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Barbiturates

Topic updated on 01/14/17 6:32pm

Snapshot
  • A 3-hour-old boy presents with asynchronous distal limb muscle twitching, followed by generalized myoclonus. The neonate appears encephalopathic. Airway, breathing, and circulation are secured. Blood tests are obtained, and EEG testing is performed. He is started on phenobarbital. (Early myoclonic encephalopathy)
Introduction
  • Examples
    • phenobarbital, pentobarbital, thiopental, and secobarbital
  • Mechanism
    • increases GABAA action by ↑ duration of Cl- channel opening resulting in ↓ neuron firing
      • barbitDURATE
  • Clinical use
    • CNS depressant for anxiety and seizures
    • induction of anesthesia (thiopental)
  • Toxicity
    • dependance
    • additive CNS depression effects with other CNS depressants (EtOH and benzodizepines)
    • respiratory or CV depression
    • drug interactions owing to induction of liver P-450
      • contraindicated in porphyria
      • can decrease concentration of other drugs
    • may inhibit complex I of the electron transport chain
    • treat overdose with symptom management
      • assist respiration
      • BP maintenance


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