What is Phenytoin?
Phenytoin is a well-known
anticonvulsant medication used primarily in the management of
seizures. It is particularly effective in treating tonic-clonic and partial seizures. The drug works by slowing down impulses in the brain that cause seizures. Nursing professionals must be familiar with its uses, administration, and potential side effects to ensure optimal patient care.
Indications for Use
Phenytoin is indicated for the control of generalized tonic-clonic (grand mal) and complex partial (psychomotor, temporal lobe) seizures. It is also used in the prevention and treatment of seizures occurring during or following
neurosurgery. Nurses should be aware that phenytoin is not effective for absence seizures.
Administration
Phenytoin can be administered orally or intravenously. The
oral form is most commonly used for long-term therapy, while the intravenous form is reserved for situations where rapid control of seizures is needed, such as in status epilepticus. Nurses must ensure that the drug is administered correctly to avoid complications. For oral administration, phenytoin should be given at the same time each day to maintain consistent blood levels. For IV administration, it should be given slowly to prevent severe cardiovascular reactions.
Dosage and Monitoring
The dosage of phenytoin is individualized based on the patient's response and serum levels. Therapeutic levels typically range from 10 to 20 mcg/mL. Nurses play a crucial role in monitoring these levels and observing for signs of toxicity, such as
nystagmus, ataxia, and confusion. Regular blood tests are necessary to ensure that levels remain within the therapeutic range.
Side Effects
Patients on phenytoin may experience a range of side effects. Common side effects include dizziness, drowsiness, and
gingival hyperplasia. Serious side effects can include severe skin reactions, liver damage, and cardiac arrhythmias. Nurses should educate patients about these potential side effects and advise them to report any unusual symptoms immediately.
Interactions
Phenytoin can interact with numerous other medications, potentially altering its effectiveness or increasing the risk of adverse effects. Notable interactions include those with
warfarin, oral contraceptives, and certain antibiotics. Nurses must review a patient's medication history comprehensively and consult with the healthcare team to manage potential interactions effectively.
Patient Education
Nurses are responsible for educating patients about their medication regimen. Key points for phenytoin include taking the medication consistently, not skipping doses, and not abruptly discontinuing the drug without medical advice. Patients should also be informed about the importance of maintaining regular follow-up appointments for blood level monitoring and adjusting doses as necessary.Special Considerations
Certain populations require special consideration when using phenytoin. For instance, elderly patients may be more susceptible to the side effects and may require lower doses. Pregnant women should be made aware that phenytoin can cause fetal harm, and alternative treatments may need to be considered. Additionally, patients with preexisting liver conditions should be monitored closely, as phenytoin is metabolized in the liver.Nursing Implications
Nurses must be vigilant in monitoring for therapeutic effectiveness and adverse effects. Keeping accurate records of seizure frequency, duration, and any triggering factors is essential. Additionally, nurses should provide comprehensive care, including regular dental checkups to manage gingival hyperplasia and nutritional counseling to mitigate potential side effects like weight loss or gain.
