Phenytoin Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the
Brand name (not all brands, just the brand used by the patient), Action, Indication,
Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug
interaction and Nursing Consideration/Intervention. Most clinical instructors preferred this
to be in a long bond paper in printed or handwritten with paper in landscape.

Phenytoin (diphenylhydantoin, phenytoin sodium)

Brand Name: Dilantin-125, Dilantin Infatab, Dilantin Injection, Dilantin
Kapseals, Diphenylan (CAN), Phenytek, Phenytex (CAN)
Pregnancy Category D
Drug classes: Antiepileptic agent, Hydantoin
Therapeutic actions
Has antiepileptic activity without causing general CNS depression; stabilizes
neuronal membranes and prevents hyperexcitability caused by excessive
stimulation; limits the spread of seizure activity from an active focus; also
effective in treating cardiac arrhythmias, especially those induced by
digitalis; antiarrhythmic properties are very similar to those of lidocaine; both
are class IB antiarrhythmics.
Indications
Control of grand mal (tonic-clonic) and psychomotor seizures
Prevention and treatment of seizures occurring during or following
neurosurgery
Control of status epilepticus of the grand mal type (parenteral
administration)
Unlabeled uses: antiarrhythmic, particularly in digitalis-induced arrhythmias
(IV preparations); treatment of trigeminal neuralgia (tic douloureux)
Contraindications
Contraindicated with hypersensitivity to hydantoins, sinus bradycardia,
sinoatrial block, Stokes-Adams syndrome, pregnancy (data suggest an
association between antiepileptic drug use and an elevated incidence of birth
defects; however, do not discontinue antiepileptic therapy in pregnant
women who are receiving such therapy to prevent major seizures; this is
likely to precipitate status epilepticus, with attendant hypoxia and risk to
both mother and fetus), lactation.

Adverse effects
Nystagmus, ataxia, dysarthria, slurred speech, mental confusion, dizziness,
drowsiness, insomnia, transient nervousness, motor twitchings, fatigue,
irritability, depression, numbness, tremor, headache, photophobia, diplopia,
conjunctivitis
Dermatologic reactions, scarlatiniform, morbilliform, maculopapular,
urticarial and nonspecific rashes; serious and sometimes fatal dermatologic
reactions--bullous, exfoliative, or purpuric dermatitis, lupus erythematosus,
and Stevens-Johnson syndrome, toxic epidermal necrolysis, hirsutism,
alopecia, coarsening of the facial features, enlargement of the lips,
Peyronie's disease
Nausea, vomiting, diarrhea, constipation, gingival hyperplasia, toxic
hepatitis, liver damage, sometimes fatal; hypersensitivity reactions with
hepatic involvement, including hepatocellular degeneration and fatal
hepatocellular necrosis
Nephrosis
Hematopoietic complications, sometimes fatal: thrombocytopenia,
leukopenia, granulocytopenia, agranulocytosis, pancytopenia; macrocytosis
and megaloblastic anemia that usually respond to folic acid therapy;
eosinophilia, monocytosis, leukocytosis, simple anemia, hemolytic anemia,
aplastic anemia, hyperglycemia
Drug Interactions:
Increased pharmacologic effects with chloramphenicol, cimetidine,
disulfiram, isoniazid, phenacemide, phenylbutazone, sulfonamides,
trimethoprim
Complex interactions and effects when phenytoin and valproic acid are
given together; phenytoin toxicity with apparently normal serum phenytoin
levels; decreased plasma levels of valproic acid; breakthrough seizures when
the two drugs are given together
Decreased pharmacologic effects with antineoplastics, diazoxide, folic acid,
sucralfate, rifampin, theophylline (applies only to oral hydantoins, absorption
of which is decreased)
Increased pharmacologic effects and toxicity with primidone,
oxyphenbutazone, amiodarone, chloramphenicol, fluconazole, isoniazid
Increased hepatotoxicity with acetaminophen
Decreased pharmacologic effects of the following: corticosteroids,
cyclosporine, disopyramide, doxycycline, estrogens, furosemide, levodopa,
methadone, metyrapone, mexiletine, hormonal contraceptives, quinidine,
atracurium, gallamine triethiodide, pancuronium, tubocurarine, vecuronium,
carbamazepine, diazoxide
Severe hypotension and bradycardia when IV phenytoin is given with
dopamine

Nursing considerations
Use only clear parenteral solutions; a faint yellow color may develop, but
this has no effect on potency. If the solution is refrigerated or frozen, a
precipitate might form, but this will dissolve if the solution is allowed to stand
at room temperature. Do not use solutions that have haziness or a
precipitate.
Administer IV slowly to prevent severe hypotension; the margin of safety
between full therapeutic and toxic doses is small. Continually monitor
patient's cardiac rhythm and check BP frequently and regularly during IV
infusion. Suggest use of fosphenytoin sodium if IV route is needed.
Monitor injection sites carefully; drug solutions are very alkaline and
irritating.
Monitor for therapeutic serum levels of 1020 mcg/mL.
Give oral drug with food to enhance absorption and to reduce GI upset.
Recommend that the oral phenytoin prescription be filled with the same
brand each time; differences in bioavailability have been documented.
Suggest that adult patients who are controlled with 300-mg extended
phenytoin capsules try once-a-day dosage to increase compliance and
convenience.
Reduce dosage, discontinue phenytoin, or substitute other antiepileptic
medication gradually; abrupt discontinuation may precipitate status
epilepticus.
Phenytoin is ineffective in controlling absence (petit mal) seizures. Patients
with combined seizures will need other medication for their absence
seizures.
Discontinue drug if rash, depression of blood count, enlarged lymph nodes,
hypersensitivity reaction, signs of liver damage, or Peyronie's disease
(induration of the corpora cavernosa of the penis) occurs. Institute another
antiepileptic drug promptly.
Monitor hepatic function periodically during long-term therapy; monitor
blood counts, urinalysis monthly.
Monitor blood or urine sugar of patients with diabetes mellitus regularly.
Adjustment of dosage of hypoglycemic drug may be necessary because
antiepileptic drug may inhibit insulin release and induce hyperglycemia.
Have lymph node enlargement occurring during therapy evaluated
carefully. Lymphadenopathy that simulates Hodgkin's disease has occurred.
Lymph node hyperplasia may progress to lymphoma.
Monitor blood proteins to detect early malfunction of the immune system
(eg, multiple myeloma).
Arrange dental instruction in proper oral hygiene technique for long-term
patients to prevent development of gum hyperplasia.