UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCE

School of pharmacy
DIC Report Consultation

Submitted by-Blen G/kirstos

ID Number-chs/ur116642/09
 Phenytoin use in epilepsy?
Epilepsy- is a disorder of the brain characterized by repeated seizures; a seizure is
usually defined as a sudden alteration of behavior due to a temporary change in the
electrical functioning of the brain.normally the brain continuously generates tiny
electrical impulses in an orderly pattern.these network of nerve cells in the brain
and throughout the whole body via chemical messengers called neurotransmitters.

EPIDEMIOLOGY
 Epilepsy is the fourth most common neurologic disorder globally.
 The majority of patients with epilepsy has a good prognosis and will be able
to attain seizure freedom. However overall, the mortality rate of patients
with epilepsy is 2 to 3 times that of the general population and life
expectancy in some of these patients is reduced.This increase in mortality
has been attributed to a wide variety of reasons including sudden
unexplained death in epilepsy (SUDEP). While the exact mechanisms
underlying SUDEP are unclear, recent research suggests there may be a
cardio-respiratory mechanism involved.
 Although all individuals with epilepsy experience seizures, not all
individuals who experience seizures will be diagnosed with epilepsy.
 Some seizures are provoked and occur as a result of systemic, toxic, or
metabolic insults such as drug overdose; alcohol, barbiturate, or
benzodiazepine withdrawal; or acute neurologic (eg, brain hemorrhage) or
systemic illnesses (eg, hypocalcemia, hypoglycemia, uremia, and
eclampsia). Furthermore, some patients will have seizures only associated
with fever (eg, febrile seizures).
 Types of seizure
Focal Aware Seizures
 Patient retains awareness of themselves and their environment including
 external stimuli
Focal to Bilateral Tonic–Clonic
 Focal seizure with impaired awareness which progresses to bilateral
 convulsive features such as with tonic–clonic motor features
Focal Impaired Awareness Seizure
 Patient has impaired awareness at any time during the seizure
 May be able to respond to questions during the seizure, but inappropriate
 response
 May not recall actions after event
Motor signs
 Automatisms: automatic behaviors like lip smacking, chewing, picking at
 clothing
 Atonic: loss of tone, going limp
 Clonic: rhythmic jerking or twitching of arm, shoulder, face, or leg
 Spasm: trunk flexion
 Hyperkinetic: thrashing/pedaling
 Myoclonic: arrhythmic jerking of arm, shoulder, face, or leg
 Tonic: extension or flexion postures
Nonmotor signs
 Autonomic: flushing, sweating, piloerection, salivation, pallor
 Behavior arrest: pausing, freezing, activity arrest
 Cognitive: language problems, thinking problems, memory phenomenon,
 and feelings of familiarity (déjà vu) or unfamiliarity (jamais vu)
 Emotion: feelings of fear, depression, joy, anger, extreme aberration of
 behavior
 Sensory: numbness, tingling, sounds (ringing/buzzing), smells,
tastes,visions (hallucinations), vertigo
Generalized Onset
 Impaired awareness
Motor signs
 Tonic–clonic: sudden sharp tonic stiffening of muscles with a subsequent
 period of clonic movements such as rhythmic jerking of arms and legs
(previously called “grand mal”)
 Clonic: rhythmic jerking or twitching of arm, shoulder, face, or leg
  Myoclonic: arrhythmic jerking of arm, shoulder, face, or leg
 Atonic: loss of tone, going limp
 Epileptic spasms: trunk flexion
Non motor
 Typical: sudden arrest of behavior, blank stare with brief upward rotation
of
 the eyes lasting 2 to 30 seconds
 Eyelid myoclonia: lid jerks
Phenytoin
Phenytoin- is an anti epileptic drug ,also called an anticonvulsant,it works by
slowing down impulses in the brain that cause seizures. It is useful for for the
prevention of tonic-clonic seizures and partial seizures.the intravenous form is used
for status epilepticus that does not improve with benzodiazepins. The intravenous
form generally begins working within 30mins and is effective for 24hrs .

Side effects
 Signs of an allergic reaction to phenytoin(Hives,difficult breathing, swelling
of face)
 Severe skin reaction(fever, sore throat, burning of eyes,skin pain red or
purple skin rash that spreads and causes blistering and peeling)
 Liver problems(loss of appetite, upper stomach pain ,dark urine, clay colored
stools,jaundice)
 Severe low BP and abnormal heart rhythms seen with rapid infusion of IV
phenytoin.
 Double vision, sedation, slurred speech, cerebellar ataxia, tremor.
 Reduction in folic acid levels
 Known teratogen;cleft lip and palate,smaller than normal head
 Gingival enlargement
 Steven Johnson syndrome
 Exfoliative dermatitis
 Drug induced lupus
 Precautions
 Don’t use phenytoin if you also take delavirdine,or allergic to ethotoin or
mephenytoin.
 If pregnant don’t start taking this medication unless your doctor tells you to.
 If become pregnant while taking this medicine don’t stop taking the
medicine until you are told to do so
 Report and worsening symptoms to your doctor such as; mood or behavior
changes, depression,anxiety,feeling agitated,hostile,restless,hyperactive or
thoughts of suicide.
 Ask a doctor or pharmacist before using OTC such as
cimetidine,omeprazole,vitamins and mineral supplements that contain folic
acid.
Significance of the study

 Phenytoin blocks movement of ions through sodium channels during

propagation of the action potential and thus blocks and prevents post
titanic potentiation limits development of maximal seizure activity
and reduces the spread of seizures.
 Oral bioavailabilty is approximately 95 percent and peak level after
oral admistration is reached in approximately 4-12hrs.
 Has an inhibiting effect on calcium channels and the sequestration of
calcium ions in nerve terminals thereby inhibin voltage dependent
neurotransmission at level of the synapse.
 Reference
-Dipiro 11th edition
-Drugs.com

-https://www.aans.org