c


 
 

 
 
  „
PHENYTOIN SODIUM EXTENDED

 
 
„
PHENYTOIN SODIUM PROMPT

 „

 


 





!
 !
" 

   „  
„
À
À
À
Assessment & Drug Effects
 Continuously monitor vital signs and symptoms during IV infusion and for an hour afterward. Watch for respiratory
depression. Constant observation and a cardiac monitor are necessary with older adults or patients with
cardiac disease. Margin between toxic and therapeutic IV doses is relatively small.
 Be aware of therapeutic serum concentration: 10±20 mcg/mL; toxic level: 30±50 mcg/mL; lethal level: 100
mcg/mL. Steady-state therapeutic levels are not achieved for at least 7±10 d.
 Lab tests: Periodic serum phenytoin concentration; CBC with differential, platelet count, and Hct and Hgb;
serum glucose, serum calcium, and serum magnesium; and liver funtion tests.
 Observe patient closely for neurologic adverse effects following IV administration. Have on hand oxygen,
atropine, vasopressor, assisted ventilation, seizure precaution equipment (mouth gag, nonmetal airway, suction
apparatus).
 Be aware that gingival hyperplasia appears most commonly in children and adolescents and never occurs in
patients without teeth.
 Make sure patients on prolonged therapy have adequate intake of vitamin D-containing foods and sufficient
exposure to sunlight.
 Monitor diabetics for loss of glycemic control.
 Check periodically for decrease in serum calcium levels. Particularly susceptible: patients receiving other
anticonvulsants concurrently, as well as those who are inactive, have limited exposure to sun, or whose dietary
intake is inadequate.
 Observe for symptoms of folic acid deficiency: neuropathy, mental dysfunction.
 Be alert to symptoms of hypomagnesemia (see Appendix F); neuromuscular symptoms: tetany, positive
Chvostek¶s and Trousseau¶s signs, seizures, tremors, ataxia, vertigo, nystagmus, muscular fasciculations.
Patient & Family Education
 Be aware that drug may make urine pink or red to red-brown.
 Report symptoms of fatigue, dry skin, deepening voice when receiving long-term therapy because phenytoin can
unmask a low thyroid reserve.
 Do not alter prescribed drug regimen. Stopping drug abruptly may precipitate seizures and status epilepticus.
 Do not to request/accept change in drug brand when refilling prescription without consulting physician.
 Understand the effects of alcohol: Alcohol intake may increase phenytoin serum levels, leading to phenytoin
toxicity.
 Discontinue drug immediately if a measles-like skin rash or jaundice appears and notify physician.
 Be aware that influenza vaccine during phenytoin treatment may increase seizure activity. Understand that a
change in dose may be necessary.
 Do not breast feed while taking this drug.
„