Lecture Notes: Neurological Drugs - Anti-Convulsants

Introduction

• Presenter: Nurse Mike from simplenursing.com
• Topics: Anti-convulsant drugs, specifically Phenytoin and Levetiracetam

Phenytoin (Fenny Toen)

Indications

• Used for long-term protection against seizures (e.g., epilepsy, chronic seizure disorders)
• Important for maintaining therapeutic levels (10-20 mcg/mL)

Therapeutic Range

• Therapeutic range: 10-20 mcg/mL
  • Below 10 mcg/mL: Increase seizure risk (report to HCP)
  • Above 20 mcg/mL: Risk of toxicity (hold and notify HCP)

Monitoring & Administration

• Routine blood tests for therapeutic range and liver function
• Narrow therapeutic index: Take medication at the same time daily
• Tube feeding interaction: Stop tube feedings 1-2 hours before and after administration
• IV Administration: Flush IV with normal saline before and after

Toxicity and Adverse Effects

• Early signs of toxicity: Ataxia, hand tremor, slurred speech
• Adverse effects: Suicidal ideations, skin rash (possible Stevens-Johnson syndrome)
  • Gingival hyperplasia (big gums): Normal, no need to stop medication
• Reportable conditions: Skin rash, new suicidal thoughts

Patient Teaching

• Inform dentist about Phenytoin use
• Use a soft-bristled toothbrush and attend regular dental visits
• No oral contraceptives: Use alternative birth control methods
• Supplementation: Folic acid, calcium, vitamin D recommended
  • Foods: Milk, cantaloupe, kale
• Do not stop medication abruptly

Common Misconceptions

• No need for an electric shaver (gums bleed, face does not)
• No metallic taste (metronidazole has this side effect)
• No photosensitivity (no need for sunglasses)

Levetiracetam

Indications

• Used to prevent and treat seizures in high-risk patients (brain tumor, surgery, trauma)
• Preferred over Phenytoin due to minimal drug-drug interactions

Side Effects

• Drowsiness and fatigue due to CNS depression

Adverse Effects

• Suicidal thoughts and Stevens-Johnson syndrome
  • Report new anxiety, mood changes, rash, blistering, or muscle/joint pain

Patient Teaching

• Obtain permission from HCP before driving

Conclusion

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• Acknowledgment to the team of experts

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Note: Always verify and practice these guidelines in a clinical setting under supervision.