Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

Phenytoin Dilantin Antiarrhythmics, 300mg Q am and 400 PO Refer to dose
anticonvulsants mg QHS
Peak Onset Duration Normal dosage range
1.5-3 hours 2-24 hours 6-12 hours 200-600 mg/day in divided doses
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Prevention of seizures N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Limits seizure propagation by altering ion transport. May also .Contraindicated in pt’s with hypersensitivity, sinus bradycardia,
decrease synaptic transmission. Indicated for prevention of sinoatrial block, 2nd- or 3rd-degree heart block, or Adams--Stokes
seizures syndrome. Use cautiously in obese patients (initial dose of IV phenytoin
should be based on ideal body weight + 1.33 times excess weight).
Common side effects
Ataxia, diplopia, nystagmus, hypotension, gingival hyperplasia, nausea,
hypertrichosis, rashes
Interactions with other patient drugs, OTC or herbal medicines Lab value alterations caused by medicine
(ask patient specifically) CBC and platelet count, serum calcium, albumin, urinalysis, and hepatic
May alter the effect of corticosteroids. and thyroid function tests should be monitored prior to and monthly for
the first several months, then periodically throughout therapy. May cause
increased serum alkaline phosphatase, GTT, and glucose levels. Serum
folate concentrations should be monitored periodically during prolonged
therapy. Toxicity and Overdose: Phenytoin: Serum phenytoin levels
should be routinely monitored. Therapeutic blood levels are 10-20
mcg/ml in patients with normal serum albumin and renal function.
Be sure to teach the patient the following about this medication
May cause drowsiness or dizziness. Advise patient to carry identification
at all times describing disease process and medication regimen. Advise
patient to notify health care professional if skin rash, severe nausea or
vomiting, drowsiness, slurred speech, unsteady gait, swollen glands,
bleeding or tender gums, yellow skin or eyes, joint pain, fever, sore
throat, unusual bleeding or bruising, or persistent headache occurs.
Emphasize the importance of routine exams to monitor progress. Instruct
patient to take medication exactly as directed, at the same time each day.
If a dose is missed from a once-a-day schedule, take as soon as possible
and return to regular dosing schedule. If taking several doses a day, take
missed dose as soon as possible within 4 hr of next scheduled dose; do
not double doses. Consult health care professional if doses are missed for
2 consecutive days. Abrupt withdrawal may lead to status epilepticus.
Instruct patient on importance of good dental hygiene and seeing dentist
frequently. Inform patient that phenytoin may color urine pink, red, or
reddish brown, but color change is not significant. Advise patient not to
take phenytoin within 2-3 hr of antacids or antidiarrheals

Nursing Process- Assessment Assessment Evaluation

(Pre-administration assessment) Why would you hold or not give this med? Check after giving
Assess location, duration, frequency, and If the patient was experiencing signs of toxicity which are Decrease of seizures
characteristics of seizure activity. EEG may be nystagmus, ataxia, confusion, nausea, slurred speech, and without excessive
monitored Serum phenytoin levels should be dizziness or if serum levels were elevated above normal. sedation and no signs
routinely monitored.periodically throughout of toxicity.
therapy.