Drug Dilantin
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NURS 1556 Clinical Medication Worksheet Karen Nielsen Generic Name Phenytoin
Trade Name Dilantin
Peak 1.5-3 hr
Onset 2-24 hr
Classification Dose Route Time/frequency Antiarrhythmic (group IB), 100 mg PO QD anticonvulsant Duration For IV meds, compatibility with IV drips and /or solutions 6-12 hr N/A but of note: use of IV phenytoin in geriatric pt may increase risk of serious adverse effects.
Mechanism of action and indications: (Why med ordered) Rx limits seizure propagation by altering ion transport, may also decrease synaptic transmission. For Tic disorder.
Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically): Gabapentin and omeprazole may increase drug levels. The SSRI Zoloft may cause additive CNS depression effects.
Nursing Process- Assessment (Pre-administration assessment) Assess for phenytoin hypersensitivity syndrome, (fever, skin rash, lymphadenopathy). Vital signs.
Nursing Implications (what to focus on) Contraindications/warnings/interactions-Hypersensitivity; Sinus bradycardia, SA node block, 2nd or 3rd degree heart block. Caution in pt with severe cardiac or respiratory disease. Interacts with alcohol, gabapentin, omeprazole, (may increase phenytoin drug levels). Antidepressants may cause additive CNS depression. Common side effects: CNS: ataxia, agitation, confusion, drowsiness, dizziness, dysarthria, dyskinesia, extra pyramidal syndrome, H/A, insomnia, weakness.EENT: diplopia, nystagmus. CV: hypotension, tachycardia. GI: gingival hyperplasia, N/V, constipation, drug-induced hepatitis. Derm: hypertrichosis, rash, pruritis. Hemat: Agranulocytosis, aplastic anemia, leukopenia, megaloblastic anemia, thrombocytopenia. MS: osteomalacia. Misc: allergic reactions including StevensJohnson syndrome, fever, lymphadenopathy. Lab value alterations caused by medicine:May increase serum alkaline phosphatase, GGT, and glucose levels. Monitor serum folate concentrations periodically during prolonged therapy. Be sure to teach the patient the following about this medication: Take with meals or right after to minimize GI irritation. Chewable tablets must be crushed or chewed well before swallowing. Take same time each day. May cause drowsiness or dizziness. Maintain good oral hygiene.
Assessment Why would you hold or not give this med? Signs of hypersensitivity, or abnormally low heart rate, <50.
Evaluation Check after giving: Decrease in Tic disorder. Monitor serum phenytoin levels routinely. Therapeutic blood levels ( 10-20 mcg/ml).
Trade Name Dilantin
Peak 1.5-3 hr
Onset 2-24 hr
Classification Dose Route Time/frequency Antiarrhythmic (group IB), 100 mg PO QD anticonvulsant Duration For IV meds, compatibility with IV drips and /or solutions 6-12 hr N/A but of note: use of IV phenytoin in geriatric pt may increase risk of serious adverse effects.
Mechanism of action and indications: (Why med ordered) Rx limits seizure propagation by altering ion transport, may also decrease synaptic transmission. For Tic disorder.
Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically): Gabapentin and omeprazole may increase drug levels. The SSRI Zoloft may cause additive CNS depression effects.
Nursing Process- Assessment (Pre-administration assessment) Assess for phenytoin hypersensitivity syndrome, (fever, skin rash, lymphadenopathy). Vital signs.
Nursing Implications (what to focus on) Contraindications/warnings/interactions-Hypersensitivity; Sinus bradycardia, SA node block, 2nd or 3rd degree heart block. Caution in pt with severe cardiac or respiratory disease. Interacts with alcohol, gabapentin, omeprazole, (may increase phenytoin drug levels). Antidepressants may cause additive CNS depression. Common side effects: CNS: ataxia, agitation, confusion, drowsiness, dizziness, dysarthria, dyskinesia, extra pyramidal syndrome, H/A, insomnia, weakness.EENT: diplopia, nystagmus. CV: hypotension, tachycardia. GI: gingival hyperplasia, N/V, constipation, drug-induced hepatitis. Derm: hypertrichosis, rash, pruritis. Hemat: Agranulocytosis, aplastic anemia, leukopenia, megaloblastic anemia, thrombocytopenia. MS: osteomalacia. Misc: allergic reactions including StevensJohnson syndrome, fever, lymphadenopathy. Lab value alterations caused by medicine:May increase serum alkaline phosphatase, GGT, and glucose levels. Monitor serum folate concentrations periodically during prolonged therapy. Be sure to teach the patient the following about this medication: Take with meals or right after to minimize GI irritation. Chewable tablets must be crushed or chewed well before swallowing. Take same time each day. May cause drowsiness or dizziness. Maintain good oral hygiene.
Assessment Why would you hold or not give this med? Signs of hypersensitivity, or abnormally low heart rate, <50.
Evaluation Check after giving: Decrease in Tic disorder. Monitor serum phenytoin levels routinely. Therapeutic blood levels ( 10-20 mcg/ml).
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