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Hey guys nurse mike here and welcome to simplenursing.com before we get today’s lectures started please remember check out our brand new app and get access to our new pharmacology and med surg mastery courses plus 11 other courses like fundamentals pediatrics maternity mental health and more complete with over 300 follow along cheat sheets and a massive quiz
Bank loaded with detailed rationales to test your knowledge join for free click the link in our description below alright guys let’s begin is our anti-convulsant phenytoin given for long-term protection against seizures like with patients with epilepsy and other long-term chronic seizure disorders now the key word here is long term so it lasts longer in the
Body and patients can get very toxic so the memory trick is we call phenytoin phenytoxic since like most toxic drugs the max range is 20 and that’s the number to know for the nclex so the big key points to write down is 10 to 20 is the therapeutic range so below 10 we have to report to the hcp since there’s a huge seizure risk and over 20 we hold as well and
Notify the hcp because of the huge toxicity risk now like any toxic drug we do routine blood tests so question banks love to ask blood level monitored routinely so that’s usually the correct answer now we do this to check the therapeutic range of the drug as well as to monitor liver function since any drug that can cause toxicity can also affect the liver heavily
So the hesi mentions we hold the med for levels higher than 20. so remember guys over 20 is very toxic and we take the medication at the same time daily because of the narrow therapeutic index now that’s a really big keyword same time every day for drugs with a narrow therapeutic range now the next key point is toxicity the early signs to report to the hcp
These are the big nclex tips so write this down ataxia or basically an unsteady gate or gate disturbance as well as hand tremor and slurred speech or having trouble forming sentences so just think phenytoin is fanny toxic you can’t talk and you can’t walk so if any talk or fenny walk if you’re fanny toxic now for the other adverse effects the key word here is
Suicidal ideations and skin rash that are new and painful these are typically priority since it could indicate stephen johnson’s syndrome so we report these to the hcp immediately now some expected side effects we expect to have bradycardia and hypotension since it’s a cns depressant we expect to have low and slow vitals now the big key point here is gingival
Hyperplasia huge nclex tip fancy words for overgrowth of gum tissue around the teeth resulting in big gums that bleed very easily again this is to be expected so we don’t stop the drug for this 40 of students got this wrong and wanted to stop the drug for this so guys remember don’t stop big gums are completely normal so we teach the patients good dental hygiene
With a soft bristled toothbrush the big thing here is soft toothbrush and regular dentist visits and follow-up visits so ati says that you teach patients to inform the dentist that they’re taking phenytoin and the hesi mentions perform or assist with oral care every shift and a skin rash and fatigue and dyspnea are priority remember any type of skin rash could
Mean stephen johnson’s syndrome very deadly now the kaplan mentions statements requiring immediate intervention so i noticed a rash on my stomach last week again deadly stephen johnson syndrome and the second point mentioned was lately i find myself thinking about driving off a cliff definitely not normal we need immediate intervention here so as far as patient
Teaching here switching gears there’s no oral contraceptives so phenytoin deactivates the pill leading to accidental pregnancies so we teach patients to use alternative birth control like an iud and there’s no stopping abruptly this typically goes for any drug that’s acting on the brain and we take folic acid calcium and vitamin d since this drug decreases
Folic acid absorption and decreases bone density so the kaplan mentions this in a very interesting way encourage foods such as milk cantaloupe and kale now all these foods are high in folate and vitamin d and they had a second question that mentions requires further teaching when the patient states if i start having adverse effects i will stop taking this
Medication immediately guys that’s a big no-no we never stop abruptly or immediately we always taper off now as far as administration one question bank stresses the importance of phenytoin with tube feedings stating it can decrease the absorption as well as cause seizures so big key word here stop two feedings one to two hours before and after administration
This was mentioned multiple times as a priority since tube feedings can interfere with the absorption and decrease phenytoin effectiveness so guys we always administer the medication correctly so for two feedings we flushed with 30 to 50 mls of tap water before and after the drug is given and then normal saline is not required so tap water is okay now as far
As iv administration we always flush the iv with normal saline before and after given this drug now lastly don’t let the nclex trick you here so here’s three points that students usually get tripped up on so again gums typically bleed and that’s to be expected because of the overgrowth of the gum tissue but not the face so there’s no need to use an electric
Shaver and secondly there’s no metallic taste that’s typically for metronidazole 30 of students chose this as an expected side effect and lastly there’s no photosensitivity 50 percent of students wanted to think that phenytoin caused photosensitivity and worse sunglasses outside but guys no that’s not the case here now our second drug for anticonvulsants is
Levitaracetam given to prevent and treat seizures for those that are at high risk like those following a brain tumor or surgery or trauma on the brain which can increase intracranial pressure this is often preferred over phenytoin due to the minimal drug to drug interactions now the big common side effects like phenytoin it’s a cns depressant so we get a low and
Slow body with drowsiness and fatigue now the major adverse effects just like phenytoin we get the double s’s here suicidal thoughts and stephen johnson syndrome so we report any key words like new anxiety new agitation depression or even mood changes and for stephen johnson’s we report rash blistering and even muscle joint pain and even conjunctivitis now
The big key point is for the patient teaching in terms of driving so we have to get permission from the hcp and follow transportation department guidelines since this drug can cause drowsiness and fatigue which is common in the first four to six weeks when starting the medication so guys don’t let the nclex trick you always be sure to get driving permissions
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Transcribed from video
Pharmacology – Seizures (Epilepsy) drugs for nursing RN PN NCLEX By Simple NursingliveBroadcastDetails{isLiveNowfalsestartTimestamp2021-02-22T013015+0000endTimestamp2021-02-22T014046+0000}
