Seizure and the Medications
Molly is seen in the clinic for routine blood levels to monitor her seizure medications. Her new boyfriend is accompanying her today. She is currently taking carbamazepine (Tegretol) 400 mg PO t.i.d and has recently started on Lamictal 250 mg PO b.i.d after developing breakthrough seizures on the maximum dose of Dilantin. During her exam, she admits to being sexually active with her boyfriend.
What is the prescriber’s responsibility regarding drug therapy for this pediatric patient?
What teaching does Molly need concerning her medications and sexual activity?
How does Dilantin prevent seizures?
Why would Lamictal be added to Molly’s medications?
Consider if Molly were pregnant. Would you make any changes in her seizure medications?
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Seizure
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Seizure
Healthcare providers have a sensitive and sometimes complicated responsibility while prescribing and administering medications for pediatric patients up to 18 years. In the case of Molly, she appears to be experiencing unexpected seizures when she should be in remission. As a result, the prescriber must thoroughly analyze her health status and drug-taking practices to determine the cause of Dilantin’s inability to maintain seizure control. While prescribing the new regimen, including Carbamazepine and Lamictal, it will be fundamental to provide adequate information to Molly to ensure that she understands the value of adhering to intake regularity as part of care quality. These healthcare providers also ensure the drug therapy satisfies the basic concepts of safety, efficacy, and appropriateness for the established health condition of the patient. Such an aspect would translate to positive health outcomes for Molly as she regains control of the seizures.
Since Molly indicates that she is sexually active with her boyfriend, the prescriber should educate her about the likely teratogenic effects that may arise from the medications if she becomes pregnant. For instance, Kaplan and Demir (2021) indicate that Carbamazepine is associated with potential malformations, including neural tube defects and cleft palate or lip. Wang et al. (2021) also associate Lamictal or Lamotrigine with some risks in pregnant women, although the gravity of the vulnerability is significantly lower compared to many other antiepileptic drugs. In this context, a healthcare provider should advise Molly to use diverse family planning techniques because pregnancy would bring a different dynamic in her drug regimen and associated risks. She should also remain alert to inform the healthcare experts about any positive tests for pregnancy to ensure they alter her medications appropriately and avert likely congenital challenges.
Although Molly’s medication has changed from Dilantin to Carbamazepine and Lamictal, this drug remains an effective anticonvulsant. This drug prevents seizures by decreasing the rate of abnormal electrical impulses. According to Patocka et al. (2020), Dilantin or Phenytoin blocks membranes that regulate action potential, obstructing the positive feedback and barring the seizures from spreading. As a result, individuals fail to experience the adverse effects of episodes because the drug interferes with br...