Topic: Seizure
Subject: Medicine
A 68-year-old man with a history of urolithiasis, suffered from a seizure attack which involved loss of consciousness with tonic and clonic muscular contractions. His tongue fell back into his throat and he choked.
Which of the following medications is contraindicated in this patient's treatment?
Levetiracetam
Phenytoin
Topiramate
Carbamazepine
Correct Answer :
C. Topiramate
This patient suffers from tonic-clonic seizures (formerly known as grand mal seizures), which is characterized by sudden loss of the consciousness followed by tonic and clonic muscular contractions. Patients with a history of kidney stones or those taking high-dose vitamin C or calcium supplementation should not take Topiramate because of the increased risk of kidney stones. Valproic acid is considered the agent of first choice for the treatment of grandmal (tonic-clonic) seizures. Phenytoin and carbamazepine are reasonable second options among the older group of medications, but the newer medications tend to work equally well if not better and have better side effect profiles, especially long-term side effect. Levetiracetam is indicated for primary generalized tonic-clonic seizures in adults and children aged 6 years or older, as well as for use in juvenile myoclonic epilepsy and for partial seizures.
Related Questions
Topic: Diagnostic Investigations
Subject: Medicine
A 50-year-old male is brought to the emergency department because of a syncopal episode. Prior to the episode, he felt bad for 30 minutes, then developed nausea followed by vomiting. During a second bout of vomiting he blacked out and fell to the floor. His wife did not observe any seizure activity, and he was unconscious only for a few seconds. His history is otherwise negative, his past medical history is unremarkable, and he currently takes no medications. A physical examination is normal.
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CT of the head
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Topic: Seizure
Subject: Medicine
A 36-year-old male with a history of a seizure disorder is brought to the emergency department with generalized tonic-clonic activity. Emergency medical personnel report this has been ongoing for 20 minutes.
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Subject: Medicine
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Subject: Medicine
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Trisomy 18
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Focal neurologic signs
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Topic: Adverse Drug Effect
Subject: Medicine
A 68-year-old man with a history of urolithiasis, suffered from a seizure attack which involved loss of consciousness with tonic and clonic muscular contractions. His tongue fell back into his throat and he choked. He is treated with valproic acid.
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Weight gain
Rash
Nausea and headache
Tardive dyskinesia
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Subject: Medicine
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Alcohol withdrawal
Stroke
Head trauma
Hypoglycemia
Topic: Normal Pressure Hydrocephalus
Subject: Medicine
A previously alert, otherwise healthy 74-year-old black male has a history of slowly developing progressive memory loss and dementia associated with urinary incontinence and gait disturbance resembling ataxia.
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Normal pressure hydrocephalus
Alzheimers disease
Subacute sclerosing panencephalitis
Multiple sclerosis