Epilepsy

1. CASE PRESENTATION
ON
EPILEPSY
PRESENTED BY
VIVEK GIRI
PHARM.D(P.B)
V YEAR
SUBMITTED
TO
K.V.
RAMANATH
ASSOCIATE
PROFESSOR

2. PATIENTS DETAILS
NAME: xyz
AGE:60 yrs
WEIGHT: 62kgs
SEX: male
UNIT: D
 Social history: Mixed
diet
Alcoholic since 15
yrs

3. SUBJECTIVE EVIDENCE:
 c/o seizures yesterday morning 7-8
episodes
Loss of conciousness

4. OBJECTIVE EVIDENCE-
 Episodes of seizures
 Loss of consciousness

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.

9. DISCHARGE MEDICATION
 Tab. Phenytoin 100 mg 1-0-1
 Cap. Neurobione forte 0-1-0
(NEUROBION FORTE: cyanocobalamin 1000
mcg, D-panthenol 50 mg, nicotinamide 100
mg, pyridoxine hydrochloride 100 mg,
riboflavin sodium phosphate 5 mg, thiamine
hydrochloride 100 mg.)

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