Problem
A 28-year-old man is admitted to the ICU for management of status epilepticus. He has a history of seizures following a traumatic brain injury (TBI) 4 years prior and takes levetiracetam (Keppra). He has no obvious residual deficits of brain injury except mild to moderate short-term memory loss. Due to his memory loss, his wife manages his medications and reports that he consistently takes his levetiracetam. This morning his wife brought him to the ED after he experienced three seizures within 2 hours, and he had one more seizure in the ED. Soon after admission to the ICU for monitoring, he has a generalized tonic-clonic seizure.
Task
i. What are the initial priorities of care for this patient?
ii. What is the primary adverse effect associated with aphenytoin?