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A patient is admitted to the hospital after having multiple seizures and fosphenytoin is administered. The patient's phenytoin blood level is checked later and is 19 mcg/ml. Which of the following observed conditions is a side effect of fosphenytoin?

Explanation

• Fosphenytoin is a phenytoin prodrug, both are hydantoin anticonvulsants. It works by modulating neuronal sodium and calcium channels 

• The therapeutic phenytoin level is 10-20 mcg/ml. Even at therapeutic levels, side effects such as nystagmus can occur 

• Hypotension or constipation, not hypertension or diarrhea, are side effects of fosphenytoin 

• Agitation is not a side effect of fosphenytoin.  However, it may cause confusion and/or somnolence   

• Other side effects include paresthesia, sedation, ataxia, rash, bradycardia, hypokalemia, tinnitus, and gingival hyperplasia 

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