Clinical Medications WorksheetsGeneric NamePhenytoin

Trade NameDilantin

ClassificationAntiarrhythmics, anticonvulsants

Dose300mg Q am and 400 mg QHS

RoutePO

Time/frequencyRefer to dose

Peak1.5-3 hours

Onset2-24 hours

Duration6-12 hours

Normal dosage range200-600 mg/day in divided doses

Why is your patient getting this medicationPrevention of seizures

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Limits seizure propagation by altering ion transport. May also decrease synaptic transmission. Indicated for prevention of seizures

Nursing Implications (what to focus on) Contraindications/warnings/interactions.Contraindicated in pt’s with hypersensitivity, sinus bradycardia, sinoatrial block, 2nd- or 3rd-degree heart block, or Adams--Stokes syndrome. Use cautiously in obese patients (initial dose of IV phenytoin should be based on ideal body weight + 1.33 times excess weight).Common side effectsAtaxia, diplopia, nystagmus, hypotension, gingival hyperplasia, nausea, hypertrichosis, rashes

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)May alter the effect of corticosteroids.

Lab value alterations caused by medicineCBC and platelet count, serum calcium, albumin, urinalysis, and hepatic and thyroid function tests should be monitored prior to and monthly for the first several months, then periodically throughout therapy. May cause increased serum alkaline phosphatase, GTT, and glucose levels. Serum folate concentrations should be monitored periodically during prolonged therapy. Toxicity and Overdose: Phenytoin: Serum phenytoin levels should be routinely monitored. Therapeutic blood levels are 10-20 mcg/ml in patients with normal serum albumin and renal function.Be sure to teach the patient the following about this medicationMay cause drowsiness or dizziness. Advise patient to carry identification at all times describing disease process and medication regimen. Advise patient to notify health care professional if skin rash, severe nausea or vomiting, drowsiness, slurred speech, unsteady gait, swollen glands, bleeding or tender gums, yellow skin or eyes, joint pain, fever, sore throat, unusual bleeding or bruising, or persistent headache occurs. Emphasize the importance of routine exams to monitor progress. Instruct patient to take medication exactly as directed, at the same time each day. If a dose is missed from a once-a-day schedule, take as soon as possible and return to regular dosing schedule. If taking several doses a day, take missed dose as soon as possible within 4 hr of next scheduled dose; do not double doses. Consult health care professional if doses are missed for 2 consecutive days. Abrupt withdrawal may lead to status epilepticus. Instruct patient on importance of good dental hygiene and seeing dentist frequently. Inform patient that phenytoin may color urine pink, red, or reddish brown, but color change is not significant. Advise patient not to take phenytoin within 2-3 hr of antacids or antidiarrheals

Nursing Process- Assessment(Pre-administration assessment)Assess location, duration, frequency, and characteristics of seizure activity. EEG may be monitored Serum phenytoin levels should be routinely monitored.periodically throughout therapy.

AssessmentWhy would you hold or not give this med?If the patient was experiencing signs of toxicity which are nystagmus, ataxia, confusion, nausea, slurred speech, and dizziness or if serum levels were elevated above normal.

EvaluationCheck after givingDecrease of seizures without excessive sedation and no signs of toxicity.