Investigating a Car Crash Case
Questions posed by this case:
* Why did the Connie crash the car?
* What triggered her status epilepticus?
* Was she taking phenytoin at the time, if so why did IT not prevent
her fit?
* How did Connie become pregnant if she was taking oral
contraceptives?
PHENYTOIN
COULD PHENYTOIN LEVELS BECOME UNSTABLE LEADING TO SEIZURE?
In most patients maintained at a steady dosage, stable phenytoin serum
levels are achieved.
Patients with unusually low levels may be noncompliant or
hypermetabolizers of phenytoin.
As phenytoin is highly protein bound, free phenytoin levels may be
altered in patients whose protein binding characteristics differ from
normal
.Determine Connie's plasma levels, if low, she may not be complying.
Since she has been stable for more than two years we can assume she
has no protein binding problems.
PHENYTOIN - ORAL CONTRACEPTIVE INTERACTION
Hepatic enzyme-inducing anti-epileptic drugs increase the metabolism
of both progesterone and oestrogen. As the concentrations of these
hormones may be lowered by 50% or more, adjustments are required in
contraceptive regimes to ensure that pregnancy is prevented
Oral contraceptives may have increased metabolism by phenytoin,
carbamazepine and phenobarbital and therefore may not adequately
protect against pregnancy.
TRIGGERS OF STATUS EPILEPTICUS
Abrupt withdrawal of phenytoin in epileptic patients may precipitate
status epilepticus. When, in the judgment of the clinician, the need
for dosage reduction, discontinuation, or substitution of alternative
antiepileptic medication arises, this should be done gradually
It is important to note that antiepileptic drugs should not be
discontinued in patients in whom the drug is administered to prevent
major seizures, because of the strong possibility of precipitating
status epilepticus with attendant hypoxia and threat to life.
RATIONALE FOR DRUGS GIVEN
ANTI-EPILEPTICS
Use in Pregnancy-do they harm the fetus?
· A number of reports suggest an association between the use of
antiepileptic drugs by women with epilepsy and a higher incidence of
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