BARBITURATES

1. Most commonly used in pt with  SZ history, induction of  anesthesia. Acts by enhancing GABA activity.
    
2. Metabolism of medications such as Phenytoin, Warfarin, Dig  and TCA are increased.
    
3. S & S most common CNS, vary from mild slurred speech to flaccid tone, lethargy and coma. Bradycardia and hypotension develop. Along with CV depression, pt can develop Respiratory depression, NCPE.Pupils always remain reactive to light regardless their size. Skin bullae are described in 10% of cases and are seen @ pressure points (elbow, metacarpal joints). Hypothermia also described.
    
4. DX is based on hx, physical and lab report of barbiturates (must be requested along with APAP, ASA and ETOH when evaluating pt with AMS). The level  and type of barbiturate may also predict the duration of symptoms. Phenobarbital, for example acts 6-12 hr. For others see text book.
    
5. 5) Treatment remains supportive, i.e. lavage, AC, airway protection, IVF. In addition, Phenobarbital (and only a few others) responds to diuresis with alkalinization of urine. Pts with coma, and renal/hepatic failure that ingested  long acting barbiturates (less protein bound) such as Phenobarbital, will benefit from  hemodialysis .

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