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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Develop an appropriate treatment plan during pregnancy

  • Properly educate a patient taking drugs during pregnancy

  • Identify the risks of epilepsy during pregnancy

  • Identify the risks of anticonvulsants during pregnancy and lactation

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PATIENT PRESENTATION

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Chief Complaint

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"I think I am pregnant."

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History of Present Illness

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Loretta Baldwin is a 26-year-old woman who presents to her primary care physician after completing a pharmacy pregnancy test that was positive 2 days ago. Her period is 3 weeks late. Her menstrual cycle is usually 28–32 days. She stopped her medications yesterday because she has been told that they may cause fetal malformations. She has never been pregnant before.

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Past Medical History

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Epilepsy (generalized tonic–clonic seizures) for 13 years following viral encephalitis. No seizures since one episode last year. Last visit to her neurologist 6 months ago.

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Overweight since childhood

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Chronic HAs

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Occasional constipation

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Family History

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Mother is alive at age 51 with DM, obesity, and HTN. Father is alive at age 53 with hypothyroidism. She has one brother who is healthy and two sisters who had normal pregnancies. There have been no multiple pregnancies in the family.

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Social History

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Born in the United States. Married and lives with her husband. Works full time as a clerk. Dislikes fruit and vegetables, eats two meals a day, often in fast-food restaurants. (−) Exercise. No pets.

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Phenytoin (unknown reaction at age 13)

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Medications (Current)

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Lamotrigine 200 mg PO twice daily, stopped yesterday

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Carbamazepine CR 400 mg PO twice daily, stopped yesterday

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MOM 30 mL PO once daily as needed for constipation

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Feverfew herbal tea two to five times a week

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Ibuprofen 400 mg PO as needed for HA, twice weekly in the last month

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Review of Systems

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No seizure; occasional HA relieved with ibuprofen; increased urinary frequency and constipation in the past 2 weeks; occasionally SOB; tiredness and mild nausea.

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Physical Examination

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General
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Overweight young Caucasian woman in no acute distress

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Vital Signs
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BP 112/76 mm Hg, P 89, RR 12, T 36.2°C

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Weight 207.2 lb (94.2 kg)

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Height 67 in. (170 cm)

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Denies pain

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Skin
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Normal

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HEENT
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PERRLA, EOMI; ...

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