Pharmacology Seizure meds #9

Question

The nurse is assessing a patient who has been on phenytoin for 10 years. Which characteristic finding is observed in patients with a long-term history of taking phenytoin sodium?

Answers

  1. Excessive growth of gum tissue.
    • Rationale:

      This answer is correct because long-term use of phenytoin can cause gingival hyperplasia (excessive growth of gum tissue). The patient should be instructed to have good oral hygiene and to follow up at least every 6 months with the dentist to have this potential complication of phenytoin monitored.

  2. Enlarged tonsils.
    • Rationale:

      This answer is not correct because enlarged tonsils are not associated with phenytoin therapy. Usual side effects to monitor a patient for on phenytoin therapy includes gingival hyperplasia (excessive growth of gum tissue) and CNS effects, such as nystagmus, slurring speech, lethargy, coma, or death.

  3. Dry scaly skin.
    • Rationale:

      This answer is not correct because dry, scaly skin is not associated with phenytoin therapy. A skin rash can be associated with phenytoin therapy but is generally not serious. Report any redness or rash to the health care provider since it could be associated with the beginning of a rare, but life-threatening skin condition, Stevens-Johnson syndrome.

  4. Mania
    • Rationale:

      This answer is not correct because mania is not associated with phenytoin therapy. On the other hand, depression can occur during any stage of phenytoin therapy and should be reported to the health care provider.

Overview

Phenytoin is used to prevent and treat seizures. Long-term use of phenytoin can cause gingival hyperplasia (excessive growth of gum tissue).

Explanation

Excessive growth of gingival tissue is a common adverse effect of long-term use of phenytoin therapy. Teaching good hygiene and dental monitoring is important. Common effects do not include enlarged tonsils or dry skin. Serious effects in skin include spreading rashes. Depression and suicidal thoughts are adverse side effects and should always be reported to the health provider; however, depression side effects may occur at onset or any time during therapy (not only long-term use).

Learning Outcomes

Phenytoin is an anti-epileptic or anticonvulsant medication used to prevent and treat certain types of seizures. It works by decreasing the impulse activity in the brain that can cause seizures. Long-term use of phenytoin can cause gingival hyperplasia (excessive growth of gum tissue). The patient should be instructed to have good oral hygiene and to follow up at least every 6 months with the dentist to have this potential complication of phenytoin monitored.

Test Taking Tip

The nursing student preparing for NCLEX will be wise to remember unusual side effects associated with certain medications. Phenytoin and gingival hyperplasia is a very unique side effect which should be put to memory.

Video Rationale