Phenobarbital medcard PDF

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Phenobarbital...

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INSTRUCTIONS: 1. For each chapter that teaches about medications, fill in the following table regarding the chosen meds. CLASS: Barbiturates GENERIC NAME: Phenobarbital TRADE NAMES: Ancalixir MOA: Functions as a CNS depressant, depressing sensory cortex, decreases motor activity, alters cerebellar function, inhibits transmission in the nervous system and raises the seizure threshold, and speeds up enzyme reactions in the liver involved in metabolism of drugs, bilirubin, and other compounds. INDICATIONS: Anticonvulsant in tonic-clonic (grand mal), partial, and febrile seizures in children, preoperative sedative and in other situations in which sedation may be required, short term hypnotic. OFF LABEL USAGE: Prevention/treatment of hyperbilirubinemia in neonates. CONTRAINDICATIONS/PRECAUTIONS: CONTRAINDICATED IN: Hypersensitivity, comatose patients or those with pre-existing CNS depression, severe respiratory disease with dyspnea or obstruction, uncontrolled severe pain, known alcohol intolerance (elixir only), lactating moms: discontinue drug or bottle feed. USED CAUTIOUSLY IN: Hepatic dysfunction, severe renal impairment, history of suicide attempt or drug abuse, hypnotic use should be short-term. Chronic use may lead to dependence, in OB: Chronic use during pregnancy results in drug dependency in the infant; may result in coagulation defects and fetal malformation; acute use at term may result in respiratory depression in the newborn, in GERI: Initial dose lower than recommended dose INTERACTIONS with other Drugs/Substances: Additive CNS depression when used with other CNS depressants (alcohol, antihistamines, opioid analgesics, and other sedative/hypnotics), drugs that induce hepatic metabolism which can decrease effectiveness (hormonal contraceptives, warfarin, chloramphenicol, cyclosporine, dacarbazine, corticosteroids, tricyclic antidepressants, felodipine, clonazepam, carbamazepine, verapa mil, theophylline, metronidazole, and quinidine), increased risk of hepatic toxicity with acetometaphin, MAO inhibitors, valproic acid, or divalproex may decrease metabolism of phenobarbital, and increase sedation, Rifampin may increase metabolism of and decrease effects of phenobarbital, increased risk of hematologic toxicity with use of cyclophosphamide. Kava kava, chamomine, valerian can increase CNS depression whereas St. John’s wort in decreases effects PATIENT RESPONSE / COMMON SIDE ADVERSE REACTIONS: S/S TOXICITY: TOXICITY/OVERDOSE TX: REACTIONS: EFFECTS: Confusion, drowsiness, Treat supportively and • Laryngospasm CNS: hangover, dyspnea, slurred speech, symptomatically and potential • Hypersensitivity DESIRED OUTCOME: depression, drowsiness, and staggering. use of activated charcoal reactions including Anticonvulsant activity and excitation, lethargy, and angioedema and serum vertigo sickness sedation before surgery, Respiratory: respiratory depression, bronchospasms improvement in sleep patterns, GI: constipation, diarrhea, decrease in serum bilirubin nausea, vomiting Derm: increased sensitivity levels. to light, rashes, urticaria MS: arthralgia, myalgia, and neuralgia Miscellaneous: hypotension, physical dependence, physiological dependence

NURSING ACTIONS:

ASSESS: Monitor respiratory status, pulse, and BP, and signs and symptoms of angioedema (swelling of lips, face, throat, dyspnea) frequently in patients receiving phenobarbital IV. Equipment for resuscitation and artificial ventilation should be readily available. Respiratory depression is dose-dependent. Prolonged therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient, especially if depressed, suicidal, or with a history of addiction. Geri: Elderly patients may react to phenobarbital with marked excitement, depression, and confusion. Monitor for these adverse reactions. Seizures: Assess location, duration, and characteristics of seizure activity. Sedation: Assess level of consciousness and anxiety when used as a preoperative sedative. Assess postoperative patients for pain with a pain scale. Phenobarbital may increase sensitivity to painful stimuli.

CARE/IMPLEMENT: Supervise walking and transfer of patients following administration. Two side rails should be raised and call bell within reach at all times. Keep bed in low position and institute seizure and fall precautions. When changing from phenobarbital to another anticonvulsant, gradually wean off phenobarbital dose while concurrently increasing dose of replacement medication to maintain anticonvulsant effects. PO: Tablets may be crushed and mixed with food or fluids (do not administer dry) for patients with difficulty swallowing. Oral solution may be taken undiluted or mixed with water, milk, or fruit juice. Use calibrated measuring device for accurate measurement of liquid doses. IM: Injections should be given deep into the gluteal muscle to minimize tissue irritation. Do not inject >5 mL into any one site, because of tissue irritation. V: Doses may require 15-30 min to reach peak concentrations in the brain. Administer minimal dose and wait for effectiveness before administering 2nd dose to prevent cumulative barbiturateinduced depression. IV Push: Diluent: Reconstitute sterile powder for IV dose with a minimum of 3 mL of sterile water for injection. Dilute

TEACH: Advise patient EVALUATE: Decrease or to notify health care cessation of seizure activity professional if signs and without excessive sedation (this symptoms of could take several weeks before angioedema, fever, sore therapeutic effects are seen), throat, mouth sores, preoperative sedation, unusual bleeding or improvement in sleep patterns, bruising, nosebleeds, or and a decrease in serum petechiae occur. advise bilirubin levels. patients to take medication as directed and if a missed dose occurs take it as soon as you remember, do not discontinue the medication if on prolonged therapy for the risk of status epilepticus, medication may cause daytime drowsiness so avoid operating machinery, especially driving, until physician clears you, inform of proper sleep techniques, inform female patients to use another form of birth control if on oral contraceptives during this therapy or until next period, PEDI: teach parents their child may have irritability, hyperactivity, and/or sleep disturbances and should dimmish within a few days or weeks of therapy. Also teach parents the symptoms of toxicity and to be on the lookout for a rash that develops 7-20 days after

Lab Test Considerations: Have hepatic, renal, and CBC tests run periodically as well as serum folate and bilirubin concentrations

further with 10 mL of sterile water. Do not use solution that is not absolutely clear within 5 min after reconstitution or that contains a precipitate. Discard powder or solution that has been exposed to air for longer than 30 min. Solution is highly alkaline; avoid extravasation, which may cause tissue damage and necrosis. If extravasation occurs, injection of 5% procaine solution into affected area and application of moist heat may be ordered. Concentration: 130 mg/mL (undiluted). Rate: Do not inject IV faster than 1 mg/kg/min with a maximum of 30 mg over 1 min in infants and children and 60 mg over 1 min in adults. Titrate slowly for desired response. Rapid administration may result in respiratory depression.

SPECIAL CONSIDERATIONS/NOTES: Do not confuse phenobarbital with pentobarbital.

first dosage and contact PCP immediately if one develops....