*hydantoin

*Iminostilbenes

*Valproic acid

*tonic-clonic seizures

*partial seiures

*inhibits passage of sodium through sodium channels

* ↓ d/c of neurons around areas of ↑ activity

*drowsiness

*gingival hyperplasia

*skin rash

*withdrawal symptoms

* ↑ drowsiness may indicate toxicity

*observe gingiva

*monitor for rash

*give w/ food

*inject IV form SLOWLY (no more than 50mg/min)

*monitor vitals

*monitor plasma levels (10-20 mcg/ml)

* ↑ levels s/s: nystagmus, ataxia, sedation, blurred/double vision

*no driving

*notify provider of CNS effects

*regular dental checkups

*brush w/ soft toothbrush

*report rash

*do not stop taking phenytoin abruptly

*Pregnancy

*skin rash

*Bradycardia or heart block

*allergy

*seizures caused by low blood sugar

*liver/kidney disease

* ♥ dysfunction

*diabetes

*older adults

*debilitated pts

*alcoholism

*resp. dysfunction

*IV form is incompatible w/ many other drug solutions

*ETOH may ↑ or ↓ phytoin levels

*CNS depressants ↑ sedative effects

* phenytoin ↓ birth control effectiveness

*partial seizures

*tonic-clonic seizures

*bipolar disorder

*trigeminal neuralgia (V)

*inhibit the transfer of sodium thru sodium channels

* ↓ the d/c of neurons aroud areas of ↑ activity

*visual disturbances

* fluid retention

*skin rash

*epidermal necrolysis

*Stevens-Johnson syndrome

*bone marrow suppression

*start low, ↑ slow

* give at bedtime

*monitor WBC and CBC (may ↓ levels)

*monitor for skin rash

*asians may be at risk of severe skin reactions

*give w/ meals

*do not mix oral suspension w/ other oral drug suspensions

*maintain therapeutic levels

*no driving

*CNS effects

*prevent falls

*Report: rash, ↓ urine output, edema, SOB

*use sunscreen

*bone marrow suppression

*Pregnancy

*Seizures

*blood disorders

*heart failure

*cardiac or hepatic disesases

*HLA-B1502 (asian) gene

*alcoholism

*grapefruit juice may ↑ plasma levels

*may cause a false negative pregnancy test

*most drugs effect iminostilbene plasma levels

*all seizure types

*mania (bipoliar)

*migraine headaches (prevention)

*inhibits the passage of Na+ thru Na+ channels

* ↓ d/c of neurons around areas of ↑ activity

*inhibits the passage of calcium thru calcium channels

* ↑ the inhibitory effects of GABA

*GI upset

*bruising, bleeding, prolonged bleeding time, ↓ platelet counts

*skin rash

*hepatotoxicity

*hyperammonemia

Monitor: bleeding time, platelet count, blood ammonia levels

Observe for: bruising, bleeding, N/V, ↓ LOC

Monitor: serum amylase for pancreatitis, liver function tests prior to and periodically during therapy.

Observe for: s/s of hepatitis

*take the lowest effective dose

*PO (enteric coating) w/ food

*IV diluted in at least 50mL of dilutent. Not compatible w/ other drugs

*Report: rash, N/V, abd pain, jaundice, anorexia, bruises, bleeding, confusion, ↓ LOC

*Pregnant women should take folic acid supplements to prevent neural tube defects

*pregnancy

*liver disorders

*throbocytopenia

*hyperammonemia

*children taking other anticonvulsants

*kidney disease

*older adults

* ↑ blood levels of phenytoin and phenobarbital

*topiramate (topamax) ↑ risk of hyperammonemia