5. ASSESSMENT:
From subjective and objective evidence, it has
been diagnosed as Epilepsy.
THERAPEUTIC GOALS:
Patient specific:- To relieve from the signs and
symptoms of disease.
Disease specific:- To prevent further complications
of disease.
6. ASSESSMENT OF CURRENT THERPHY:
CURRENT DRUG DOSE ROUTE FRE 1 2 3 4 5 6 7
Inj Phenytoin 300 mg Iv 1-1-1 + + + + + + +
Inj Neurobion 50 mb ORAL 0-1-0 + + + + + + +
Inj 5% Dextrose 100 ml Iv 0-1-0 + + + + + + +
Pantoprazole 40 mg ORAL 1-0-0 + + + + + + +
Ondansetron 4 mg Iv sos + + + + + + +
7. PROGRESS CHART:
day 2
3 episodes of seizures
BP:136/90 mm of Hg.
PR:86 bpm.
day 3
Decreased episodes of seizures
BP:130/90 mm of Hg.
PR:88bpm.
day 4
BP:128/80 mm of Hg.
PR:84 bpm.
8. day 5
BP:130/80 mm of Hg.
PR:86 bpm.
day 6
One episode of seizure
BP:130/90 mm of Hg.
PR:88bpm.
day 7
No episodes of seizures
BP:120/80 mm of Hg.
PR:86 bpm.
10. MONITORING PARAMETERS
Therapeutic parameters:
Phenytoin: To monitor the blood levels of
hepatic enzymes AST, ALT, ALP and bilirubin,
ammonia.
Toxicity parameters:
Phenytoin : Hypersensitivity, lack of appetite,
headache, dizziness, tremor, transient
nervousness, insomnia, GI disturbances
11. PATIENT COUNSELLING
Phenytoin -Tell patient to use same brand of
phenytoin consistently. Changing brands may
change therapeutic effect.
Instruct patient to take drug with food or milk
to minimize GI distress
Warn patient not to discontinue drug, except
medical supervision.
12. Explain to the patients the various symptoms
of overdose. Monitor for gum bleeding, bone
malformations, headache.
Life-style modification-Avoid alcohol
General – don’t go for driving, swimming and
risky works.
13. DRUG INTERACTION
cyanocobalamin
vs
pantoprazole
Adverse Effect:
cyanocobalamin has its effect reduced by pantoprazole
Probable Mechanism:
Absorption of protein bound vitamin B12 appears to be
reduced in patients taking proton pump inhibitors (PPIs) due
to low gastric acidity. The interaction is not generally
clinically significant
Actions to be Taken:
1. No action required; be alert for evidence of interaction.
14. phenytoin
vs
pyridoxine
Adverse Effect:
phenytoin has its effect reduced by pyridoxine
Probable Mechanism:
Intake of pyridoxine in doses of 80-400mg/day has been
reported to result in decreased phenytoin serum
concentrations (range 17-70%) in some patients.
Actions to be Taken:
1. Use combination with caution
