed
at least every 6 months.
5. Question:
Beta-blockers, used for the prophylactic treatment of migraines, would NOT
be contraindicated in a patient with a history of:
ventricular arrhythmias.
2nd degree heart block.
pulmonary congestion.
acute coronary syndrome. Correct
Explanation:
Beta-blockers are contraindicated in patients who have a history of
ventricular arrhythmias, sick sinus syndrome, 2nd or 3rd degree heart block,
cardiogenic shock, and pulmonary congestion. Beta-blockers are indicated in
acute coronary syndrome in order to prevent recurrent ischemia and life-
threatening ventricular arrhythmias.
6. Question:
Patients who are taking carbidopa/levodopa (Sinemet) for Parkinson's
disease should be advised to avoid a diet high in:
carbohydrates.
fat.
protein. Correct
sodium.
Explanation:
,Since levodopa competes with certain amino acids for transport across the
gut wall, the absorption of levodopa may be impaired in some patients on a
high-protein diet. The patient should be advised that a change in diet to
foods that are high in protein may delay the absorption of levodopa and may
reduce the amount taken up in the circulation. Excessive acidity also delays
stomach emptying, thus delaying the absorption of levodopa. Iron salts (such
as in multivitamin tablets) may also reduce the amount of levodopa available
to the body. The above factors may reduce the clinical effectiveness of the
levodopa or carbidopa levodopa therapy.
7. Question:
Which of the following statements is NOT true about antiepileptic drugs
(AEDs)?
Antiepileptics should be withdrawn gradually.
Antiepileptics may increase the risk of suicidal thoughts.
Dosing of antiepileptics should be based on therapeutic drug
levels. Correct
The pharmacokinetics of antiepileptics are influenced by age, especially
during childhood.
Explanation:
Due to individual variation, many patients may require concentrations
outside the reference ranges. Dosing of antiepileptic drugs (AEDs) is best
defined as the concentration at which a person achieves the best
compromise between improvement in seizure control and concentration-
related adverse effects. All antiepileptic drugs should be withdrawn gradually
to minimize the potential for increased seizure frequency. AEDs may
increase the risk of suicidal thoughts or behavior in patients taking these
drugs for any indication. The pharmacokinetics of AEDs are markedly
influenced by age, especially during infancy and childhood. For most AEDs
studied in infants and young children, pharmacokinetic characteristics
include shorter elimination half-lives and, at times, larger volume distribution
values compared with adults.
8. Question:
Patients who are taking divalproex sodium (Depakote) and lamotrigine
(Lamictal) are at higher risk for developing:
central nervous system depression.
false-positive drug screens for tetrahydrocannabinol.
hormone-related side effects.
rash, including Stevens-Johnson syndrome. Correct
Explanation:
Serious rashes (including Stevens-Johnson syndrome and toxic epidermal
necrolysis) requiring hospitalization and discontinuation of treatment have
occurred in pediatric and adult patients who have received the drug as
, adjunctive therapy with valproic acid for the treatment of epilepsy. When
Lamictal is given in conjunction with estrogen plus oral contraceptives, the
dose of Lamictal will need to be adjusted, especially if hormone therapy is
discontinued. Lamictal may interfere with the assay used in some rapid urine
drug screens, which can result in false-positive readings, particularly for
phencyclidine (PCP). Use a more specific analytical method to confirm a
positive result.
9. Question:
Children who are receiving gabapentin (Neurontin) should be monitored for:
emotional lability. Correct
hypoesthesia.
symptoms of tardive dyskinesia.
weight loss.
Explanation:
Use in pediatric patients with epilepsy has been associated with CNS adverse
effects of mild to moderate intensity. The most significant include emotional
lability, hostility (e.g., aggressive behaviors), changes in behavior and
thinking (e.g., concentration problems and changes in school performance),
and hyperkinesia (primarily restlessness and hyperactivity). Monitor all
patients for notable changes in behavior that might indicate suicidal
thoughts or depression. Other side effects include hyperesthesia (sensitive
skin), weight gain, nystagmus, dizziness and drowsiness.
