Generalized Tonic-Clonic Seizure
\nPlease answer all the questions and provide your rationales with supportive evidence in well-developed paragraphs using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook. (Do not use lay press Internet sites.)
\nAccompanied by her boyfriend, Shaynah Anderson, age 23, visits your office. Her boyfriend states, \u201cShe hasn\u2019t been herself the last month. She has headaches and is completely confused and tired for no reason.\u201d Shaynah denies using illicit drugs and any recent traumatic injuries. She thinks her problem started approximately a month ago when she was at a club dancing. Her friends told her that she became confused and began tugging at her clothes. Then she fell down and was unconscious for a few minutes. When she awoke, she felt extremely tired and did not know what was going on. Her boyfriend recalls that she had been hit in the head with a softball during a game the day before they went dancing. Past medical history discloses insulin use since early childhood (currently 10 units NPH in the morning and 10 units regular insulin before meals), Prilosec at bedtime, and Ibuprofen (1 or 2 tablets twice a day) for headaches. She is interested in becoming pregnant in the next 12 to 24 months. The patient says she has no allergies and does not drink or use recreational drugs or tobacco.
\nOn physical examination, Shaynah is 5 foot 4 inches and 130 lb. Her temperature is 37\u00b0C, pulse rate 78, blood pressure 118\/76, and glucose level 90. Skin appears normal. Head and neck are normal, chest is clear for anterior and posterior sounds, cardiovascular RRR and (2) r\/m\/g, and laboratory values are within normal limits. EEG findings include sharp-wave discharges. At a follow-up visit 2 months later, patient and her boyfriend report that things have gotten worse. The boyfriend states that as the patient was eating dinner one night she had a seizure. She was completely stiff for a short time, and then her arms and legs began moving. He believes that she was unconscious for a few minutes.Patient says she could not remember what had happened when she woke up.
\nDiagnosis: Generalized Tonic-Clonic Seizure
\n1.\tWhich of the following should be true regarding your initial Adverse Effect Drugs (AED) regimen? (75 words)
\na.\tInitial combination therapy is warranted due to increased success rates.
\nb.\tDrugs that are taken two to three times daily are preferred due to a lower risk of seizure if a dose is missed.
\nc.\tLevetiracetam is the preferred agent for all seizure types and patients.
\nd.\tThe risks of pregnancy must be discussed prior to starting any AED.
\n2.\tWhich of the following is the most appropriate initial antiepileptic regimen for this patient? (50 words)
\na.\tLevetiracetam 500 mg PO daily
\nb.\tPhenytoin 100 mg PO three times daily
\nc.\tPregabalin 50 mg PO three times daily
\nd.\tClobazam 5 mg PO twice daily
\n3.\tThe patient fails to respond and has significant side effects to her initial therapy. Her initial therapy is to be discontinued. Which of the following would be the most appropriate replacement? (50 words)
\na.\tValproic acid 500 mg twice daily
\nb.\tLamotrigine 100 mg twice daily
\nc.\tLacosamide 100 mg twice daily
\nd.\tRufinamide 200 mg twice daily
\n4.\tAfter several different AEDs, the patient ends up on carbamazepine and phenytoin. The carbamazepine serum concentration on week 2 [Essay writing service – your education, our expertise: Get any assignment done with our professional essay writers before your deadlines – Zero AI, Human experts and Fast delivery.] of therapy was 6 mcg\/mL. The patient presents after 8 weeks of therapy with increased seizures and she is found to have a serum concentration of 2 mcg\/mL. Which of the following is a likely cause? (75 words)
\na.\tAutoinduction of CYP3A4.
\nb.\tPatient has the HLA-B*1502 subtype.
\nc.\tThe oral contraceptive that she recently started.
\nd.\tCo-administration with alcohol.
\n5.\tDespite the use of oral contraception, the patient becomes pregnant. Her AED regimen consists of valproic acid and lacosamide. What is the most appropriate treatment intervention? (50 words)
\na.\tDiscontinue valproic acid and continue lacosamide monotherapy.
\nb.\tDiscontinue lacosamide and continue valproic acid monotherapy.
\nc.\tContinue combination therapy.
\nd.\tDiscontinue valproic acid and add phenytoin.<\/p>\n","protected":false},"excerpt":{"rendered":"
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