Question

ctq8 Critical Thinking Questions for Submissions: 1. Phenytoin has been prescribed for your patient. What patient teaching information should be provided? 2. What over the counter drugs can decrease the therapeutic effectiveness of phenytoin? What is the therapeutic range of serum levels for Tegretol and Dilantin? How frequent should it be monitored please put citation

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Answer 1

1)phenytoin is an antiepiletic drug used to control seizures by reducing the impulse cause seizures few patient education to be provided while the patient is on phenytoin

a)Advice the patient to take the drug strictly as per the prescribed dose at the same time with or without food .Coated tablets should not be crushed or chewed it should be swallowed ,liquid suspension should be shaken well before withdrawing.

b)Don not stop taking phenytoin abruptly .the dose should be gradually decreased else the patient can suffer sudden seizures.

c)inform the physician in case of any hypersensitivity reaction like facial puffiness,breathing difficulty,sore throat, rashes these may be the sign of phyntoin toxicity.regular blood workup to be done to check the therapeutic level of phyntoin.

d)Suicidal thoughts is a common side effect for patients in phyntoin advice the relatives to keep a safe environment around the patient away from sharps, furniture that the patient can use for self harm.

e) Oral hygiene :advise the patient to have brrush teeth twice a day and use chlorhexidine mouth wash to prevent gingivitis which is a side effect of phyntoin.

f)Advice the patient to monitor for blood sugar level as phyntoin cause hyperglycemia.

g)Advice the relatives about the possible cardiac side effects like bradycardia,arrest for patients on phyntoin.

h)Advice the patient and relative to have an ID card which says that the patient is on phyntoin the side and the doctors name .

I)Instruct the patient to avoid alcohol while in ohyn6as it reduces the absorption level.and to be careful of over the counter medication like antacids,vitamins or supplement that can reduce the effect of phyntoin.

j)Help the patient to connect to self help groups for seizures and patients on Anti epileptic drugs .

2)Over the counter medication like antacids namely ranitidine,cemetidine, Omeprazole,vitamin supplement like folic acid,can reduce the therapeutic effect of phenytoin.

3) Therapeutic range of tegretol is between 4-12mg/L .anything near to 10mg/L is considered as minimum toxic level and anything more than 30mg/l is considered as critical lab value of toxicity .Phenytoin therapeutic level is 10-20mcg/ml . phenytoin and tegretol therapeutic testing for stable patients should be done at an interval of 3-6 months .blood should be withdrawn just before the next dose .

Citations

Fda

Emedicine.medscape.com