10. Question:
During initiation of treatment and escalation of doses, pramipexole (Mirapex)
and other dopamine agonists are known to cause:
akathisia.
gastrointestinal bleeding.
orthostatic hypotension. Correct
thrombocytopenia.
Explanation:
In clinical studies and clinical experience, dopamine agonists appear to
impair the systemic regulation of blood pressure, resulting in orthostatic
hypotension. This occurs at initiation and during dose escalation. In addition,
Parkinson's disease patients appear to have an impaired capacity to respond
to an orthostatic challenge. For these reasons, both Parkinson's disease
patients and restless leg syndrome (RLS) patients being treated with
dopaminergic agonists ordinarily require careful monitoring for signs and
symptoms of orthostatic hypotension, especially during dose escalation.
They should be informed of this risk.
1. Question:
Which of the following medications is NOT a serotonin 5-HT1 receptor
agonist?
Axert.
Fioricet. Correct
Maxalt.
Zomig.
Explanation:
Fioricet is a combination of butalbital, acetaminophen and caffeine. Axert
(almotriptan), Maxalt (rizatriptan), Zomig (zolmitriptan) are all classified as
serotonin 5-HT1 receptor agonists, or triptans.
2. Question:
A patient presenting with a transient ischemic attack (TIA) is taking
nifedipine (Adalat CC) for hypertension. Pharmacokinetics of nifedipine may
be altered in patients with:
renal insufficiency.
hepatic impairment. Correct
irritable bowel disease.
G6PD deficiency.
Explanation:
Since hepatic biotransformation is the predominant route for the disposition
of nifedipine, the pharmacokinetics may be altered in patients with chronic
liver disease. Patients with hepatic impairment have a longer disposition
half-life and higher bioavailability of nifedipine than healthy volunteers.
3. Question:
Oxcarbazepine (Trileptal) is structurally similar to:
carbamazepine (Tegretol). Correct
divalproex sodium (Depakote).
lamotrigine (Lamictal).
topiramate (Topamax).
Explanation:
As the name suggests, oxcarbazepine (Trileptal) is related to carbamazepine
(Tegretol, Carbatrol) and appears to be similarly effective for controlling
complex partial seizures and primary and secondary generalized tonic-clonic
seizures. It seems to cause fewer unwanted side effects in many (but not all)
patients. Oxcarbazepine is not effective against absence or myoclonic
seizures.
, 4. Question:
Patients who experience greater than 7 to 9 tension-type headaches per
month may be considered for maintenance therapy including:
anticonvulsants and tricyclic antidepressants.
antidepressants and beta-blockers.
anticonvulsants and muscle relaxants.
muscle relaxants and tricyclic antidepressants. Correct
Explanation:
Patients who experience greater than 7 to 9 tension-type headaches per
month may be considered for maintenance therapy including muscle
relaxants (i.e., tizanidine) and tricyclic antidepressants (i.e., amitriptyline).
Muscle relaxants are considered second-line therapy to be added to TCAs if
inadequate in reducing headache episodes. Antiepileptics and beta-blockers
may be indicated for the prophylactic treatment of migraines. There is more
evidence of effectiveness with amitriptyline than doxepin, or with other
antidepressants such as venlafaxine and mirtazapine. Doses used are
generally low and not in the range used to treat depression. The need for
continued chronic treatment of tension-type headaches should be reviewed
at least every 6 months.
5. Question:
Beta-blockers, used for the prophylactic treatment of migraines, would NOT
be contraindicated in a patient with a history of:
ventricular arrhythmias.
2nd degree heart block.
pulmonary congestion.
acute coronary syndrome. Correct
Explanation:
Beta-blockers are contraindicated in patients who have a history of
ventricular arrhythmias, sick sinus syndrome, 2nd or 3rd degree heart block,
cardiogenic shock, and pulmonary congestion. Beta-blockers are indicated in
acute coronary syndrome in order to prevent recurrent ischemia and life-
threatening ventricular arrhythmias.
6. Question:
Patients who are taking carbidopa/levodopa (Sinemet) for Parkinson's
disease should be advised to avoid a diet high in:
carbohydrates.
fat.
protein. Correct
sodium.
