This case is more important to know about epilepsy

1. Zamzam Hamed
ALShabibi

2. ‫تين‬‫ر‬‫م‬‫واحدة‬‫كبسولة‬‫خذ‬
‫لمدة‬‫ات‬‫ر‬‫م‬‫ثالث‬ ‫واحدة‬ ‫حبة‬‫خذ‬
16
‫يوما‬

3. Epilepsy is a common condition that affects the brain and causes frequent seizures.
Seizures are bursts of electrical activity in the brain that temporarily affect how it
works. They can cause a wide range of symptoms. Epilepsy can start at any age,
but usually starts either in childhood or in people over 60.

4. uncontrollable jerking and shaking, called a "fit“ losing awareness and staring
blankly into space becoming stiff strange sensations, such as a "rising" feeling
in the tummy, unusual smells or tastes, and a tingling feeling in your arms or
legs collapsing Sometimes you might pass out and not remember what
happened.

5. Occasionally, epilepsy can be caused by damage to the
brain, such as damage from:
*a stroke
*a brain tumour.
*a severe head injury.
*drug abuse or alcohol misuse.
*a brain infection.
*a lack of oxygen during birth.

6. Finding out about your seizures It can be hard to diagnose epilepsy quickly
because other conditions, such as fainting, migraines and panic attacks, can
cause similar symptoms. It often cannot be confirmed until you've had more
than 1 seizure.
Tests for epilepsy The specialist may suggest having a test to check your brain
activity called an electroencephalogram (EEG), or a brain scan to look for any
problem in your brain.

7. Treatment can help most people with epilepsy have
fewer seizures or stop having seizures completely.
medicines called anti-epileptic drugs (AEDs)surgery
to remove a small part of the brain that's causing the
seizures a procedure to put a small electrical device
inside the body that can help control seizures a
special diet (ketogenic diet) that can help control
seizures Some people need treatment for life. But you
might be able to stop if your seizures disappear over
time. You may not need any treatment if you know
your seizure triggers and are able to avoid them.

8. Treatment can help most people with epilepsy
have fewer seizures, or stop having seizures
completely.medicines called anti-epileptic drugs
(AEDs)surgery to remove a small part of the
brain that's causing the seizuresa procedure to
put a small electrical device inside the body
that can help control seizuresa special diet
(ketogenic diet) that can help control
seizuresSome people need treatment for life.
But you might be able to stop if your seizures
disappear over time.You may not need any
treatment if you know your seizure triggers and
are able to avoid them.
Phenytoin is used to control certain type of seizures, and to treat and
prevent seizures that may begin during or after surgery to the brain or
nervous system.
Generic name: Phenytoin.
Brand Names: Epanutin , Dilantin.
Dosage form: Tablet , Capsule, suspension and injection.
Rout of administration: Orally and IV injection.
Dose for ADULT :
-Capsule : 30 mg, 100 mg, 200 mg and 300 mg.
-Tablet : 50 mg
Class of medication: anticonvulsants.

9. •Typical starting dosage:
One 100-mg capsule taken once or three times per day.
•Maintenance dosage:
One 100 mg-capsule taken 3–4 times per day. Doctor may increase dosage to
200-mg capsule taken three times per day if needed.
•Once-daily dosing:
If the seizures are under control with divided doses of 100-mg capsules
taken three times a day, doctor may switch it to one 300-mg capsule taken
once per day.

10. Mechanism of action
Phenytoin is often described as a non-specific sodium channel blocker and targets. More
specifically, phenytoin prevents seizures by inhibiting the positive feedback loop that
results in neuronal propagation of high frequency action potentials.

11. Indication for:
1- Epilepsies
2- Generalized tonic clonic seizures
3- Partial onset seizures
4- Myoclonic seizures
* If phenytoin is taken by the mother in the first
trimester, there is approximately a 5 to 10 percent
chance that the baby could be born with a
combination of birth defects known as the Fetal
Hydantoin Syndrome.
* NOT available to pregnant and breastfeeding
women. Fetal hydantoin syndrome

12. Contraindications
* Hypersensitivity
* Sinus bradycardia
* Second- and third-degree A-V block
* Adams-Stokes syndrome
* Hypoglycemia
Side effect

13. * Phenytoin may interact with other medications:
A) Heart or cardiovascular drugs.
•amiodarone.
•Ticlopidine.
B) Oral birth control pills.
-Taking phenytoin with oral birth control pills that contain estrogen can
make those pills less effective. This means they won’t work as well to
prevent pregnancy.
C) Fluvastatin.
D) Ketoconazole –itraconazole.

14. Caution
-ONLY extended-release capsules should be used for once-daily dosing regimens.
-Decreased bone mineral density reported with chronic use.
-May cause fetal harm when administered to a pregnant woman.
-Use caution in cardiovascular disease and hypoalbuminemia ; because fraction of unbound
phenytoin is increased in patients with renal or hepatic disease.
-Antiepileptic drugs should not be abruptly discontinued because of the possibility of increased
seizure frequency, including status epilepticus.
-Low vitamin D levels warning: This drug can decrease the levels of vitamin D in your body. This can
lead to a vitamin D deficiency.

15. Progyluton 2mg/0.5mg tablet is composed of
Estradiol valerate (2mg) + Norgestrel (0.5mg).
Generic name: Progyluton.
Brand Names: Progyluton.
Dosage form: Tablet.
Rout of administration: Orally.
Active ingredients: Estradiol / Norgestrel.
Class of medication: hormonal replacement therapy.

16. How to Use Progyluton Pill
•This medication must be used orally.
• This pill must be swallowed whole with water, not chewed, crushed, or broken. If this
drug is prescribed daily, it is best to take it at a certain time each day.
•For 21 days, one pill should be taken orally once each day.
* The white tablets should be taken from day one to day 11.
*The brown tablets should be taken from day 12 to day 21 after the white ones.
•Then, there should be a seven-day break from tablets. As a result, each new pack is
initiated after a cycle of 28 days.

17. Indications
•Decrease pain and blood loss from a certain menstrual condition
•Vasomotor symptoms associated with the menopause
•Prevent pregnancy
•Primary ovarian failure

18. Side Effects
.Headache.
•Hair loss.
•Vaginal bleeding, spotting.
•Irregular periods.
•Increased weight.
•Abdominal cramps
•Contraindication
•Allergic reactions
•Pregnancy
•Smoking
•cancer of the breast
•estrogen-dependent neoplasia
•Hypersensitivity
•Breastfeeding

19. Drug- Drug interaction :
•Carbamazepine and Phenytoin.
•Acitretin.
•Clarithromycin.
•Isotretinoin.
•Erythromycin.
•Ketoconazole.
•Phenobarbital.
•Itraconazole.
•Rifampin.
Because the Progyluton contains estrogen,
and the epilepsy drug Phenytoin reduces
the effect of estrogen and makes it
ineffective, so pregnancy can occur.

20. 1-NOT the full name.
2-Brand name of phenytoin .
*Phenytoin drug
3-Low dose of phenytoin and no
duration.
Because she suffers from epilepsy for
a long time, she must take a
maintained dose of about 100 mg
three or four times a day, so that the
total reaches 300 or 400 mg per day.
*Progyluton drug
4-Used ones tablet daily only .
5-Duration not correct ( 21 day ) .
-No strength.
-
6 Drug –Drug Interaction

21. Phenytoin drug
changed because it
cannot be used for
pregnant women.
1
Use of physical
contraceptives or that
do not contain
estrogen do not
interfere with epilepsy
drugs
2