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Phenytoin commonly causes gingival hyperplasia. Good oral hygiene and use of a soft toothbrush reduce gum overgrowth and bleeding. The medication is not discontinued unless toxicity or severe adverse effects occur.
Valproic acid carries a significant risk of hepatotoxicity. Liver function tests (AST, ALT) must be monitored routinely to detect early liver damage.
Levetiracetam may cause mood instability, depression, or agitation. Behavioral changes should be reported to prevent safety risks, including self-harm.
Lamotrigine can cause Stevens-Johnson syndrome, a life-threatening dermatologic emergency. The medication must be stopped immediately and the provider notified.
Topiramate can decrease sweating (oligohidrosis) and cause metabolic acidosis. Patients are at risk for overheating and dehydration.
Gabapentin is primarily used to treat neuropathic pain and partial seizures. It is not used in acute cardiovascular emergencies.
Lacosamide may prolong the PR interval and increase the risk for heart block. ECG monitoring is recommended in at-risk patients.
A sudden severe headache in a patient on anticoagulants may indicate intracranial hemorrhage, which is life-threatening and requires immediate evaluation.
Black tarry stools indicate gastrointestinal bleeding. Immediate assessment and intervention are required.
Muscle pain with dark urine suggests rhabdomyolysis, a serious adverse effect that can lead to acute kidney injury.
HMG-CoA reductase inhibitors reduce LDL cholesterol levels and help prevent cardiovascular disease and stroke.
tPA is contraindicated in hemorrhagic stroke. A CT scan must confirm ischemic stroke before administration.
tPA is most effective and safest when administered within 3–4.5 hours of symptom onset.
Uncontrolled hypertension increases risk for cerebral hemorrhage and worsens intracranial pressure.
Lorazepam enhances GABA activity and is first-line for stopping active seizure activity in status epilepticus.
Clonazepam is indicated for seizure disorders and panic disorders due to its CNS depressant effects.
Phenobarbital enhances GABA-mediated inhibition in the CNS, reducing neuronal excitability.
Cyclobenzaprine causes CNS depression. Alcohol increases sedation and respiratory suppression risk.
Mannitol is an osmotic diuretic that draws fluid out of brain tissue, reducing intracranial pressure.
Improvement in level of consciousness suggests decreased intracranial pressure.
A new severe headache in a patient taking anticoagulants may indicate intracranial hemorrhage. This is a life-threatening emergency and takes priority over non-urgent medication side effects.
Mannitol can cause fluid overload and pulmonary edema. Crackles and dyspnea indicate respiratory compromise. The infusion should be stopped immediately and the provider notified.
tPA is contraindicated in hemorrhagic stroke. A head CT must confirm ischemic stroke before thrombolytic therapy is initiated.
Right upper quadrant pain and jaundice suggest hepatotoxicity. Valproic acid can cause severe liver damage and must be discontinued immediately.
Lorazepam is a benzodiazepine that depresses the central nervous system. It can cause respiratory depression, hypotension, and sedation. Increased alertness is not expected. Bradycardia is not a primary adverse effect.
Mannitol shifts fluid into the bloodstream and increases urine output. This can cause fluid overload (pulmonary edema), dehydration, electrolyte imbalance, and renal dysfunction. It should decrease ICP, not increase it.
Valproic acid may cause hepatotoxicity. Jaundice, RUQ pain, and elevated liver enzymes indicate liver damage. Tremors may occur but are not a primary toxicity indicator. Hyperactivity is not expected
After tPA, signs of bleeding must be monitored closely. Severe headache and decreased LOC suggest intracranial hemorrhage. Oozing indicates bleeding risk. Normal blood pressure does not require intervention.
Phenytoin requires therapeutic drug monitoring. Abrupt discontinuation can cause seizures. Rash may indicate serious reaction. Grapefruit juice should be avoided due to drug interactions.
Phenobarbital (barbiturate), lorazepam and clonazepam (benzodiazepines), and cyclobenzaprine all depress the CNS. Mannitol is an osmotic diuretic and does not cause CNS depression.
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