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1. Which of the following drugs is not indicated for the treatment of Lennox-Gastaut syndrome according to the United States Food and Drug Administration approvals? (
For purposes of this monograph, we will use both the brand and generic name for the FDA approved form of cannabidiol (Epidiolex) to differentiate it from forms available in dispensaries.)
D. Cannabidiol (Epidiolex)
2. Which medication is associated with increases in levels of aspartate aminotransferase and alanine aminotransferase?
A. Cannabidiol (Epidiolex)
3. Which of the following is true regarding the Drug Enforcement Administration scheduling status of cannabidiol (Epidiolex) in the United States?
A. All cannabidiol products are now approved for medical use
B. Cannabidiol is derived from the cannabis plant material; therefore, any preparation of this compound is considered a Schedule I drug by the Food and Drug Administration
C. The specific cannabidiol preparation used in Epidiolex is approved for the treatment of Lennox-Gastaut syndrome and Dravet syndrome and is classified in Schedule V; all other preparations of cannabidiol remain in Schedule I
D. Only cannabidiol products manufactured and distributed through a licensed cannabis dispensary are approved for medical use
Use the following
to answer questions 4 and 5:
RK is one of your regular patients. He has epilepsy and comes to your practice asking about treatment for his seizures using cannabidiol. RK is well controlled on his current medications, levetiracetam and lamotrigine, for his generalized tonic-clonic seizures. He read that cannabidiol (Epidiolex) was recently approved by the Food and Drug Administration (FDA) to treat seizures.
RK states that he would like to try cannabidiol (Epidiolex) so he can stop taking levetiracetam due to mild mood changes. What do you tell the patient?
A. Yes, the FDA has approved cannabidiol (Epidiolex) for the treatment of your form of epilepsy. Stop taking levetiracetam and start cannabidiol (Epidiolex) 2.5 mg/kg twice daily.
B. Yes, the FDA has approved cannabidiol (Epidiolex) for the treatment of your form of epilepsy. Decrease the dose of levetiracetam and start cannabidiol (Epidiolex) 2.5 mg/kg twice daily.
C. Yes, the FDA has approved cannabidiol (Epidiolex) for the treatment of your form of epilepsy. Stop taking lamotrigine and start cannabidiol (Epidiolex) 2.5 mg/kg twice daily.
D. The FDA approval for cannabidiol (Epidiolex) does not apply to your type of epilepsy. We do not know if cannabidiol (Epidiolex) will help your epilepsy or if it can replace your levetiracetam.
5. RK ignores your recommendation and tells you that he plans to buy cannabidiol (CBD) oil from a local dispensary. Which of the following is most important to tell this patient regarding the use of CBD prepared at dispensaries?
A. The preparations of CBD sold at dispensaries are equivalent to cannabidiol (Epidiolex)
B. The quality and purity of CBD preparations from a dispensary cannot be verified, even among batches of the same product at a single location
C. CBD oil from a dispensary will precipitate seizures in a patient with RK's form of epilepsy
D. CBD preparations are all required to be independently verified for purity and quality by the United States Pharmacopoeia
6. A patient is picking up a new prescription for cannabidiol (Epidiolex) from your pharmacy. She wants to know how to store the medication. Which of the following is
appropriate storage for cannabidiol (Epidiolex)?
A. Cannabidiol (Epidiolex) should be kept upright in its original container
B. Cannabidiol (Epidiolex) should be frozen, with an average temperature of -10°C to prevent degradation of the active compound
C. Cannabidiol (Epidiolex) should be kept at room temperature
D. Cannabidiol (Epidiolex) should be discarded 12 weeks after opening the original container
7. Which of the following is true regarding medications approved to treat Dravet syndrome (DS)?
A. Cannabidiol (Epidiolex) is not yet indicated for the treatment of DS
B. Stiripentol is in phase 2 trials for the treatment of DS
C. Levetiracetam is approved by the Food and Drug Administration to treat DS
D. Clobazam is used in conjunction with valproate to treat DS
8. Which of the following is true of Dravet syndrome (DS) but not of Lennox-Gastaut syndrome (LGS)?
A. DS is a rare epileptic encephalopathy
B. DS is more common in boys than girls
C. DS occurs within the first year of life
D. DS is often refractory to treatment
9. Which of the following is a known contraindication to the use of cannabidiol (Epidiolex)?
A. Pregnancy or nursing
B. HLA-B *5701 allele
C. Known allergy to cannabidiol or any ingredients in the preparation
D. Moderate liver dysfunction
10. A 50-year-old female patient presents to your practice wanting to try cannabidiol (Epidiolex) for seizures related to Lennox-Gastaut syndrome. She is currently taking valproate, clobazam, aspirin, rosuvastatin, and a multivitamin. She is employed in law enforcement; her place of employment has a strict no-drug policy and implements random drug testing with a highly sensitive assay. Which counseling point would be most important to tell this patient about cannabidiol (Epidiolex)?
A. Cannabidiol (Epidiolex) may cause decreased appetite
B. Cannabidiol (Epidiolex) should be stored upright in its original container
C. Cannabidiol (Epidiolex) may cause a positive drug screen for cannabis
D. This patient would have no issues using cannabidiol (Epidiolex)
11. How confident are you in your decision about treatment for the 50-year-old patient described in question 10?
A. Not at all confident
B. Somewhat confident
D. Highly confident
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