Phenobarbital Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Phenobarbital

Brand Name: Barbilixir (CAN), Barbita (CAN), Bellatal, Solfoton, phenobarbital sodium, Parenteral: Luminal Sodium

Pregnancy Category D, C-IV controlled substance

Drug classes: Barbiturate (long acting), Sedative, Hypnotic, Anticonvulsant, Antiepileptic agent

Therapeutic actions

General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at subhypnotic doses, has anticonvulsant activity, making it suitable for long-term use as an antiepileptic.

Indications

· Sedative (oral or parenteral)

· Hypnotic, short-term (up to 2 wk) treatment of insomnia (oral or parenteral)

· Long-term treatment of generalized tonic-clonic and cortical focal seizures (oral)

· Emergency control of certain acute convulsive episodes (eg, those associated with status epilepticus, eclampsia, meningitis, tetanus, and toxic reactions to strychnine or local anesthetics; parenteral)

· Preanesthetic (parenteral)

· Anticonvulsant treatment of generalized tonic-clonic and cortical focal seizures (parenteral)

· Emergency control of acute convulsions (tetanus, eclampsia, epilepticus; parenteral)

Contraindications

· Contraindicated with hypersensitivity to barbiturates, manifest or latent porphyria; marked liver impairment; nephritis; severe respiratory distress; previous addiction to sedative-hypnotic drugs (may be ineffective and may contribute to further addiction); pregnancy (fetal damage, neonatal withdrawal syndrome); lactation.

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Adverse effects

Somnolence, agitation, confusion, hyperkinesia, ataxia, vertigo, CNS depression, nightmares, lethargy, residual sedation (hangover), paradoxical excitement, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, thinking abnormality

Bradycardia, hypotension, syncope

Nausea, vomiting, constipation, diarrhea, epigastric pain

Rashes, angioneurotic edema, serum sickness, morbiliform rash, urticaria; rarely, exfoliative dermatitis, Stevens-Johnson syndrome

Pain, tissue necrosis at injection site, gangrene; arterial spasm with inadvertent intra-arterial injection; thrombophlebitis; permanent neurologic deficit if injected near a nerve

Hypoventilation, apnea, respiratory depression, laryngospasm, bronchospasm, circulatory collapse

Tolerance, psychological and physical dependence, withdrawal syndrome

Drug Interactions:

· Increased serum levels and therapeutic and toxic effects with valproic acid

· Increased CNS depression with alcohol

· Increased risk of nephrotoxicity with methoxyflurane

· Increased risk of neuromuscular excitation and hypotension with barbiturate anesthetics

· Decreased effects of the following drugs: theophyllines, oral anticoagulants, beta-blockers, doxycycline, griseofulvin, corticosteroids, hormonal contraceptives and estrogens, metronidazole, phenylbutazones, quinidine

Nursing considerations

· Monitor patient responses, blood levels (as appropriate) if any of the above interacting drugs are given with phenobarbital; suggest alternative means of contraception to women using hormonal contraceptives.

· Do not administer intra-arterially; may produce arteriospasm, thrombosis, gangrene.

· Administer IV doses slowly.

· Administer IM doses deep in a large muscle mass (gluteus maximus, vastus lateralis) or other areas where there is little risk of encountering a nerve trunk or major artery.

· Monitor injection sites carefully for irritation, extravasation (IV use). Solutions are alkaline and very irritating to the tissues.

· Monitor P, BP, respiration carefully during IV administration.

· Arrange for periodic laboratory tests of hematopoietic, renal, and hepatic systems during long-term therapy.

· Taper dosage gradually after repeated use, especially in epileptic patients. When changing from one antiepileptic drug to another, taper dosage of the drug being discontinued while increasing the dosage of the replacement drug.