Problem: If you were prescribing the patient's medication, what would you try first and 2nd if the first line was not adequately preventing recurrent seizures? What would you monitor for efficacy and side effects for the medication you started him on? I would prescribe phenytoin as the first-line treatment and carbamazepine as a second-line option for grand mal seizures. For phenytoin, therapeutic drug monitoring should include measuring plasma concentrations, as high serum levels can lead to serious toxicity. Potential neurotoxic effects of excessive phenytoin levels include nystagmus, ataxia, slurred speech, vomiting, lethargy, and in severe cases, coma or death. The therapeutic range for total phenytoin plasma concentration is between 10 µg/mL and 20 µg/mL (Singu, 2022). Common side effects of phenytoin include headache, nausea, vomiting, constipation, dizziness, a spinning sensation, drowsiness, trouble sleeping, and nervousness. For carbamazepine, monitoring is essential because the drug must be maintained within a narrow therapeutic range, which is between 4 µg/mL and 12 µg/mL. Looking for Assignment Help?