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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Define epilepsy.

  • Differentiate seizure types based on clinical presentation and description.

  • Recommend drugs of choice and alternative therapies for different types of seizures.

  • Identify appropriate dosing, the most common adverse effects, and monitoring parameters for anticonvulsants.

  • Develop an appropriate pharmaceutical care plan for a patient with epilepsy.

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PATIENT PRESENTATION

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Chief Complaint

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“I had a seizure a few weeks ago and banged up my head.”

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HPI

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Carter McNeely is a 68-year-old man whose seizures are well controlled with carbamazepine monotherapy. The seizure from 2.5 weeks ago was the first seizure in 20 months. During the seizure, he fell to the floor and sustained a laceration to his occipital region that required staples for closure. The description of his seizures is vague because there have been only six seizures documented since he developed epilepsy 3 years ago. Because Mr McNeely lives alone in an assisted living facility, only half of the documented seizures have been witnessed by another individual who could provide a description. Two seizures were witnessed by other residents who described him as “falling to the ground and starting to shake.” One seizure occurred in the day room when a facility nurse was in the room, and he documented that Mr McNeely fell to the ground, developed rhythmic extensions to both his legs, became incontinent of urine, and was sleepy and disoriented for 2 hours after the episode.

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He has only been treated with carbamazepine. This was started by his family practice physician after his second seizure. An EEG was obtained at that time and was unremarkable. Because the seizures are so infrequent, the dose of carbamazepine has never been adjusted.

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PMH

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  • Tonic–clonic seizures diagnosed 3 years ago

  • HTN adequately controlled with lisinopril monotherapy

  • Dyslipidemia controlled with atorvastatin and low-cholesterol diet

  • BPH, currently symptom-free on dutasteride

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FH

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Mother died at age 74 of “natural causes”; had HTN for many years. Father died at age 70 of “natural causes”; did not have any known medical illnesses. All of his children and grandchildren are alive and well. One son and one daughter have HTN.

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SH

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Retired factory worker; resides in an assisted living facility. He is widowed and has six children and nine grandchildren, whom he sees frequently. He denies past or present tobacco and illicit drug use. He reports a history of regular alcohol use but now only drinks one beer that his grandson brings to him every Saturday evening.

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Meds

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  • Aspirin 81 mg PO once daily

  • Atorvastatin 40 mg PO once daily

  • Carbamazepine XR 200 mg PO twice daily

  • Dutasteride 0.5 mg PO once daily

  • Lisinopril 20 mg PO ...

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