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INTRODUCTION

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amobarbital (am-oh-bar-bi-tal)

Amytal

Classification

Therapeutic: sedative/hypnotics

Pharmacologic: barbiturates

Schedule II

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Indications
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Preoperative sedative and in other situations in which sedation may be required. Hypnotic for short-term treatment of insomnia. Unlabeled Use: Psychiatric interviews. Wada testing (intracarotid administration to determine hemispheric locus of language dominance prior to epilepsy surgery).

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Action
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Produces all levels of CNS depression: Depresses sensory cortex, Decreases motor activity, Alters cerebral function. Inhibits transmission in the CNS and raises seizure threshold. Therapeutic Effects: Hypnosis, Sedation.

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Adverse Reactions/Side Effects
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CNS: drowsiness, abnormal thinking, agitation, ataxia, CNS depression, confusion, dizziness, headache, nightmares, vertigo. Resp: BRONCHOSPASM (IV ONLY), LARYNGOSPASM (IV ONLY), apnea, respiratory depression. CV: bradycardia, hypotension, syncope. GI: constipation, nausea, vomiting. Derm: ANGIOEDEMA, exfoliative dermatitis, purpura, rash. Local: pain or sterile abscess at IM site, phlebitis at IV site. MS: hyperkinesia. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypersensitivity reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, burning/itching skin). Be especially alert for exfoliation and other severe skin reactions that might indicate Stevens-Johnson syndrome. Notify physician or nursing staff immediately if these reactions occur.

  • Assess symptoms of bronchospasm and laryngospasm (wheezing, coughing, tightness in chest), especially after IV administration. Perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function, or if patient exhibits signs of respiratory depression (dyspnea, hypoxia).

  • Assess blood pressure periodically, and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an abnormally slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor respiration, and notify physician or nursing staff immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory depression (rapid labored breathing, cyanosis, confusion, irritability, sleepiness, headache, oxygen desaturation).

  • Assess dizziness, syncope, and vertigo that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor excessive sedation or changes in mood and behavior such as agitation, hyperactivity, confusion, or abnormal thoughts. Notify physician if these changes become problematic.

  • Assess injection site following IV or IM administration, and report excessive or prolonged local pain, swelling, and inflammation.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth), especially if drowsiness and confusion carry over into the daytime. Implement fall prevention strategies, especially ...

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