What teaching should the patient receive regarding self care and adverse effects of phenytoin Dilantin )?
Antiseizure agents (also known as antiepileptic drugs or as anticonvulsants) are drugs used to manage epilepsy, the most prevalent neurological disorder. Antiseizure agents of choice depends on the type of epilepsy, age of the patient, patient tolerance, and specific patient characteristics. Show
Antiseizure Agents: Generic and Brand NamesHere is a table of commonly encountered antiseizure agents, their generic names, and brand names:
Disease Spotlight: EpilepsyEpilepsy is a collection of different syndromes, all of which is characterized by sudden discharge of excessive electrical energy from nerve cells located within the brain. The resultant reaction is called Nature of seizures depends on the location of the cells that initiate the electrical discharge as well as the neural pathways which were stimulated. Seizures can be primary (no underlying cause) or secondary (brought about by external factors like head injury). Status epilepticus is a state in which seizures rapidly recur with no recovery between seizures. It is potentially the most dangerous of seizures. International Classification of Seizures categorized seizures based on symptoms and characteristics. The two main categories include: Generalized SeizuresThese seizures are characterized by a massive electrical activity that begins in one area of the brain and rapidly spread to both hemispheres. It is usually accompanied by loss of consciousness. It is further classified into five types: Tonic-clonic seizure It involves involuntary muscle contraction (tonic) followed by relaxation appearing as an aggressive spasm (clonic), loss of consciousness, and confusion and exhaustion in the early recovery period. Absence seizure It is an abrupt and brief (3-5 s) period of loss of consciousness common in children (starting at age 3) but frequently disappears by puberty. This seizure does not usually involve muscle contractions. Myoclonic seizure It is characterized by short, sporadic periods of muscle contractions that last for several minutes. It is relatively rare. Febrile seizure Self-limited seizure related to very high fevers and usually involves tonic-clonic seizures. This type most frequently occurs in children. Jacksonian Seizures Begins in one area of the brain and involve only one part of the body but this later on spread to other parts until a generalized tonic-clonic seizure has developed. Partial (Focal) SeizuresThese are characterized by seizures that originate from one area of the brain which do not spread to other parts. It can be further classified into two: Simple Partial Seizure It occurs in a single area of the brain and may involve a single muscle movement or sensory alteration. Complex Partial Seizure It is a type which occurs by late teenage years and involves a series of reactions or emotional changes and complex sensory changes (hallucinations, mental distortion, personality changes, loss of consciousness, and loss of social inhibition). Motor changes may include involuntary urination, chewing motions, and diarrhea. Drugs for Treating Generalized SeizuresDrugs used for treatment of generalized seizures exert their therapeutic effects by blocking channels in the cell membrane or by altering their receptor sites. As a result, nerve membranes become stabilized. Their work involves the entire nervous system so sedation is an expected result. Drugs used to treat generalized seizures include hydantoins, barbiturates, barbiturate-like drugs, benzodiazepines, and succinimides. Succinimides and drugs that modulate the inhibitory GABA are used to treat absence seizures. HydantoinsTherapeutic ActionThe desired and beneficial actions of hydantoins are as follows:
IndicationsHydantoins are indicated for the following medical conditions:
Here are some important aspects to remember for indication of hydantoins in different age groups: Children
Adults
Older adults
PharmacokineticsHere are the characteristic interactions of hydantoins and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of hydantoins:
Adverse EffectsUse of hydantoins may result to these adverse effects:
InteractionsThe following are drug-drug interactions involved in the use of hydantoins:
Barbiturates and Barbiturate-like DrugsTherapeutic ActionThe desired and beneficial action of barbiturates and barbiturate-like drugs is:
IndicationsBarbiturates and barbiturate-like drugs are indicated for the following medical conditions:
Here are some important aspects to remember for indication of barbiturates and barbiturate-like drugs in different age groups: Children
Adults
Pregnant women
Older adults
PharmacokineticsHere are the characteristic interactions of barbiturates and barbiturate-like drugs and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and Cautions
Adverse Effects
Interactions
BenzodiazepinesTherapeutic ActionThe desired and beneficial action of benzodiazepines is as follows:
IndicationsBenzodiazepines are indicated for the following medical conditions:
Here are some important aspects to remember for indication of benzodiazepines in different age groups: Children
Adults
Pregnant women
Older adults
PharmacokineticsHere are the characteristic interactions of benzodiazepines and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of benzodiazepines:
Adverse EffectsUse of benzodiazepines may result to these adverse effects:
