CNS drugs (antiepileptics, anesthetics) — MCQs

A 68-year-old woman with hepatic cirrhosis (Child-Pugh class B) and portal hypertension requires emergency surgery for perforated diverticulitis. During anesthesia planning, the anesthesiologist must select agents considering her hepatic dysfunction. Analyze which anesthetic combination would be most appropriate for induction and maintenance.

A 19-year-old man with juvenile myoclonic epilepsy controlled on levetiracetam for 2 years presents with irritability, depression, and suicidal ideation that began 3 weeks ago. He has no prior psychiatric history. His seizures are well-controlled with no breakthrough events. Which modification to his treatment regimen is most appropriate?

A 42-year-old man with refractory status epilepticus has failed treatment with lorazepam, phenytoin, and valproic acid. He remains unconscious with ongoing seizure activity on continuous EEG monitoring. He has chronic kidney disease with GFR 25 mL/min/1.73m². Blood pressure is 88/52 mmHg requiring vasopressor support. Evaluate the most appropriate next pharmacologic intervention.

A 55-year-old man undergoing general anesthesia for coronary artery bypass grafting receives rocuronium for muscle relaxation. At the end of surgery, neostigmine is administered for reversal, but the patient remains apneic with no response to nerve stimulation. His brother had a similar prolonged paralysis after surgery. Dibucaine number testing shows 25% inhibition (normal: 80%). What is the underlying mechanism?

A 25-year-old woman with bipolar disorder well-controlled on valproic acid presents for preconception counseling. She has been seizure-free for 2 years and wants to become pregnant. Her psychiatrist is concerned about mood destabilization if medication is changed. Analyze the risk-benefit profile and determine the most appropriate management strategy.