Pharmacist Impact on Posttraumatic Seizure Prophylaxis in Patients with Head Injury

Phenytoin is the most commonly administered antiepileptic agent for the prevention of early (≤ 7 days) posttraumatic seizures. Use of the agent, however, requires strict monitoring due to its narrow target range and nonlinear pharmacokinetics. The impact of a clinical pharmacist participating in the...

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Bibliographic Details
Published in:	Pharmacotherapy Vol. 22; no. 2; pp. 251 - 255
Main Authors:	Brophy, Gretchen M., Tesoro, Eljim P., Schrote, Gretchen L., Garnett, William R.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-02-2002 Pharmacotherapy
Subjects:	Adult Anticonvulsants - administration & dosage Anticonvulsants - economics Anticonvulsants - therapeutic use Anticonvulsants. Antiepileptics. Antiparkinson agents Biological and medical sciences Craniocerebral Trauma - complications Craniocerebral Trauma - drug therapy Education, Pharmacy - statistics & numerical data Female Humans Male Medical sciences Middle Aged Neuropharmacology Pharmacists - economics Pharmacology. Drug treatments Phenytoin - administration & dosage Phenytoin - economics Phenytoin - therapeutic use Retrospective Studies Seizures - drug therapy Seizures - etiology Seizures - prevention & control Time Factors Human Nervous system diseases Health staff Craniocerebral Epilepsy Chemist Diseases of the osteoarticular system Anticonvulsant Trauma Cerebral disorder Prevention Therapeutic drug monitoring Chemotherapy Central nervous system disease Skull disease Complication Phenytoin
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Summary:	Phenytoin is the most commonly administered antiepileptic agent for the prevention of early (≤ 7 days) posttraumatic seizures. Use of the agent, however, requires strict monitoring due to its narrow target range and nonlinear pharmacokinetics. The impact of a clinical pharmacist participating in the care of patients with head injury on posttraumatic seizure prophylaxis with regard to phenytoin dosing and monitoring, cost avoidance, and patient outcome, was measured retrospectively. Parameters from time periods before (BP) and after (AP) a clinical pharmacist participated in patient care were compared. The average number of days that phenytoin was given was 13.4 (BP) and 7.6 (AP), and the duration of phenytoin prophylaxis was 7 days or less in 35% and 65% of patients, respectively. The average number of phenytoin levels drawn from each patient was 10.3 (BP) and 3.4 (AP). Seizures occurred in 4.7% (BP) and 1.5% (AP) of patients. A cost savings of approximately $28,000 was observed for the AP group. A clinical pharmacist reduced the use of posttraumatic seizure prophylaxis and associated costs without jeopardizing patient outcomes.
Bibliography:	ArticleID:PHAR2372 istex:4B05B8CE4BE31808FD1A5BF3720C623B21B93866 ark:/67375/WNG-1CS34L3X-2 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0277-0008 1875-9114
DOI:	10.1592/phco.22.3.251.33547