[Music] phenetoin is an anti-seizure medication that is tested a lot on the nclex because of its narrow therapeutic window and risk for toxicity in this mnemonic video we'll make sure you're up to speed on everything you need to know about phenytoin for test day these troublemaking kids are playing around a phone tower not their brightest idea but before we talk about the kids let's focus on the phone tower this phone tower will serve as your memory anchor to phenytoin you know a phone tower for phenytoin because phone tower and phenytoin sound pretty similar you may sometimes hear phenytoin called by its trade name delanten but the nclex will always use the generic name of phenytoin so just remember this phone tower and you'll be good to go the phone tower has been built with these anti-shake shocks i mean we definitely don't want the phone tower coming down in an earthquake or other disaster these anti-shake shocks improve stability by preventing the phone tower from shaking by the way these anti-shake shocks remind me of how phenytoin is used to treat seizures because both work to stop shaking get it phenytoin is effective in treating both tonic clonic and partial seizures it works by inhibiting the flow of sodium ions stopping the repetitive neuron firing that causes seizures now that we know what phenytoin does let's move on to learn about its side effects take a look at that sign by the phone tower it's warning people to not climb up too high on the phone tower because it's super dangerous up there just like people can get hurt from climbing too high up a phone tower it's dangerous to have high levels of phenytoin in the blood when the phenytoin level rises above a certain cutoff range patients will develop symptoms which we call acute toxicity so what exactly is this cut-off range let's find out back to those kids the girl here dared her friend to climb the phone tower despite all the warning signs in fact she even said she'd give him two ten dollar bills that's twenty dollars for those of you keeping score at home these are both important numbers to remember 10 and 20. you see phenotone has a very narrow therapeutic range of 10 to 20 milligrams per milliliter below this range the dose is ineffective and the patient might still develop seizures however if we go above the high end of this range toxicity can occur leading to many harmful side effects speaking of which next let's talk about what side effects to watch out for in case of phenytoin toxicity kids will do anything for twenty dollars despite the warnings the boy climbed to the tower and he looks like he's about to fall you can use this boy falling as the symbol for ataxia because ataxia is just a fancy term for impaired balance and coordination in other words you can expect someone with ataxia to fall or stumble a lot like this boy get it ataxia is an important symptom of phenytoin toxicity and as with any of these toxicity symptoms it should be reported to the provider if noticed the boy is yelling out for help but the shock of the situation has caused the words to come out all slurred which reminds me slurred speech is another possible symptom of phenytoin toxicity the girl is starting to get nervous maybe breaking the rules wasn't such a good idea after all she's looking side to side to keep a lookout for the authorities the way she is moving her eyes side to side is similar to nystagmus nystagmus is a condition where the eyes make repetitive uncontrolled movements side to side this may be a pretty subtle symptom in patients so as the nurse keep a close eye on their eyes okay these three adverse effects ataxia slurred speech and nystagmus are the most common signs of phenytoin toxicity like i mentioned before they should be reported to the provider immediately if seen and you'll likely be instructed to hold the next dose of phenytoin until blood work can be verified last but not least let's talk about one side effect that isn't related to toxicity but rather is a general side effect of taking phenetoin even at normal doses take a close look at the girl's bubble gum it's hard to miss the way she's blowing it in a big bubble here at pixer eyes we use big bubble gum is our symbol for gingival hyperplasia because gingival hyperplasia is really just a fancy way of saying overgrowth of gum tissue big bubble gum to symbolize big gums gingival hyperplasia is an expected side effect of phenytoin it can often be controlled with good oral hygiene and regular dentist visits unlike the effects of toxicity we talked about earlier gingival hyperplasia is not a reason to stop the medication alright that's all for this mnemonic let's recap phenytoin is an anti-convulsant drug used to treat seizures phenytoin has a narrow therapeutic range of 10 to 20 micrograms per milliliter high doses of phenytoin above this cut off can lead to symptoms of acute toxicity these symptoms include ataxia slurred speech and nystagmus the provider should be notified immediately if these symptoms are seen another expected side effect of phenytoin is gingible hyperplasia so encourage your patients to practice good oral hygiene and visit the dentist regularly and now we're actually done with phenytoin let's be sure to keep those kids off the phone tower see you next time thanks for watching for more videos like this one subscribe to our channel and check out our newest lessons for more resources on this topic including fact lists and interactive review images click the image next to the more here arrow i'll see you next time