A child is admitted with frequent seizures and irritability. The doctor prescribes a drug that controls seizures and also has sedative properties. Which drug is most appropriate?

1. A

   Carbamazepine

2. B

   Phenobarbitone

3. C

   Phenytoin

4. D

   Lithium

Appeared in: RML MAINS 2025

Explanation

• Phenobarbitone is a barbiturate that possesses both strong anticonvulsant and sedative properties.
• Its mechanism involves enhancing the effect of the inhibitory neurotransmitter GABA in the brain, which leads to central nervous system depression, thereby controlling seizures and producing a calming effect.
• This dual action makes it particularly suitable for a patient who is not only having seizures but is also irritable.
• While effective, its use has declined due to side effects like sedation and potential cognitive impairment with long-term use (SRC_20229).

Why Other Options Were Wrong

• Option A: Carbamazepine is a primary antiepileptic drug but does not have the strong sedative properties of phenobarbitone. While it can cause drowsiness, it is not its primary feature.
• Option C: Phenytoin is a first-line antiepileptic drug that is not a general CNS depressant and produces minimal sedation at therapeutic doses.
• Option D: Lithium is a mood stabilizer, not an antiepileptic drug. It is used to treat bipolar disorder and has no indication for seizure control.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological management of seizures with consideration of drug side effect profiles in acute care settings.
• When administering phenobarbitone, nurses must prioritize monitoring for excessive sedation and respiratory depression, especially in children and with IV use.
• It is crucial to educate parents about the importance of adherence and the dangers of abrupt discontinuation, which can lead to status epilepticus.
• Paradoxical hyperactivity can occur in children taking phenobarbitone, so any unusual changes in behavior should be reported to the prescriber.

How to Approach the Question

• First, analyze the clinical scenario to identify the patient's needs. The patient is a child with both 'frequent seizures' and 'irritability'.
• The question asks for the 'most appropriate' drug, which implies you must find the best fit for both conditions.
• Break down the requirements: the drug must have 1) anticonvulsant action and 2) sedative properties.
• Evaluate each option against these two requirements.
• Eliminate Lithium as it is a mood stabilizer, not an antiepileptic.
• Compare the remaining antiepileptics (Carbamazepine, Phenobarbitone, Phenytoin) based on their sedative effects. Phenytoin and Carbamazepine have minimal sedative properties compared to Phenobarbitone.

Concept Tested & Keywords

• Concept Tested: Pharmacological management of seizures with consideration of drug side effect profiles.
• Stem keywords: child, frequent seizures, irritability, sedative properties, antiepileptic
• Lead-in keywords: most appropriate
• Clinical cues: [object Object]
• Negative lead-in flag: false

Question ID

QJxUT_o3M3CLPtm_fwdgWB

Copy ID

Reference Book

E6 Pharmacology KD Tripathi Essentials 9e Part 2 p. 80-82

E6 Pharmacology Nursing Lilley 11e Part 1 p. 240-242

E6 Pharmacology Nurses Shanbhag 3e p. 155-157