Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Phenytoin is an oral and injectable
anti-seizure medication first synthesized in 1908. The exact mechanism of action
is not known, Phenytoin may work by reducing the sensitivity of nerves in the
brain to excessive stimulation and reducing transmission of impulses between
nerves. Phenytoin was originally approved by the FDA in 1939.
STORAGE: Capsules, tablets, and suspension should be kept at room
temperature, 68-77 F (20-25 C).
PRESCRIBED FOR: Phenytoin is an anti-seizure medication
(anticonvulsant) used for preventing or treating
generalized tonic-clonic (grand
mal) seizures, complex partial seizures (psychomotor seizures), and seizures
occurring during or after neurosurgery. It may be used alone or with phenobarbital or other anticonvulsants.
DOSING: The dosing of phenytoin is patient specific. It may be given
once, twice, 3, or 4 times daily. Doses are often adjusted to find the
optimal dose based on measurement of blood levels. Taking phenytoin with food
may reduce some of the side effects. Elderly patients, debilitated persons, and
patients with certain kidney or
liver diseases may need lower doses. The
suspension should not be given at the same time as tube feedings since tube
feedings bind to phenytoin and reduce its absorption. The recommended adult dose
is 100 mg two to four times daily. Some patients may require 200 mg three times
daily. Patients stabilized on 100 mg three times daily may receive 300 mg once
daily of the extended release capsules.
DRUG INTERACTIONS: There are many potential
drug interactions with phenytoin. Phenytoin can increase the metabolism (elimination) of many drugs,
reducing their concentrations in the body. Drugs that may be affected include:
Phenytoin can interact with these drugs not only when
it is added to therapy but also when it is discontinued. In the latter case, the
concentration of the other drugs may increase. Sometimes the effect may be
unpredictable. Phenytoin's metabolism may be affected by other drugs. Drugs that
increase phenytoin blood levels and toxicity include:
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People with Fragile X syndrome suffer from physical, social, emotional, speech, language, sensory, intelligence, and learning impairments. There is no definitive treatment for Fragile X, though there are ways to minimize the symptoms.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
Peyronie's disease is a condition characterized by a hard lump, or plaque, that forms within the penis. Symptoms of Peyronie's disease range from mild to severe. Treatment for Peyronie's disease includes medication, and often surgery.
Cysticercosis is an infection caused by Taenia solium, the pork tapeworm. Symptoms include seizures, lethargy, nausea and vomiting, headache, vision changes, weakness, and confusion. Treatment depends upon the individual's symptoms and the stage of the infection. Treatment may incorporate anthelmintics, corticosteroids, anticonvulsants, and/or surgery.
We normally have antibodies in our blood that repel invaders into our body,
such as virus and bacteria microbes. Antinuclear antibodies (ANAs) are unusual
antibodies, detectable in the blood, that have the capability of binding to
certain structures within the nucleus of the cells. The nucleus is the innermost
core within the body's cells and contains the DNA, the primary genetic material. ANAs
are found in patients whose immune system may be predisposed to cause
inflammation against their own body tissues. Antibodies that are directed
against one's own tissues are referred to as auto-antibodies. The propensity for
the immune system to work against its own body is referred to as autoimmunity.
ANAs indicate the possible presence of autoimmunity and provide, therefore, an
indication for doctors to consider the possibility of autoimmune illness.
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