Indications
&
Mechanism of Action MOA
&
Mechanism of Action MOA
Name 3 different Hydantoins
ethotoin (Peganone)
fosphenytoin (Cerebyx)
phenytoin (Dilantin)
What other medical conditions can phenytoin cause?
Neuropathy
Drug-induced Lupus
Why is phenytoin contraindicated in pregnancy's
Pregnancy class D
Has shown to cause severe developmental delays and physical deformities.
Only advised when priority for stabilization outweighs risk.
Older adults dosage might need adjusting because of:
Aging affects on metabolism and elimination
What is a tonic-clonic siezure?
A type of seizure that involves loss of consciousness and violent muscle contractions. Also known as Grand Mal Seizure.
Where does metabolism and excretion occur?
Metabolize in the liver
Excretion through the kidneys.
50% of patients may develop what condition?
Gingival hyperplasia- also known as an overgrowth of the gum tissue.
T or F
It is ok to take St. John's wart, Ginkgo, and Primrose while taking hydantoins?
FALSE
These can increase the risk of a seizure
Why would a provider choose a Hydantoin over a Barbiturate's in the treatment of seizure disorder?
-Less sedating
Expected Reactions can include:
constipation, dry mouth, taste perversion, swollen tongue, vomiting.
What are the routes of administration?
Oral, IM injection and IV infusion
Long term use of these drugs in women can cause what?
Hirsutism- excessive hair growth
What over the counter pain reliever has been known to decrease therapeutic affects and increase incidence of Liver toxicity
Acetaminophen: May decrease the therapeutic effects of acetaminophen and increase the incidence of hepatotoxicity. Monitor for toxicity.
The black box warning indicates slow administration of drug via IV due to the risk of what
Hypotension and cardiac arrhythmia
Select All That Apply
When unusual side effects should indicate a patient should call provider
1.very slow heartbeats, shortness of breath; light-headed, fainting.
2. confusion, unusual thoughts or behavior;
3. pain, swelling, and purple discoloration where the medicine was injected (may spread to your hand or fingers);
4. sudden fever, chills, sore throat, weakness;
5. unusual blessing and bruising
6. low blood potassium levels: exhibit: leg cramps, irregular heartbeat, fluttering in chest, muscle weakness, excessive thirst, and urination.
7. When epilepsy medicine is working and the patient is seizing the day.
How do Hydantoins work to reduce epileptic seizures?
Hydantoins slow nerve transmission. decreasing excitability and emotional responses to excitement. Without causing drowsiness or sedation
Phenytoin has been known to cause Megaloblastic anemia. What characteristics in RBCs may indicate this condition?
Large RBC
Contents not developed
Premature cell death
Fewer cells
What type of contraceptive could increase phenytoin levels and decrease te contraceptive affects.
Hormonal contraceptives: May increase phenytoin level and decrease contraceptive effectiveness.
You should: Monitor phenytoin level and adjust dosage if needed.
***Alternative form of contraception is recommended during therapy.
Enteral tube feedings: May interfere with absorption of oral drug. Do you stop enteral feeding
1 hour before and after drug use?
2 hours before and after drug use?
4 hours before and after drug use?
Hint * This is not a SATA, Select All That Apply
Stop enteral feedings for 2 hours before and 2 hours after drug use. Monitor serum drug level more frequently.
Why should you call the provider before discontinuing medication?
Discontinuing the medicine can cause status epilepticus.
Status Epilepticus: A seizure or seizures that last longer than five minutes, the severity of these seizures can cause brain permanent brain damage, and death.
fosphenytoin vs phenytoin
Fosphenytoin are preferred over phenytoin's given intravenously.
Fosphenytoin deliver a quicker intravenous response than phenytoin.
Fosphenytoin have a lower potential for local tissue and cardiac toxicity.
True or False:
When phenytoin is injected. The doctor will watch your child's heart closely when your child gets this drug. Tell your child's doctor right away if your child has a fast, slow, or abnormal heartbeat during or after a dose.
Warning
True
SELECT ALL THAT APPLY:
Adverse effects include.
A: CNS suppression
B:Gingival Hyperplasia
C: Hatred for SATA questions
D: Liver Damage
E: Dermatological reactions
F: Bone Marrow depression
All of the above.
Hydantoin taken with Warfarin may increase the effects of Warfarin. What affect should the nurse and Patient monitor for?
Warfarin prevents blood clots. Monitor for bleeding
What the clients need to know
1. Take oral medication with or after meals to reduce GI effects.
2. Do drink alcohol while taking this medication can contribute to depression
3. Urge Women of childbearing age to use barrier contraceptives while taking these drugs.
4. when taking this medication it can induce coma,
5. If you develop a rash, and or painful blisters call you provider immediately