A patient who has partial seizures has been taking phenytoin (Dilantin). The patient has recently developed thrombocytopenia
The primary care nurse practitioner (NP) should contact the patient's neurologist to discuss changing the patient's medication to: a. topiramate (Topamax).
b. levetiracetam (Keppra).
c. zonisamide (Zonegran).
d. carbamazepine (Tegretol).
D
Evidence-based recommendations exist showing carbamazepine to be effective as monotherapy for partial seizures. Because this patient has developed a serious side effect of phenytoin, changing to carbamazepine may be a good option. The other three drugs may be added to phenytoin or another first-line drug when drug-resistant seizures occur, but are not recommended as monotherapy.
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