Which of the following is a first-line medication for generalized tonic-clonic seizures?

Correct Answer: D

Rationale: Topiramate, a broad-spectrum antiepileptic, treats generalized tonic-clonic seizures by blocking sodium channels, enhancing GABA, and inhibiting glutamate, making it a first-line option per guidelines. Ethosuximide targets absence seizures. Felbamate, vigabatrin, and ezogabine have narrower uses or toxicity risks (e.g., aplastic anemia, vision loss), limiting them to refractory cases. Topiramate's efficacy, tolerability, and broad action suit primary generalized seizures, distinguishing it as a standard choice.

Correct Answer: A

Rationale: Simvastatin, a statin, lowers cholesterol by inhibiting HMG-CoA reductase, most active at night when synthesis peaks. Evening dosing optimizes efficacy. Grapefruit juice increases levels, risking toxicity. Stopping if normal risks rebound. Breakfast misses the cycle. Evening aligns with simvastatin's pharmacodynamics, key in hyperlipidemia where timing boosts results, making A the key instruction.

Correct Answer: A

Rationale: Oxytetracycline's bioavailability increases in the fasting state as food, particularly calcium, can bind the drug and reduce its absorption.

Correct Answer: A

Rationale: Monitoring weight daily (A) helps assess fluid balance, as sudden changes may indicate fluid retention or loss. Thirst (B) is an early sign of mild dehydration. Monitoring intake and output (C) is essential to evaluate fluid status. Avoiding calcium and chloride supplements (D) is not relevant to fluid replacement. Reviewing electrolyte labs (E) is important but not part of routine health teaching for fluid replacement.

Correct Answer: B

Rationale: Valproate is classified as an anti-convulsant medication. It is commonly used to treat seizures, particularly in the management of epilepsy. Valproate works by affecting certain chemicals in the brain to control seizures and stabilize mood in some psychiatric conditions. It is not classified as an anti-diabetic, anti-ulcer agent, or anti-hypertensive medication.

Correct Answer: D

Rationale: Metformin belongs to the therapeutic classification of antidiabetic agents. It is commonly used to treat type 2 diabetes by helping to control blood sugar levels. Metformin works by decreasing glucose production in the liver and improving insulin sensitivity in the body's tissues. This helps the body use insulin more effectively, leading to better blood sugar control.

Correct Answer: C

Rationale: Migraine prophylaxis reduces attack frequency. Ergotamine treats acute migraines, not prophylaxis, risking vasoconstriction. Paracetamol relieves pain but doesn't prevent migraines. Propranolol, a beta-blocker, reduces migraine frequency via vascular and CNS effects, proven effective and safe in healthy adults. Carbamazepine suits trigeminal neuralgia, not migraines. Sumatriptan is acute, not preventive. Propranolol's efficacy makes it first-line, balancing prevention and tolerability.

Correct Answer: C

Rationale: Ionized drugs cross renal tubular membranes poorly, staying in urine for excretion, unlike non-ionized or lipid-soluble drugs reabsorbed easily. Volatile drugs (e.g., anesthetics) excrete via lungs, not kidneys. Ionization traps drugs, a pharmacokinetic excretion key.

Correct Answer: B

Rationale: Heparin is an anticoagulant medication used to prevent blood clots. If a patient on heparin therapy experiences excessive bleeding or needs to quickly reverse the anticoagulant effects of heparin, the antidote is protamine sulfate. Protamine sulfate works by neutralizing the effects of heparin by forming a complex with it. It is important for healthcare providers to have protamine sulfate readily available when managing patients on heparin therapy to effectively reverse its anticoagulant effects in emergency situations.