Explanation:
,Since levodopa competes with certain amino acids for transport across the
gut wall, the absorption of levodopa may be impaired in some patients on a
high-protein diet. The patient should be advised that a change in diet to
foods that are high in protein may delay the absorption of levodopa and may
reduce the amount taken up in the circulation. Excessive acidity also delays
stomach emptying, thus delaying the absorption of levodopa. Iron salts (such
as in multivitamin tablets) may also reduce the amount of levodopa available
to the body. The above factors may reduce the clinical effectiveness of the
levodopa or carbidopa levodopa therapy.
7. Question:
Which of the following statements is NOT true about antiepileptic drugs
(AEDs)?
Antiepileptics should be withdrawn gradually.
Antiepileptics may increase the risk of suicidal thoughts.
Dosing of antiepileptics should be based on therapeutic drug
levels. Correct
The pharmacokinetics of antiepileptics are influenced by age, especially
during childhood.
Explanation:
Due to individual variation, many patients may require concentrations
outside the reference ranges. Dosing of antiepileptic drugs (AEDs) is best
defined as the concentration at which a person achieves the best
compromise between improvement in seizure control and concentration-
related adverse effects. All antiepileptic drugs should be withdrawn gradually
to minimize the potential for increased seizure frequency. AEDs may
increase the risk of suicidal thoughts or behavior in patients taking these
drugs for any indication. The pharmacokinetics of AEDs are markedly
influenced by age, especially during infancy and childhood. For most AEDs
studied in infants and young children, pharmacokinetic characteristics
include shorter elimination half-lives and, at times, larger volume distribution
values compared with adults.
8. Question:
Patients who are taking divalproex sodium (Depakote) and lamotrigine
(Lamictal) are at higher risk for developing:
central nervous system depression.
false-positive drug screens for tetrahydrocannabinol.
hormone-related side effects.
rash, including Stevens-Johnson syndrome. Correct
Explanation:
Serious rashes (including Stevens-Johnson syndrome and toxic epidermal
necrolysis) requiring hospitalization and discontinuation of treatment have
occurred in pediatric and adult patients who have received the drug as
, adjunctive therapy with valproic acid for the treatment of epilepsy. When
Lamictal is given in conjunction with estrogen plus oral contraceptives, the
dose of Lamictal will need to be adjusted, especially if hormone therapy is
discontinued. Lamictal may interfere with the assay used in some rapid urine
drug screens, which can result in false-positive readings, particularly for
phencyclidine (PCP). Use a more specific analytical method to confirm a
positive result.
9. Question:
Children who are receiving gabapentin (Neurontin) should be monitored for:
emotional lability. Correct
hypoesthesia.
symptoms of tardive dyskinesia.
weight loss.
Explanation:
Use in pediatric patients with epilepsy has been associated with CNS adverse
effects of mild to moderate intensity. The most significant include emotional
lability, hostility (e.g., aggressive behaviors), changes in behavior and
thinking (e.g., concentration problems and changes in school performance),
and hyperkinesia (primarily restlessness and hyperactivity). Monitor all
patients for notable changes in behavior that might indicate suicidal
thoughts or depression. Other side effects include hyperesthesia (sensitive
skin), weight gain, nystagmus, dizziness and drowsiness.
10. Question:
During initiation of treatment and escalation of doses, pramipexole (Mirapex)
and other dopamine agonists are known to cause:
akathisia.
gastrointestinal bleeding.
orthostatic hypotension. Correct
thrombocytopenia.
Explanation:
In clinical studies and clinical experience, dopamine agonists appear to
impair the systemic regulation of blood pressure, resulting in orthostatic
hypotension. This occurs at initiation and during dose escalation. In addition,
Parkinson's disease patients appear to have an impaired capacity to respond
to an orthostatic challenge. For these reasons, both Parkinson's disease
patients and restless leg syndrome (RLS) patients being treated with
dopaminergic agonists ordinarily require careful monitoring for signs and
symptoms of orthostatic hypotension, especially during dose escalation.
They should be informed of this risk.
