My Drug Card

Name: Gifther John

Reference
Karch, A. M. (2016) Lippincott: Pocket Drug Guide for Nurses 4th ed. Wolters Kluwer: China

Skidmore, L. (2018) Mosby’s 2018: Nursing Drug Reference 31st ed. Elsevier: United States of America

Generic Name: Phenytoin Trade Name: Dilantin, Dilantin Infatab, Phenytek

Classification: Antiarrhythmic, Anticonvulsant, Antiepileptic, Hydantoin

Mechanism of Action: Inhibits spread of seizure activity in motor Usage: Control of generalized tonic-clonic and complex partial seizures
cortex by altering ion transport and increases atrioventricular (AV) (psychomotor seizures), prevention and treatment of seizures occurring during or
conduction. Phenytoin tends to stabilize the threshold against following neurosurgery, control of status epilepticus, non-epileptic seizures
hyperexcitability caused by excessive stimulation or environmental changes associated with Reye’s syndrome, after head trauma.
capable of reducing membrane sodium gradient

Dosage: Treatment of Status Epilepticus: Adult IV 10-15mg/kg, Maintenance, 100mg PO IV q6-8h, maximum infusion rate, 50mg/min. Child 10-15mg/kg IV
in divided doses of 5-10mg/kg. Neonates 15-20mg/kg IV in divided doses of 5-10mg/kg. Seizures prophylaxis during neurosurgery: Adult 100-200mg IM q
4hr during surgery. For post-operation, IM is not the preferred route. Treatment of tonic-clonic and psychomotor seizures: Adult loading dose in hospitalized
patients: 1g phenytoin capsules divided into three doses (400mg, 300mg, and 300mg) and given PO q 2hr. When control is established, may consider once-a-day
dosing with 300mg PO. With no previous treatment: initially, 100mg PO tid; maintenance, 300-400mg/day. Child not previously treated: 5mg/kg/day PO in two to
three equally divided doses, maximum, 300mg/day, maintenance, 4-8mg/day. Child over 6 years may need minimum adult dose of 300mg/day

Side Effects:

CNS: mental confusion, drowsiness, dizziness, slurred speech CV: hypotension, bradycardia, cardiac arrest EENT: Nystagmus, diplopia, blurred vision GI:

Gingival hyperplasia, constipation, nausea, vomiting, hepatitis GU: Urine discoloration, sexual dysfunction HEMA: Aplastic anemia INTEG: Rash, lupus

erythematosus, hirsutism, Stevens-Johnson Syndrome

Drug Interaction

 Increase phenytoin effect – benzodiazepine, acute alcohol intake, diazepam, H2 antagonists, phenothiazine, omeprazole, cimetidine
 Decreases phenytoin effect – chronic alcohol abuse, antacids, barbiturates, rifampin, high dose of calcium, folic acid, carbamazepine
 Using acetaminophen together with phenytoin may alter the effects of acetaminophen and cause serious side effects that may affect your liver
 Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for hemorrhagic disease of
the newborn.
 Drugs whose efficacy is impaired by phenytoin include: corticosteroids, anticoagulants, digoxin, doxycycline, estrogens, furosemide, oral
 contraceptives, vitamin D
 Enteral tube feeding may decrease absorption of oral product. Do not use enteral feeding 2 hours before or 2 hours after doses

Treatment Guidelines

1. Give IV slowly to prevent severe hypotension and venous irritation.

2. In acute overdose, the possibility of other CNS depressants, including alcohol, should be borne in mind. Hence, acute alcoholic intake may

increase phenytoin serum levels, while chronic alcoholic use may decrease serum levels.

3. May increase the risk of suicidal thoughts. Monitor client for the emergence or worsening of depression, suicidal thoughts or behavior, and/or

any unusual changes in mood or behavior.

4. Risk of gingival hyperplasia

5. Prenatal exposure to phenytoin may increase the risks for congenital malformations and other adverse developmental outcomes such as orofacial

clefts, cardiac defect, growth abnormalities (including microcephaly), and mental deficiency

6. High blood sugar (hyperglycemia), resulting from drug's inhibitory effect on insulin; phenytoin may also raise serum glucose level in patients

with diabetes mellitus

7. The lethal dose in pediatric patients is not known; in adults, the lethal dose is estimated to be 2- 5 g; initial symptoms include nystagmus, ataxia,

and dysarthria; other signs are tremor, hyperreflexia, lethargy, slurred speech, blurred vision, nausea, and vomiting; death is due

to respiratory and circulatory depression.

8. Phenytoin is secreted in human milk; developmental and health benefits of breastfeeding should be considered along with
 the mother's clinical need for therapy.

9. There is no known antidote for phenytoin.

Management

1. Monitor EKG, blood pressure and respiratory function frequently during IV loading dose.

2. Caution patient to avoid alcohol and CNS depressants (e.g. Valium, Xanax). The heavy use of alcohol may diminish the effect of the product

whilst CNS depressant increase effect of the product.

3. Report suicidal thoughts/behavior immediately

4. Proper brushing of teeth, using a soft bristle toothbrush, flossing to prevent gingival hyperplasia.

5. Use non-hormonal contraception such as condoms, and notify prescriber if pregnancy is planned or suspected.

6. If diabetic, blood glucose should be monitored

7. Notify prescriber of unusual bleeding , bruising , petechiae, clay- colored stool, abdominal pain, dark urine, slurred speech, headache, drowsines

8. Do not use antacids within 2 hr of product

9. For oral, administer with or immediately after meals to minimize GI irritation

10. Observe patient for development of rash. Discontinue phenytoin at the first sign of skin reactions.