Professional Documents
Culture Documents
AGENTS
BY
Ikome, Christiana
Johnson,Charlesetta
Kuyon, Korlu
Motari, Angeline
ANTIEPILEPTICS
Edmunds, M. W., Mayhew, M.S. Pharmacology for the Primary Care Provider. 4 th Ed. Elsevier Mosby 2013.
Classification, Pharmacodynamics,
indications and contraindications
PHAMACODYNAMICS:
Treatment of epilepsy
Primary site of action- Motor cortex where
spread of seizure activity is inhibited
MECHANISM of ACTION:
Precise mechanism of action- Unknown
Its use is accompanied by reduced voltage frequency, and
the spread of electrical charges in the motor cortex, with
antiarrythmic similar to those of lidocaine and tocaninide
The anticonvulsant action of hydantoin derivatives is due to
the
selective block of high-frequency neuronal activity
The molecular mechanism for this is their binding to the
voltage-sensitive sodiumchannels responsible for the action
potential.
PHARMACOKINETICS
Renal excretion
INDICATIONS
Tonic-Clonic Seizures
Partial Seizures.
Seizures Associated with Neurosurgery
Benzodiazepines (e.g., diazepam, lorazepam)
Concurrent administration with an IV
benzodiazepine or short Acting barbiturate may be necessary for rapid
control of seizures.
Indications Contd.
Cardiac Glycoside Intoxication
Neuropathic Pain
(e.g., trigeminal neuralgia)
Unlabeled Uses:
Cardiac Arrhythmias
.
CONTRAINDICATIONS:
Rash
Sinus bradycardia
PRECAUTIONS:
Impaired liver or kidney function
Alcoholism
Blood dyscrasias
Hypotension
Bradycardia
Severe myocardial insufficiency,
Impending or frank heart failure
Pancreatic adenoma
Diabetes mellitus
Respiratory depression
Acute intermittent porphyria.
Culture: Pay special attention to Africans, Chinese, Native Americans as they may
tend to take other herbal remedies that may have drug interaction with Phenytoin.
Ethnicity: Asians have a gene marker (HLA-B 1502) which predisposes them to
increase adverse reaction to Phenytoin. Consider another antiepileptic drug (AED)
for this ethnic group. FDA Alert!
Language barrier: Patient teaching is a very important issue with all patients, but
particularly these cultures. Provide drug information in language understandable to
patient, involve care-givers if possible.
Age: Phenytoin clearance tends to decrease with increasing age (as much as 20%
less in patients >70 years compared to patients 20-30 years of age). Special
consideration should be given to the elderly patient as regards dosing.
Individualize dosing!! As always start slow and titrate/adjust dosage based on
serum level.
SPECIAL CONSIDERATIONS
SPECIAL CONSIDERATIONS
Patients with Renal or Hepatic Disease- There is an
increased fraction of unbound phenytoin in this population
Patients with HIV/AIDS- Co-administration of
phenytoin with delavirdine is contraindicated due to
potential for increased viral load
Patients with mental illness: Antiepileptic drugs (AED),
including phenytoin, increase the risk of suicidal thoughts
or behavior.
Women Bone fracture phenytoin causes softening of
the bones (Osteoporosis, osteopenia and osteomalacia).
SPECIAL CONSIDERATIONS
Literature Review
&
Evidence Based Guidelines
REFERENCES
Brewer, J., & Waltman, P. (2003). Toxicology. Epilepsy and pregnancy: maternal and fetal effects of phenytoin. Critical Care Nurse,
23(2), 93-98.
Fitzgerald, K. (2004). Use of phenytoin in pregnancy for epileptic seizure prevention: a case report. Journal Of Midwifery & Women's
Health, 49(2), 145-147.
Meador, K., Baker, G., Browning, N., Cohen, M., Bromley, R., Clayton-Smith, J., & ... Loring, D. (2012). Effects of fetal
antiepileptic drug exposure: outcomes at age 4.5 years. Neurology, 78(16), 1207-1214.
Nemanja, T., Natasa, V., & Gordana, U. (2011, 05). Solvent effects on the structure-property relationship of anticonvulsant hydantoin
derivatives: A solvatochromic analysis. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750111/
Phenytoin overview. (2014, 01). Retrieved from http://web.b.ebscohost.com.ezproxy.welch.jhmi.edu/dynamed/detail.
Phenytoin. (2013, 09). Retrieved from http://www.drugbank.ca/drugs/DB00252
Roland, G., Mathias, N., & Thomas, S. (2012). Toxic epidermal necrolysis and Stevens-Johnson syndrome: A
review*. Critical Care Medicine, 39(6), 1521-1532. doi: 10.1097/CCM.0b013e31821201ed
REFERENCES
Schachter, S. (2014, 03 19). Pharmacology of antiepileptic drugs . Retrieved from
http://www.uptodate.com/contents/pharmacology-of-antiepileptic-drugs?
source=search_result&search=dilantin&selectedTitle=2~150
Singh, R., Kumar, N., Arora, S., Bhandhari, R., & Jain, A. (2012). Fetal Hydantoin Syndrome and its
Anaesthetic Implications: A Case Report. Case Reports in Anesthesiology, 2012.
Waknine, Y. (2008, November 25). FDA Investigates Genetic Link to Phenytoin Skin Reactions. Medscape.
Retrieved March 27, 2014, from http://www.medscape.com/viewarticle/584162
Schlicher, M. L. (1998). Dilantin jeopardy: Avoiding the dangers of phenytoin. Medsurg Nursing, 7(6), 343-7, 356.
Retrieved from http://search.proquest.com/docview/230519359?accountid=11752
Waterhouse, C., & Hale, H. (2010). Clinical standards for phenytoin administration: the application of
evidence to practice. British Journal Of Neuroscience Nursing, 6(3), 116-122.
Wilder, B., Leppik, I., Hietpas, T., Cloyd, J., Randinitis, E., & Cook, J. (2001). Effect of food on absorption of
Dilantin Kapseals and Mylan extended phenytoin sodium capsules. Neurology, 57(4), 582589
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