Neurology
Melody Ryan, Pharm.D.,
MPH, BCPS
University of Kentucky
Lexington, Kentucky
Learning Objectives
1. Differentiate between various seizure medications on the basis
of use and adverse effects.
2. D evelop a treatment strategy for status epilepticus.
3. I dentify appropriate treatment strategies for primary and
secondary stroke prevention.
4. D etermine the appropriateness of treatment with tissue
plasminogen activator for acute stroke.
5. E xamine common adverse effects associated with the treatment of
Parkinson disease.
6. Differentiate between regimens for acute andprophylactic treatment
of migraine, tension, and cluster headaches.
7. Identify common adverse effects of disease- modifying therapies
for multiple sclerosis.
Self-Assessment Questions
Answers and explanations to these questions
can be found at the end of this chapter.
1. T.L. is a 35-year-old man with complex partial sei-zures. He is
otherwise healthy. He was placed on phenytoin after a seizure about 2 months
ago. He currently takes phenytoin 100 mg 3 capsules orally every night. During
his clinic visit, he tells you he has had no seizures, and he has no signs of
toxicity. He is allergic to sulfa drugs. His phenytoin serum concentration is
17.7 mcg/mL. Which is the best interpretation of this concentration? A. It is too low.
B. It is too high.
C. It is just right.
D. A serum albumin
concentration is necessary to interpret this concentration.
2. B .V. is a 28-year-old woman brought to your emergency
department for treatment of status epilepticus. She receives lorazepam 4 mg
intravenously with subsequent seizure cessation. Which medication is the best
next treatment step for B.V.?
A. Topiramate.
B. Phenytoin.
C. Zonisamide.
D. Diazepam.
3. J .H. is a 42-year-old man with complex partial seizures for
which he was prescribed topiramate. He has been increasing the topiramate dose
every other day according to instructions from his primary care provider. He
comes to the pharmacy where you work but seems a little confused and has
difficulty finding the words to have a conversation with you. Which is the best
assessment of J.H.’s condition?
A. D iscontinue topiramate; he is having an allergic reaction.
B. I ncrease the topiramate dose; he is having partial seizures.
C. Slow the rate of topiramate titration; he ishaving psychomotor
slowing.
D. Get a topiramate serum concentration; he is probably
supratherapeutic.
Questions 4 and 5 pertain to the following
case:
R.H. is a 59-year-old man who presents to the emergency
department for new-onset left-sided weakness that began 6 hours ago. He has a
history of hypertension and coronary artery disease. His medication list
includes atenolol 50 mg/day orally, hydrochlorothiazide 25 mg/day orally, and
aspirin 325 mg/day orally. His vital signs include blood pressure (BP) 160/92
mm Hg, heart rate 92 beats/minute, respiratory rate 14 breaths/ minute, and
temperature 38°C. The treatment team assesses this patient for treatment with
tissue plasminogen activator and asks for your opinion.
4. Which reply is best, given this information?
A. R .H. should be treated with tissue plasminogen activator
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