Patient Care and Monitoring

1. Obtain a seizure history from the patient or family members, including precipitating factors and duration of seizure activity.

2. Identify the underlying cause of the seizures and correct the cause, if possible. Does the patient have any laboratory abnormalities? Is there a positive toxicology screen for alcohol or drugs?

3. Obtain a thorough history of nonprescription, prescription, and alternative or herbal drug use. Determine adherence with the medication regimen and whether barriers to care exist. Does the patient have the financial ability and transportation to obtain their prescriptions?

4. Assess the AED serum concentration and adjust therapy as needed for agents with a defined therapeutic range (e.g., phenytoin, carbamazepine, valproic acid, and phenobarbital). Drug levels can also be used to determine adherence to medication regimens for agents that do not have defined ranges.

5. Evaluate the patient for adverse drug reactions, IV site extravasation, and allergic reactions. What alternative AEDs should be used if a drug allergy is identified?

6. Determine whether there are any drug interactions with the patient's current or home medication regimens. Do you need to adjust the dose of any medications for toxic or subtherapeutic concentrations from the drug interaction?

7. Maintain adequate cardiovascular support, nutrition, and electrolyte and glucose serum concentrations to prevent recurrence of seizure activity.

8. Continue to evaluate the patient for seizure activity and adjust therapy as needed to control seizures and optimize quality of life.

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