Thursday, May 15, 2014
Luminal Sodium
Action:
Long-acting barbiturate. Sedative and hypnotic effects of barbiturates appear to be due primarily to interference with impulse transmission of cerebral cortex by inhibition of reticular activating system. CNS depression may range from mild sedation to coma, depending on dosage, route of administration, degree of nervous system excitability, and drug tolerance. Initially,barbiturates suppress REM sleep, but with chronic therapy REM sleep returns to normal.
Classification:
CENTRAL NERVOUS SYSTEM AGENT; ANTICONVULSANT; SEDATIVE-HYPNOTIC; BARBITURATE
Indication:
Long-term management of tonic-clonic (grand mal) seizures and partial seizures; status epilepticus, eclampsia, febrile convulsions in young children. Also used as a sedative in anxiety or tension states; in pediatrics as preoperative and postoperative sedation and to treat pylorospasm in infants.
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Drug Name
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Dosage & Route
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Action
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Indication
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Adverse Effects
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Contraindication
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Nursing Responsibility
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PHENOBARBITAL
SODIUM
Luminal Sodium
Classifications: central nervous system agent;
anticonvulsant; sedative-hypnotic; barbiturate
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Anticonvulsant
Adult: PO 100–300 mg/d IV/IM 200–600 mg up to 20 mg/kg Child: PO/IV 3–8 mg/kg or 125 mg/m2/d Neonate: PO/IV 3–4 mg/kg/d (max: 5 mg/kg/d) Status Epilepticus Adult/Child: IV 15–18 mg/kg in single or divided doses (max: 20 mg/kg) Neonate: IV 15–20 mg/kg in single or divided doses Sedative Adult: PO 30–120 mg/d IV/IM 100–200 mg/d Child: PO 6 mg/kg/d or 180 mg/m2 in 3 divided doses IV/IM 16–100 mg/d (1–3 mg/kg) |
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Body as a Whole: Myalgia, neuralgia, CNS depression, coma, and death. CNS: Somnolence, nightmares,
insomnia, "hangover," headache, anxiety, thinking abnormalities,
dizziness, nystagmus, irritability, paradoxic excitement and exacerbation of
hyperkinetic behavior (in children); confusion or depression or marked
excitement (older adult or debilitated patients); ataxia. CV: Bradycardia, syncope, hypotension. GI: Nausea, vomiting, constipation, diarrhea, epigastric pain,
liver damage. Hematologic:
Megaloblastic anemia, agranulocytosis,
thrombocytopenia. Metabolic:
Hypocalcemia, osteomalacia, rickets. Musculoskeletal: Folic
acid deficiency, vitamin D deficiency. Respiratory: Respiratory depression. Skin: Mild maculopapular, morbilliform rash;
erythema multiforme, Stevens-Johnson syndrome,
exfoliative dermatitis (rare). .
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Sensitivity to barbiturates; manifest hepatic or familial history of porphyria; severe respiratory or kidney disease; history of previous addiction to sedative hypnotics; uncontrolled pain; pregnancy (particularly early pregnancy) (category D), lactation; sustained release formulation for children <12 y of age. |
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Observe patients receiving large doses closely for at least 30
min to ensure that sedation is not excessive.
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Keep patient under constant observation when drug is
administered IV, and record vital signs at least every hour or more often if
indicated.
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Lab tests: Obtain liver function and hematology tests and
determinations of serum folate and vitamin D levels during prolonged therapy.
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Monitor serum drug levels. Serum concentrations >50 mcg/mL
may cause coma. Therapeutic serum concentrations of 15–40 mcg/mL produce
anticonvulsant activity in most patients. These values are usually attained
after 2 or 3 wk of therapy with a dose of 100–200 mg/d.
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Expect barbiturates to produce restlessness when given to
patients in pain because these drugs do not have analgesic action.
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Be prepared for paradoxical responses and report promptly in
older adult or debilitated patient and children (i.e., irritability, marked
excitement [inappropriate tearfulness and aggression in children],
depression, and confusion).
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