SECOBARBITAL SODIUM

SECOBARBITAL SODIUM
(see-koe-bar'bi-tal)
Seconal Sodium
Classifications: sedative-hypnotic; barbiturate; anxiolytic;
Therapeutic: sedative-hypnotic

Pregnancy Category: D
Controlled Substance: Schedule II

Availability

50 mg, 100 mg capsules

Action

Short-acting barbiturate with CNS depressant effects as well as mood alteration from excitation to mild sedation, hypnosis, and deep coma. Depresses the sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation, and hypnosis.

Therapeutic Effect

Alters cerebellar function and produces drowsiness, sedation, and hypnosis.

Uses

Hypnotic for simple insomnia and preoperatively to provide basal hypnosis for general, spinal, or regional anesthesia.

Contraindications

History of sensitivity to barbiturates; porphyria; severe liver function; renal function impairment; severe respiratory disease; nephritic syndrome; parturition, fetal immaturity; uncontrolled pain. Use of sterile injection containing polyethylene glycol vehicle in patients with renal insufficiency; pregnancy (category D); children <6 y.

Cautious Use

Pregnant women with toxemia or history of bleeding; labor and delivery; seizure disorders; aspirin hypersensitivity; liver function impairment; hyperthyroidism; diabetes mellitus; severe anemia; older adults, debilitated individuals.

Route & Dosage

Sedative
Adult: PO 100–300 mg/d in 3 divided doses
Child: PO 4–6 mg/kg/d in 3 divided doses

Preoperative Sedative
Adult: PO 100–300 mg 1–2 h before surgery
Child: PO 50–100 mg 1–2 h before surgery

Hypnotic
Adult: PO 100–200 mg

Administration

Oral
  • Give hypnotic dose only after patient retires for the evening.
  • Crush and mix with a fluid or with food if patient cannot swallow pill.

Adverse Effects (≥1%)

CNS: Drowsiness, lethargy, hangover, paradoxical excitement in older adults. Respiratory: Respiratory depression, laryngospasm.

Interactions

Drug: Phenmetrazine antagonizes effects of secobarbital; cns depressants, alcohol, sedatives compound CNS depression; mao inhibitors cause excessive CNS depression; methoxyflurane increases risk of nephrotoxicity. Herbal: Kava, valerian may potentiate sedation.

Pharmacokinetics

Absorption: 90% from GI tract. Onset: 15–30 min. Duration: 1–4 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 30 h.

Nursing Implications

Assessment & Drug Effects

  • Be alert to unexpected responses and report promptly. Older adults or debilitated patients and children sometimes have paradoxical response to barbiturate therapy (i.e., irritability, marked excitement as inappropriate tearfulness and aggression in children, depression, and confusion). Protect older adult patients from falling, irrational behavior, and effects of depression (anorexia, social withdrawal).
  • Patient may become irritable, and uncooperative after a subhypnotic dose of a short-acting barbiturate (uncommon response).
  • Be aware that barbiturates do not have analgesic action, and may produce restlessness when given to patients in pain.
  • Long-term therapy may result in nutritional folate (B9) and vitamin D deficiency.
  • Lab tests: Obtain liver function and hematology tests, serum folate and vitamin D levels during prolonged therapy.
  • Observe closely for changes in established drug regimen effectiveness whenever a barbiturate is added, at least during early phase of barbiturate use. Barbiturates increase the metabolism of many drugs, leading to decreased pharmacologic effects of those drugs.
  • Be alert for acute toxicity (intoxication) characterized by profound CNS depression, respiratory depression that may progress to Cheyne-Stokes respirations, hypoventilation, cyanosis, cold clammy skin, hypothermia, constricted pupils (but may be dilated in severe intoxication), shock, oliguria, tachycardia, hypotension, respiration arrest, circulatory collapse, and death.

Patient & Family Education

  • Do not drive or engage in potentially hazardous activities until response to drug is established.
  • Store barbiturates in a safe place; not on the bedside table or other readily accessible places. It is possible to forget having taken the drug, and in half-wakened conditions take more and accidentally overdose.
  • Barbiturates are reportedly teratogenic. Do not become pregnant. Use or add barrier contraception if using hormonal contraceptives.
  • Report onset of fever, sore throat or mouth, malaise, easy bruising or bleeding, petechiae, jaundice, rash to physician during prolonged therapy.
  • Do not consume alcohol in any amount when taking a barbiturate. It may severely impair judgment and abilities.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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