InteractionsThe following are drug-drug interactions involved in the use of benzodiazepines:
SuccinimidesTherapeutic ActionThe desired and beneficial action of succinimides is as follows:
IndicationsSuccinimides are indicated for the following medical conditions:
Here are some important aspects to remember for indication of succinimides in different age groups: Children
Adults
Pregnant women
Older adults
PharmacokineticsHere are the characteristic interactions of succinimides and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of succinimides:
Adverse EffectsUse of succinimides may result to these adverse effects:
InteractionsThe following are drug-drug interactions involved in the use of succinimides:
Drugs for Treating Partial Seizures
Therapeutic ActionThe desired and beneficial actions of drugs used for treatment of partial seizures are as follows:
IndicationsDrugs used for treatment of partial seizures are indicated for the following medical conditions:
PharmacokineticsHere are the characteristic interactions of drugs used for treatment of partial seizures and the body in terms of absorption, distribution, metabolism, and excretion:
Contraindications and CautionsThe following are contraindications and cautions for the use of drugs indicated for treatment of partial seizures:
Adverse EffectsUse of drugs indicated for treatment of partial seizures may result to these adverse effects:
InteractionsThe following are drug-drug interactions involved in the use of drugs indicated for treatment of partial seizures:
Nursing ConsiderationsHere are important nursing considerations when administering this drug: Nursing AssessmentThese are the important things the nurse should include in conducting assessment, history taking, and examination:
Nursing DiagnosesHere are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Implementation with RationaleThese are vital nursing interventions done in patients who are antiseizure agents:
EvaluationHere are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Practice Quiz: Antiseizure DrugsQuiz time! Here are 5 questions about this topic: Antiseizure Agents. 1. It is a rare type of seizure that appears sporadically. A. Febrile seizure 2. Which antiseizure agents is used to treat absence seizures? A. Hydantoins 3. A patient on Dilantin began showing bruises and signs of active infection. The nurse would be right to anticipate that these manifestations give clue to ________________. A. Drug underdosage 4. Which barbiturate is also indicated for management of anxiety? A. mephobarbital 5. Benzodiazepines exert their effect primarily on which neurotransmitter? A. GABA Answers and Rationale 1. Answer: B. Myoclonic seizure. It is characterized by short, sporadic periods of muscle contractions that last for several minutes. It is relatively rare. 2. Answer: D. Succinimides. Succinimides and drugs that modulate the inhibitory GABA are used to treat absence seizures. All of them treat generalized seizures but it is succinimides that are particularly indicated for absence seizures. 3. Answer: C. Cellular toxicity. It is characterized by severe liver toxicity, bone marrow suppression, gingival hyperplasia, and serious dermatological reaction (e.g. hirsutism, Steven-Johnson syndrome). 4. Answer: A. Mephobarbital. Aside for being used as treatment for tonic-clonic and absence seizures, mephobarbital is also used as an anxiolytic or hypnotic agent. 5. Answer: A. GABA. It potentiates effects of GABA, an inhibitory neurotransmitter that stabilizes nerve cell membrane. Muscle relaxation is one result. Recommended ResourcesRecommended resources and reference books. Disclosure: Includes Amazon affiliate links.
See AlsoHere are other nursing pharmacology study guides:
Gastrointestinal System Drugs
Respiratory System Drugs
Endocrine System Drugs
Autonomic Nervous System Drugs
Immune System Drugs
Chemotherapeutic Agents
Reproductive System Drugs
Nervous System Drugs
Cardiovascular System Drugs
References and SourcesReferences and sources for this pharmacology guide for antiseizure agents:
What's an important teaching topic for a client taking phenytoin?PATIENT TEACHING
- Patients or their carers should be told how to recognise signs of blood or skin disorders, and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, bruising or bleeding develop.
What are the advice is given on phenytoin?Do not change brands or dosage forms of phenytoin without first checking with your doctor. Different products may not work the same way. If you refill your medicine and it looks different, check with your pharmacist. Swallow the tablet whole or chew it thoroughly before swallowing it together with a glass of water.
What is an important nursing consideration when administering IV phenytoin Dilantin?Nursing Considerations Across the Lifespan
Careful cardiac monitoring is needed during and after administering intravenous phenytoin. Phenytoin has a narrow therapeutic drug level, usually between 10-20 mcg/ml, so serum drug monitoring is required.
What are the adverse effects of phenytoin?Side effects of phenytoin. Headaches. Make sure you rest and drink plenty of fluids. ... . Feeling drowsy, sleepy or dizzy. As your body gets used to phenytoin, these side effects should wear off. ... . Feeling nervous, unsteady or shaky. ... . Feeling or being sick (nausea or vomiting) ... . Constipation. ... . Sore or swollen gums.. |