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25.02 Barbiturates

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Overview

      I.         Overview

A.    Purpose

1.     CNS depression

2.     Sedative and hypnotic effects

3.     Reducing the nerve impulses traveling to cerebral cortex

B.    Mechanism of Action

1.     Potentiate the action of an inhibitory amino acid known as gamma-aminobutyric acid (GABA)

     II.         Indications

A.    Anesthesia (surgical procedures)

B.    Convulsion control

C.     Narcoanalysis

D.    Reduction of ICP (neurosurgical patients)

E.     Epileptic seizure prophylaxis

F.     Neonatal hyperbilirubinemia

G.    Sedative-hypnotic needs

   III.         Types

A.    Secobarbital

B.    Butobarbital

C.     Methohexital

D.    Mephobarbital

E.     Thiamylal

F.     Thiopental

G.    Phenobarbital

H.    Pentobarbital

   IV.         Contraindications

A.    Drug allergy

B.    Pregnancy

C.     Respiratory disease

D.    Liver disease

    V.         Interactions

A.    Anticoagulants = possible clot formation

B.    Inhibited drug breakdown

1.     Monoamine oxidase inhibitors (MAOIs)

2.     Anticoagulants

3.     Glucocorticoids

4.     Tricyclic antidepressants

5.     Quinidine

6.     Oral contraceptives *accelerated metabolism

C.     Additive CNS depression

1.     Alcohol

2.     Antihistamines

3.     Benzodiazepines

4.     Opioids

5.     Tranquilizers

   VI.         Side Effects

A.    Respiratory

1.     Respiratory depression

2.     Apnea

3.     Laryngospasms

4.     Bronchospasms

5.     Coughing

B.    CNS

1.     Drowsiness

2.     Vertigo

3.     Headache

4.     Depression

C.     Hematologic

1.     Thrombocytopenia

2.     Anemia

D.    Gastrointestinal

1.     N / V / D

2.     Constipation

E.     Cardiovascular

1.     Vasodilation

2.     Hypotension

F.     Other

1.     Urticaria

2.     Angioedema

3.     Fever

4.     Stevens-Johnson syndrome

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Video Transcript

Welcome back and today we are going to discuss barbiturates.


The purpose of barbiturates is 3-fold: CNS depression, sedative and hypnotic effects, and the reduction of impulses to the cerebral cortex.


The mechanism of actions with barbiturates is based on their inhibition of GABA.

The indications for barbiturates include convulsion control, anesthesia, narcoanalysis (truth serum therapy), neonatal hyperbilirubinemia, reduction of ICU, epileptic seizure prophylaxis and sedative-hypontic needs. An easy way to remember this is CANNRES.

The types are barbiturates are plentiful with varying names but most have the same ending -BARBITAL. Don’t try to remember the full name, focus on -BARBITAL.

Contraindications include drug allergy, pregnancy (birth defects), respiratory disease (decreased breathing patterns, apnea) and liver disease (can cause liver injury). A way to remember this section is DPRL.

Interactions for barbiturates include anticoagulants, which can cause possible clot formation.

One unique Interaction for barbiturates is its inhibition or acceleration of medications. MAOIs, anticoagulants, glucocorticoids, tricyclics, quinidine will interact with inhibition or delay medication responses. While oral contraceptives are an acceleration response. An easy way to remember these is MAGTQO.

Barbiturates have additive interaction as well. When taken with alcohol, antihistamines, benzodiazepines, opioids or tranquilizers. Meaning, their effects of magnified when used together. An easy way to remember these are AABOT.

Side effects for barbiturates include 4 profiles – the first being respiratory. It includes respiratory depression, apnea, bronchospasms, and coughing.

Side effects for the CNS profile include drowsiness, vertigo, headache, and depression.

Side effects for the hematologic profile include Thrombocytopenia and anemia.

Side effects for the GI  profile include Nausea, vomiting, diarrhea, and constipation.

Side effects for the cardiovascular profile include Vasodilation and hypotension.

The last side effect profile is other and includes Urticaria, angioedema, fever and Stevens-Johnson syndrome (flu-like symptoms which leads to painful blisters).

Nursing concepts for a patient taking barbiturates include intracranial regulation and pharmacology.

Okay, let’s review. The indications for barbiturates include convulsion control, anesthesia, narcoanalysis (truth serum therapy), neonatal hyperbilirubinemia, reduction of ICU, epileptic seizure prophylaxis and sedative-hypnotic needs. An easy way to remember this is CANNRES. Most barbiturates have the same ending -BARBITAL. Contraindications include drug allergy, pregnancy (birth defects), respiratory disease (decreased breathing patterns, apnea) and liver disease (can cause liver injury). A way to remember this section is DPRL. One unique Interaction for barbiturates is its inhibition or acceleration of medications. MAOIs, anticoagulants, glucocorticoids, tricyclics, quinidine will interact with inhination or delay medication responses. While oral contraceptives are an acceleration response. An easy way to remember these is MAGTQO. Barbiturates have additive interactions as well. When taken with alcohol, antihistamines, benzodiazepines, opioids or tranquilizers. Meaning, their effects of magnified when used together. An easy way to remember these is AABOT. Lastly, the side effects covered 6 profiles – respiratory, CNS, heme, GI, cards and others.

You know now the important details regarding barbiturates. Now, go out and be your best self today and as always, Happy Nursing!

 
  • Question 1 of 3

The nurse is precepting a student nurse and the student correctly tells the nurse that barbiturates act on which one of the following neurotransmitters?

  • Question 2 of 3

The nurse is providing first-dose education for a client receiving a barbiturate. A client history of which of the following conditions would cause the nurse concern?

  • Question 3 of 3

A nurse working in the intensive care unit is receiving report on a client in the ED. The nurse learns that the client is showing signs of Stevens-Johnson syndrome following a barbiturate overdose. Which of the following is an expected finding of this condition?

Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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