24 year-old Nia Clarke has just learned that she is pregnant

24 year-old Nia Clarke has just learned that she is pregnant. This is her first pregnancy. Nia suffers from frontal lobe epilepsy for which she is taking phenytoin-ER, 200 mg, PO, twice daily. She had approximately a seizure per month in childhood until the right medication and right dose were found. She tried many different antiepileptic drugs, and phenytoin was not the first choice, but was the only one that seemed to work. Nia calls Dr. Anya Sharma’s office, where you are working as a nurse. Dr. Sharma is an OB/Gyn. She has been seeing Nia for annual exams. Her epilepsy is managed by Dr. Marcus Bell, a neurologist. Nia is panicked because she has been cautioned that epilepsy medications can cause birth defects. She had been using birth control pills and is actually quite shocked that she is pregnant. Nia’s PMH: none, other than epilepsy Meds: Phenytoin-ER, 200 mg, PO, twice daily Junel 1.5mg/30mcg (norethindrone/estradiol) Allergies: penicillin causes a mild rash Social: Nia is engaged to be married to Darren Porter who is the father of the baby. Nia works as a paralegal and Darren works as an electrician. This is Nia’s first pregnancy. Darren has not yet learned that Nia is pregnant, but Nia tells you that she knows Darren will be shocked, but really happy about the baby. She adds “He’s going to worry about the fact that I’m taking this dangerous medication though.” Q1: Are Nia’s concerns about her anti-epileptic medication justified, and is it important for her to stop the phenytoin immediately? (Look in D