Q impor - king3

[ArchivalUser]

An 80-year-old man with mild cognitive impairment is evaluated for dizziness and unsteadiness that began after he started phenytoin therapy. Three days ago, he had his second generalized tonic“clonic seizure in 3 months and was treated in the emergency department with intravenous phenytoin. He was prescribed daily oral phenytoin on discharge. His only other medication is warfarin, prescribed after heart valve surgery 8 months ago.

The patient's phenytoin level at this time is within the therapeutic range. MRI of the head and electroencephalogram are normal.

What is the best treatment option for this patient's seizure disorder?

A Continue phenytoin
B Discontinue phenytoin
C Switch to gabapentin
D Switch to carbamazepine

[ArchivalUser]

AAA

they resolve with continuous therapy

[ArchivalUser]

bb

[ArchivalUser]

C Switch to gabapentin

[ArchivalUser]

Seems like drug interaction with warfarin. I think B

[ArchivalUser]

Drug interactions: If prescribing other medications in combination with phenytoin, be very alert to the possibility of inadvertent toxicity or decreased efficacy of the antiepileptic medication. Numerous interactions between phenytoin and other medications are known to exist.
Phenytoin increases serum levels of toxic metabolites of acetaminophen, oral anticoagulants, and primidone (eg, phenobarbital).

Serum levels are increased by amiodarone, chloramphenicol, cimetidine, disulfiram, ethosuximide, fluconazole, isoniazid, "oral anticoagulants", phenylbutazone, sulfonamides, trimethoprim, and valproic acid.

[ArchivalUser]

So ANswer is B

[ArchivalUser]

Ans c you hsvr to stop phy, but hsvr to givr some thing and cannot give carbamazipine
So give gabapentine