FrontalCortex, Inc. is a non-profit corporation dedicated to neurology education.

Again, the Pills!

Topic: Adult

Created on Monday, October 27 2008 by rednucleus

Last modified on Monday, October 27 2008.

A 32-year-old woman visits the neurologist's office because of having many seizures during the past week. She takes daily lamotrigine 300 mg for the last 3 years for idiopathic grand mal epilepsy. She says that she was seizure-free. She is compliant with her medication and denies doing drugs. The woman is single but has started to take oral contraceptives pills since 2 months. Which one of the following would you do?

 
        A) Add levitiracetam
 
        B) Double the dose of lamotrigine
 
        C) Stop lamotrigine rapidly and give carbamazepine
 
        D) Add valproic acid
 
        E) Stop lamotrigine gradually and prescribe phenytoin
 

 


Back to the question = Go back to the top of the page.
See another question like this one = Reload a different version of this question ().
Click here for a random question = Load a random question from the database.
Clone this question = Use this question as a template to create a totally NEW question.
Rate this question = Enter detailed rating for this question!
Average rating not yet available
= How users like you have rated this question.
This question was created on October 27, 2008 by rednucleus.
This question was last modified on October 27, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Add levitiracetam

This answer is incorrect.


No need to add a second anti-epileptic. She was well-controlled using lamotrigine; simply increase the dose of lamotrigine.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




B) Double the dose of lamotrigine

This answer is correct.


Oral contraceptive pills have been shown to reduce the plasma level of lamotrigine by 30-50%; therefore, the dose of lamotrigine can be doubled to restore seizure control. Note that lamotrigine does not produce contraceptive failure.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




C) Stop lamotrigine rapidly and give carbamazepine

This answer is incorrect.


Long-term anti-epileptics should not be stopped rapidly or suddenly; besides, carbamazepine reduces the effectiveness of oral contraceptive pills.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




D) Add valproic acid

This answer is incorrect.


No need to add a second anti-epileptic. She was well-controlled using lamotrigine; simply increase the dose of lamotrigine.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




E) Stop lamotrigine gradually and prescribe phenytoin

This answer is incorrect.


Phenytoin reduces the effectiveness of oral contraceptive pills.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)Advertising:
Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
adult
Again, the Pills!
Question ID: 102708107
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/27/2008
Modified: 10/27/2008
Estimated Permutations: 120

User Comments About This Question:

0 user entries
Please log in if you'd like to add a comment.