phenytoin

caroladybelle, BSN, RN · Aug 10, 2006

You are correct...phenytoin may only be pushed with NS...you will get a precipate....trust me on this one, I learned the hard way :)
In addition, it can be given as a slow inital bolus but is called phosphenytion (not sure about the spelling) via IV piggyback, once that is in you can push dilantion (once again, in NS only)

Dilantin (phenytoin) is a different drug than Cerebyx (fosphenytoin). Cerebyx can be given faster than dilantin, and is less irritating if it infiltrates. But it is also much more expensive, but much fewer issues with precipitation.

BAndersonRN · Aug 17, 2006

can you provide some direction to where you found this information? many neuro docs i've spoken with state that if no previous sz hx, there is no "definitive" clinical outcomes that it actually prevents sz. mostly used as a prophylaxis. thanks.

sure, im speaking primarily from my own experience in working as a neuro critical care nurse, most if not all neurosurgeons that i've worked with place their patients on dilantin or cerebyx if the patient has sustained any type of bleed where blood would come into direct contact with the cerebral cortex (ie sah, sdh, ivh, ich) (dr. christopher baker, orlando neurosurgery assoc.) i will add that you are correct in mentioning that if there is no prior hx of siezures some studies do suggest that in the long term (emphasized on the "long term") treatment of patients there is no evidence in prevention of seizures. however, some studies also suggest that if seizure prophylaxis is initiated early in the course of an intracranial hemorrhage (limited to 1 week post injury) there is a decrease in risk for seizures early on in the course of treatment.

"therapeutic goals are blood pressure control, prevention of seizures, treatment of nausea, management of icp, prevention of vasospasm, control of pain, and maintenance of cerebral perfusion."([color=#333399]george jallo, md, assistant professor of neurosurgery, department of neurosurgery, division of pediatric neurosurgery, johns hopkins university school of medicine. 2005)

"a systematic review of the use of drugs to prevent seizures after head injury identified ten randomised controlled trials and had data on 2036 patients.7 four unpublished studies with another 630 patients could not be included. there was consistent evidence that the early treatment with antiepileptic drugs, most commonly phenytoin but also carbamazepine and phenobarbitone, decreased the relative risk (rr) of early seizures (0-34 (95% ci 0.21-0.54). treatment of 100 patients would result in the avoidance of early seizures in ten patients, but mortality was not decreased (rr 1.15 [0.89-1.51]). there is even greater uncertainty from these studies about the effect of antiepileptic drug treatment on a combined outcome variable of death or significant neurological disability (rr 1.49 [1.06-2.08] for carbamazepine and 0.96 (0.72-1.26] for phenytoin). furthermore, there was no evidence that the decrease in early seizures was accompanied by a reduction in late post-traumatic epilepsy (rr 1.28 [0.90-1.81])." (taken from:chadwick,d. (2000) the lancet. seizures and epilepsy after traumatic brain injury