Dilantin (phenytoin)

NURS 1566 Clinical Form 3: Clinical Medications Worksheets Generic Name Phenytoin Peak 1.5-3 hr

Trade Name Classification Dose Route Time/frequency Dilantin anticonvulsants 100 mg PO BID Onset Duration Normal dosage range 2-24 hr (1 6-12 hr maintenance dose 300-400 mg/day wk)

Why is your patient getting this medication Treatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures

For IV meds, compatibility with IV drips and/or solutions NA

Mechanism of action and indications (Why med ordered) • L i m i t s e i z u r e p r o p a g a t i o n b y a l t e r i n g i o n t r a n s p o r

Nursing Implications (what to focus on) Contraindications/warnings/interactions Hypersensitivity, Hepatic or renal disease (increased risk of adverse reactions; dosage reduction recommended for hepatic impairment) Common side effects Ataxia, diplopia, nystagmus, hypotension (increased with IV phenytoin and with rapid IV administration), gingival hyperplasia, nausea, hypertrichosis, rashes

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) chronic ingestion of alcohol may decrease phenytoin blood levels, Additive CNS depression with other CNS depressants, including alcohol , antihistamines , antidepressants , opioid analgesics , and sedative/hypnotics

Lab value alterations caused by medicine CBC and platelet count, serum calcium, albumin, urinalysis, and hepatic and thyroid function tests should be monitored prior to and monthly for the first several months, then periodically throughout therapy, May cause increased serum alkaline phosphatase, GTT, and glucose levels, Serum folate concentrations should be monitored periodically during prolonged therapy, Serum phenytoin levels should be routinely monitored. Therapeutic blood levels are 10-20 mcg/ml in patients with normal serum albumin and renal function. Be sure to teach the patient the following about this medication May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder. Advise patient to carry identification at all times describing disease process and medication regimen. Advise patient to notify health care professional if skin rash, severe nausea or vomiting, drowsiness, slurred speech, unsteady gait, swollen glands, bleeding or tender gums, yellow skin or eyes, joint pain, fever, sore throat, unusual bleeding or bruising, or persistent headache occurs. Emphasize the importance of routine exams to monitor progress. Patient should have routine physical exams, especially monitoring skin and lymph nodes, and EEG testing. a y m i n i m i z e g r o w t h r a t e a n d

Nursing Process- Assessment (Pre-administration assessment) Assess location, duration, frequency, and characteristics of seizure activity. EEG may be monitored periodically throughout therapy, Assess oral hygiene. Vigorous oral cleaning beginning within 10 days of initiation of phenytoin therapy may help control gingival hyperplasia

Assessment Why would you hold or not give this med? Assess patient for phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy). Rash usually occurs within the first 2 wk of therapy. Hypersensitivity syndrome usually occurs at 3-8 wk but may occur up to 12 wk after initiation of therapy. May lead to renal failure, rhabdomyolysis, or hepatic necrosis; may be fatal. Progressive signs and symptoms of phenytoin toxicity include nystagmus, ataxia, confusion, nausea, slurred speech, and dizziness

Evaluation Check after giving Decrease or cessation of seizures without excessive sedation