Barbiturates

Barbiturates are a type of sedative-hypnotic that is used to induce sleep, as an anesthetic, and in high doses to control epileptic seizures. Barbiturates are classified by duration of action referred to as ultrashort-acting, short-acting, intermediate acting, and long-acting.

Ultrashort-acting barbiturates such as thiopental sodium (Pentothal) is a commonly used anesthetic. Secobarbital (Seconal) and pentobarbital (Nembutal) are short-acting barbiturates that induce sleep. For longer periods of sleep, patients are prescribed intermediate acting such as amobarbital (Amytal), aprobarbital (Alurate) and bubatabarbital (Butisol). Phenobarbital and mephobarbital are long-acting barbiturates used for controlling epileptic seizures.

Barbiturates are Class II Controlled Substances and should be prescribed for no more than two weeks because of the adverse side effect. Barbiturates increase CNS depression in the elderly and should not be used for sleep.

See sedative-hypnotic: barbituates and others provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more; available on the book's Web site (see URL in Appendix).

Other Barbiturates

Short-acting:

Secobarbital sodium (Seconal Sodium) Class II

Preoperative sedation Used to induce sleep

PO 100-200 mg before surgery; hypnotic PO/IM 100-200 mg h.s.; Status epilepticus: IV; 5.5 mg/kg; repeat in 3-4 hours; with spinal anesthesia IV; 50-100 mg.; infused over 30 seconds; maximum dose of 250/mg

Intermediate-acting

Amobarbital sodium (Amytal Sodium)

Sleep sustainers

PB 50-60%; half life 20-40 hours; Sedative: PO 30-50 mg bid-tid; Hypnotic PO/IM 65-200 mg h.s., IV: 65-200 mg

Other Barbiturates (continued)

Other

Chloral hydrate Class IV

No hangover and less respiratory depression; give with meals or fluids to prevent gastric irritation

Pregnancy category C; PB 70%-80%; half life 8-10 hours; PO 250 mg tid before meals; Hypnotic: PO 500 mg-1g h.s.

Other

Paraldehyde Class IV

Exhaled via the lungs; strong odor and disagreeable taste; seldom used; has been used to control delirium tremens (DTS) in alcoholics; can be used for drug poisoning

Status epilepticus and tetanus to control convulsions; Pregnancy category C, PB UK; half life 7.5 hours; Sedative PO 5-10 mL q4-6h PRN in water or juice; maximum dose of 30 mL; Hypnotic: PO 10-30 mL h.s.

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