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Case 4: Mrs Connie Fulshun Questions posed by this case: Why did the Connie crash the car? What triggered her status epilepticus? Was she taking phenytoin at the time, if so why did IT not prevent her fit? How did Connie become pregnant if she was taking oral contraceptives? PHENYTOIN COULD PHENYTOIN LEVELS BECOME UNSTABLE LEADING TO SEIZURE? In most patients maintained at a steady dosage, stable phenytoin serum levels are achieved. Patients with unusually low levels may be noncompliant or hypermetabolizers of phenytoin. As phenytoin is highly protein bound, free phenytoin levels may be altered in patients whose protein binding characteristics differ from normal .Determine Connie's plasma levels, if low, she may not be complying. Since she has been stable for more than two years we can assume she has no protein binding problems. PHENYTOIN - ORAL CONTRACEPTIVE INTERACTION Hepatic enzyme-inducing anti-epileptic drugs increase the metabolism of both progesterone and oestrogen. As the concentrations of these hormones may be lowered...

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