Dilantin anticonvulsant

Many hydantoins are endowed with significant pharmacological activities as highlighted by 5,5-diphenylhydantoin (Dilantin ), an anticonvulsant and antiepileptic discovered by Parke-Davis in 1940 s. Despite the lapse of more than half a century, Dilantin still plays an important rote in modem medicine. Meanwhile, another anticonvulsant 15 was synthesized from 9,10-dimethoxy-l,3,4,6,7,llb-hexahydro-pyrido[2,l-a]isoquinolin-2-one (14) under the standard Bucherer-Lieb variation in a 2 1 water-ethanol solution (15a 15b = 8 l). ... 

Toxicological problems among infants are relatively common. For example, it is now routine to follow the course of changes in Dilantin levels of patients who are being treated for various convulsive disorders (12). It is also important to be able to detect and assay for other drugs that are used in the newborn, such as various other anticonvulsants, salicylates, and a host of others. 

Anticonvulsdnts. An early observation that BN patients may have abnormal electroencephalogram (EEG) resnlts led to specnlation that binge eating may represent an atypical behavioral presentation of seiznre activity. Thus, the first controlled medication study for the treatment of BN evaluated the use of the antiseizure medication phenytoin (Dilantin). Phenytoin was not found to be significantly superior to placebo, and the earlier reports of EEG abnormalities were not confirmed. The results of a subsequent trial of carbamazepine (Tegretol), an anticonvulsant that has been reported to be effective in the treatment of bipolar disorder, were also disappointing. As a result, anticonvulsants are not routinely used in the treatment of BN. 

Phenytoin sodium/ Dilantin/ Elkins-Sinn/ Anticonvulsant... 

Other nervous system depressants that could trigger a GHB overdose reaction are benzodiazepines (mild tranquilizers such as Valium and Xanax), phenothiazines (potent tranquilizers like Thorazine and Stellazine), various painkillers (barbiturates and opiates), anticonvulsants (Dilantin and phenobarbital), and even many over-the-counter allergy and sleep remedies. 

Problem 20.8 Dilantin (5,5-diphenylhydantoin), an anticonvulsant drug used in the treatment of epileptic seizures, is a pyrrole with the molecular formula C 5H 2N202. What is the structural formula for Dilantin ... 

A small fraction of epileptics treated with anticonvulsants dilantin, phenytoin, diphenylhydantoin) develop folate deficiency. Epilepsy is not a rare disease. Hence, there is an awareness of the possibility of the occurrence of megaloblastic anemia in epileptics treated with the aforementioned anticonvulsant. Supplementing epileptics with folate can alleviate the deficiency however, the supplements may also result in an increase in Ihe seizure rate. Thus, physicians must be prepared to halt folate supplementation of epileptics beuig treated for anemia. 

A rare form of epilepsy may be treated with injections of pyridoxine (100 mg). These injections may prevent seizures while the anticonvulsant dilantin may prove ineffective. Guess the biochemical defect resulting in the disease. (See Bankier et ah, 1983.)... 

Epilepsy Signs of vitamin D deficiency may occur in epileptics treated with anticonvulsants such as dilantin. The drugs can stimulate the activity of enzymes of the endoplasmic reticulum that catabolize and inactivate the vitamin. 

Phenytoin sodium Dilantin (Pfizer) anticonvulsant 40% propylene glycol, 10% ethanol (pH adjusted to 12) 295-298 2.24 (Avdeef, 2003)... 

Benzodiazepines - A supraspinal site of action has been demonstrated for chlordiazepoxide and diazepam as well as for meprobamate.88 xhe anticonvulsant action of chlordiazepoxide resembles that of dilantin instead of that of acetazolamide, being antagonized by reserpine but not by 0 -methyl DOPA or Ct-methyltyrosine.89 This antagonistic effect of reserpine is reduced by a-methyl DOPA, serotonin and amphetamine. The reserpine effect is thus obtained by some means other than its catecholamine-depleting action and the anticonvulsant action of chlordiazepoxide is not mediated by catecholamines. 

Fig. 5. Folate levels in patients receiving anticonvulsant drugs. P, phenobarbitone M, Mysoline D, Dilantin. [From Davis and Woodliff (D3), 1969, Tbe Medical Journal of Australia, reprinted with permission.]...

Major events preceding this work are the fortuitous discovery of phenobarbital as an anticonvulsant agent, stmcture/hypnotic activity studies with barbiturates and hydantoins in the early 1920s by A.W. Dox in the Parke Davis laboratories, and the development of anticonvulsi-vant assay techniques in animals, by a number of laboratories. Phenytoin was the first item on the list of compounds sent to Putnam by Dox and W.G. Bywater in April 1936. It was found to have anticonvulsivants properties in animals late in 1936, but no public reports were issued until the following year. Clinical efficacy was established in 1937, but again no public reports were issued until 1938. Dilantin sodium capsules were prepared by Parke, Davis Co. and were ready for marketing the same year. ... 

The anticonvulsant phenytoin (Dilantin) to a client with a Dilantin level of 14 p,g/mL. 

The client with a seizure disorder is prescribed the anticonvulsant phenytoin (Dilantin). Which statement indicates the client understands the medication teaching ... 

The client diagnosed with a stroke has been prescribed phenytoin (Dilantin), an anticonvulsant. Which statement explains the scientific rationale for prescribing this medication ... 

The male client diagnosed with a brain tumor tells the clinic nurse that he has been having seizures more frequently. The client is taking the anticonvulsant phenytoin (Dilantin), the narcotic morphine sulfate (Roxanol), the analgesic acetaminophen (Tylenol), and the antianxiety medication alprazolam (Xanax). Which question about the client s medications should the nurse ask next ... 

Dihydroxyimidazoles are involved in keto-enol tautomerism, and the diketo structure, which is known as hydantoin (9.42), is favored. This is the framework for many valuable compounds with anticonvulsant activity. These are nonh5 notic and are used in the treatment of epilepsy. Dilantin (9.55) is the best known of these. Its synthesis is shown in Scheme 9.29. The Strecker reaction of benzophenone with HCN gives an alpha-aminonitrile, which adds ammonia to form compound 9.54 (an amidine). The ring is then closed with phosgene or diethyl carbonate. Hydrolysis gives phenytoin (dilantin, Pfizer, Inc.). 

Epilepsy is a disorder characterized by recurrent spontaneous electrical discharges within the brain which are manifested by clinical seizures. Four million patients in the United States are afflicted with this ailment 20% of these have seizures that cannot be controlled sufficiently with existing medications to permit normal activities of everyday life. The market for anticonvulsants is substantial a historical growth rate of 10 to 12% is expected to be sustained thereafter. Epileptic seizures can be classified as primary epilepsies (35%) or partial epilepsies (65%). Primary epilepsies (generalized convulsions) can be controlled with valproate (Depakote), carbamazepine (Tegretol), phenytoin (Dilantin), or phenobarbi-tol. Most partial epilepsies have resisted control with chemotherapeutic agents. 

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