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Nurse practitioners need an evidence-based framework for monitoring clients on phenytoin (Dilantin) therapy. A Med-line search of published literature and a synthesis of 10 years of research was performed. The effect of phenytoin within the body is dependent on the amount of serum albumin and the functional status of the major organs in the body. The basic principles of pharmacotherapeutics holds true for phenytoin. Closer investigation of total serum phenytoin and serum albumin ratio by primary care providers is necessary for monitoring therapeutic levels of phenytoin therapy. An algorithm was developed to provide a quick reference for monitoring therapeutic phenytoin levels.

Synaptic vesicle protein 2 (SV2) is a membrane glycoprotein common to all synaptic and endocrine vesicles. Unlike many proteins involved in synaptic exocytosis, SV2 has no homolog in yeast, indicating that it performs a function unique to secretion in higher eukaryotes. Although the structure and protein interactions of SV2 suggest multiple possible functions, its role in synaptic events remains unknown. To explore the function of SV2 in an in vivo context, we generated mice that do not express the primary SV2 isoform, SV2A, by using targeted gene disruption. Animals homozygous for the SV2A gene disruption appear normal at birth. However, they fail to grow, experience severe seizures, and die within 3 weeks, suggesting multiple neural and endocrine deficits. Electrophysiological studies of spontaneous inhibitory neurotransmission in the CA3 region of the hippocampus revealed that loss of SV2A leads to a reduction in action potential-dependent gamma-aminobutyric acid (GABA)ergic neurotransmission. In contrast, action potential-independent neurotransmission was normal. Analyses of synapse ultrastructure suggest that altered neurotransmission is not caused by changes in synapse density or morphology. These findings demonstrate that SV2A is an essential protein and implicate it in the control of exocytosis.