7/28/2019 46128424 Phenobarbital Sodium

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Drug Name Dosage & Route Action Indication Adverse Effects Contraindication Nursing Responsibility

PHENOBARBITAL SODIUM

Luminal Sodium

Classifications:CENTRAL

NERVOUS SYSTEM

AGENT;

ANTICONVULSANT ;

SEDATIVE-HYPNOTIC;

BARBITURATE

AnticonvulsantAdult:PO 100300mg/d IV/IM 200600

mg up to 20 mg/kgChild:PO/IV 38mg/kg or 125 mg/m2/dNeonate:PO/IV 34mg/kg/d (max: 5mg/kg/d)

StatusEpilepticusAdult/Child:IV 1518mg/kg in single ordivided doses (max:

20 mg/kg)Neonate:IV 1520mg/kg in single or

divided doses

SedativeAdult:PO 30120mg/d IV/IM 100200mg/dChild:PO 6 mg/kg/dor 180 mg/m2 in 3

divided doses IV/IM16100 mg/d (13mg/kg)

Long-acting barbiturate.

Sedative and hypnotic effectsof barbiturates appear to be

due primarily to interferencewith impulse transmission ofcerebral cortex by inhibition

of reticular activating system.CNS depression may range

from mild sedation to coma,depending on dosage, route ofadministration, degree of

nervous system excitability,and drug tolerance. Initially,

barbiturates suppress REMsleep, but with chronictherapy REM sleep returns to

normal.

Long-term management of

tonic-clonic (grand mal)seizures and partial seizures;

status epilepticus, eclampsia,febrile convulsions in youngchildren. Also used as a

sedative in anxiety or tensionstates; in pediatrics as

preoperative andpostoperative sedation and totreat pylorospasm in infants.

Body as a Whole:Myalgia, neuralgia, CNSdepression, coma, and death.CNS:Somnolence,nightmares, insomnia,"hangover," headache,anxiety, thinking

abnormalities, dizziness,nystagmus, irritability,

paradoxic excitement andexacerbation of hyperkinetic

behavior (in children);

confusion or depression ormarked 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: Folicacid deficiency, vitamin Ddeficiency. Respiratory:Respiratory depression. Skin:Mild maculopapular,morbilliform rash; erythema

multiforme, Stevens-Johnsonsyndrome, exfoliative

dermatitis (rare). .

Sensitivity to barbiturates;

manifest hepatic or familialhistory of porphyria; severe

respiratory or kidney disease;history of previous addictionto sedative hypnotics;

uncontrolled pain; pregnancy(particularly early pregnancy)

(category D), lactation;sustained release formulationfor children 50 mcg/mLmay cause coma. Therapeutic

serum concentrations of 1540mcg/mL produce anticonvulsant

activity in most patients. Thesevalues are usually attained after 2 or3 wk of therapy with a dose of 100

200 mg/d.

Expect barbiturates to produce

restlessness when given to patients

in pain because these drugs do nothave analgesic action.

Be prepared for paradoxical

responses and report promptly inolder adult or debilitated patient and

children (i.e., irritability, markedexcitement [inappropriate

tearfulness and aggression inchildren], depression, andconfusion).