This case presentation summarizes the details of a 60-year-old male patient admitted with epilepsy. The patient reported 7-8 seizures that morning with loss of consciousness. Over the course of a week-long hospital stay, the patient's seizure episodes decreased in frequency and severity. He was discharged on medications including phenytoin and Neurobion to prevent further seizures and complications. The case discusses monitoring parameters, patient counseling points, and potential drug interactions for the discharge medications.

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