Phenobarbital

INTRODUCTION

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. Hypnotic (short-term). Unlabeled Use: Prevention/treatment of hyperbilirubinemia in neonates.

Action

Produces all levels of CNS depression. Depresses the sensory cortex, decreases motor activity, and alters cerebellar function. Inhibits transmission in the nervous system and raises the seizure threshold. Capable of inducing (speeding up) enzymes in the liver that metabolize drugs, bilirubin, and other compounds. Therapeutic Effects: Anticonvulsant activity. Sedation.

Adverse Reactions/Side Effects

CNS: hangover, delirium, depression, drowsiness, excitation, lethargy, vertigo. Resp: respiratory depression. IV: LARYNGOSPASM, bronchospasm. CV: IV: hypotension. GI: constipation, diarrhea, nausea, vomiting. Derm: photosensitivity, rashes, urticaria. Local: phlebitis at IV site. MS: arthralgia, myalgia, neuralgia. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANGIOEDEMA AND SERUM SICKNESS, physical dependence, psychological dependence.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including skin problems (rashes, raised patches of red or white skin, burning/itching skin), fever, swelling in the face, difficulty breathing, muscle aches (myalgia), and joint pain (arthralgia). Notify physician or nursing staff immediately because these symptoms may indicate serious reactions such as angioedema and serum sickness.

• 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 document suspected changes in ventilation and respiratory function, or if patient exhibits signs of respiratory depression (dyspnea, hypoxia).

• Monitor daytime drowsiness and “hangover” symptoms (headache, nausea, irritability, dysphoria, lethargy, vertigo). Repeated or excessive symptoms may require change in dose or medication.

• Be alert for depression, delirium, excitation, or other alterations in mood or behavior. Notify physician promptly if these symptoms develop (See Appendix D).

• In patients with seizures, document the number, duration, and severity of seizures to help document antiseizure drug effects.

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

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

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if drowsiness and vertigo carry over into the daytime. Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

• If treating insomnia, help patient explore nonpharmacologic methods to induce sleep, such as relaxation techniques, reduced caffeine intake, and so forth.

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Advise ...