CNS drugs and antiepileptics: felbamate toxicity: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · CNS drugs and antiepileptics: felbamate toxicity

Sample item

A 19-year-old with Lennox-Gastaut syndrome, resistant to several drugs, is given a new add-on antiepileptic. Six weeks later she has fatigue, pallor, mucosal bleeding and pancytopenia, and the drug is withdrawn. Which drug is the likely cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Felbamate

Felbamate is kept for refractory epilepsy such as Lennox-Gastaut syndrome because it can cause aplastic anaemia and fatal hepatic failure. Blood counts and liver tests are monitored, and the drug is stopped if marrow suppression appears.

Option by option

  • A. Clobazam

    Clobazam is a benzodiazepine whose main problems are sedation and tolerance, not marrow failure.

  • B. Lamotrigine

    Lamotrigine's chief hazard is a rash that can progress to Stevens-Johnson syndrome.

  • C. Rufinamide

    Rufinamide mainly causes somnolence, vomiting and QT shortening rather than pancytopenia.

  • D. Felbamate (correct)

    Correct. Felbamate is the antiepileptic classically linked with aplastic anaemia and hepatic failure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Felbamate. Felbamate is kept for refractory epilepsy such as Lennox-Gastaut syndrome because it can cause aplastic anaemia and fatal hepatic failure.

Why is "Clobazam" not the answer?

Clobazam is a benzodiazepine whose main problems are sedation and tolerance, not marrow failure.

Why is "Lamotrigine" not the answer?

Lamotrigine's chief hazard is a rash that can progress to Stevens-Johnson syndrome.

Why is "Rufinamide" not the answer?

Rufinamide mainly causes somnolence, vomiting and QT shortening rather than pancytopenia.

What concept does this question test?

It tests CNS drugs and antiepileptics: felbamate toxicity in Pharmacology. Blood counts and liver tests are monitored, and the drug is stopped if marrow suppression appears.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study CNS drugs and antiepileptics: felbamate toxicity?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.