CASE PRESENTATION

CASE DETAILS: https://rsubhiksha128.blogspot.com/2023/12/a-case-of-60-yr-old-female.html OSCE QUESTION AND ANSWER Q1) Discuss about therapeutic index of phenytoin. PHENYTOIN maintains a narrow therapeutic range of 10 to 20 mcg/ml .  Pharmacokinetics :  In therapeutic doses, phenytoin is absorbed entirely and reaches peak plasma concertation at 1.5 to 3 hours.  Distribution :  Phenytoin is usually 90% bound to plasma proteins (mostly albumin), and only its unbound form is pharmacologically active. The fraction of protein binding may be lower in neonates, pregnant patients, hypoalbuminemia, and uremia. It is distributed in all tissues and becomes firmly tissue-bound with a large volume of distribution.  Its levels are higher in the central nervous system as compared to the serum. Metabolism:   The hepatic P450 enzyme system metabolizes phenytoin (predominantly CYP2C9 and CYP 2C19) to inactive metabolites and is an inducer of CYP3A4, which accounts for many of its drug-drug interactions

A CASE OF  60 YR OLD FEMALE   This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's consent. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs in the comment box below. Note : This is an ongoing case and will be updated regularly.  Date of admission: 01/12/2023 Chief complaint : A 60 Yr old female, unemployed, resident of chinnakapati (nalgonda district) was brought to the casualty with c/o prolonged abnormal involuntary movements bilaterally in both upper and lower limbs for duration of > 30 minutes. History of Presenting Illness: Patient was apparently asymptomatic 23 years ago when she had first episode of fits (after sustaining a head injury due to fall 7 years before her first episode) .Each episode begins with patient feeling dizzy,  uprolling of eyes, headache radiating from front to back of right side of head only(does not radiate to other side); dragg