VIOS, Venus E.

4B
Generic Name Phenytoin (diphenylhy dantoin) Brand Name Dilantin Infatabs, Epanutin Dilantin125 Classification Dosage and frequency Adults: Initially, 100 mg P.O TID., Increased in increments of 100 mg O.O. q 2-4 weeks until desired response obtained. Children: 5 mg/kg or 250 mg/m2 P.O. divided BID or TID. Maximum daily dose is 300 mg Mechanism of Action UNKNOWN. A hydantoin derivative that probably stabilizes neuronal membranes and limits seizure activity by either increasing reflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses. Indication Contraindications Adverse Reaction Nursing Management

central nervous system agent; anticonvuls ant; hydantoin

 Control of tonic-clonic (grandma) and complex partial (temporal lobe) seizures.  For patient requiring a loading dose.  Prevention and treatment of seizures occurring during neurosurge ry.  Status Epilepticus.

Contraindicated in patient hypersensitive to hydantoin and those with sinus bradycardia, SA block, second or third degree AV block or Adams-Stokes syndrome.

CNS: ataxia, slurred speech, dizziness, insomnia, nervousness, twitching, headache, mental confusion, decreased coordination. CV: periarteritis nodosa EENT: nystagmus, diplopia, blurred vision GI: gingival hyperplasia, nausea, vomiting, constipation Hematologic: thrombocytopenia, leukopenia, megaloblastic anemia, agrunolocytosis Hepatic: toxic hepatitis Metabolic: hyperglycemia Muscuskeletal: osteomalacia Skin: purpuric dermatitis, photosensitivity reactions, necrosis, inflammation at injectionsite, discoloration of skin if given by IV push in back of hand Other: hirsutism, lymphadenopathy

 Observe ten rights in giving medication.  Use cautiously in patients with hepatic dysfunction, hypotension, myocardial infarction, diabetes, or respiratory depression, in elderly or debilitated patients and in those receiving other hydantoin derivatives.  Elderly patients tend to metabolize phenytoin slowly and may need reduced dosages.  Phenytoin requirements usually increase during pregnancy.  Stop drug if rash appears.  Use only clear solution for injection. A slight yellow color is acceptable. Don t refrigerate.  Don t give I.M. unless dosage adjustments are made; drug may precipitate at injection site, cause pain, and be absorbed erratically.  Divided doses given with or after meals may decrease adverse GI reactions.  Advise patient to avoid alcohol.  Warn patient not to stop drug abruptly because seizures may worsen.  Stress importance of good oral hygiene and regular dental examinations.  Caution patient that drug may have color pink, red or reddish brown urine.