Sedative hypnotics

Barbiturates
Types:
Long acting gp: Phenobarbital
onset 30 min, duration 6-12 hs
Intermediate acting gp :Amobarbital
3-6 hs
Short acting gp : Secobarbital
2-3 hs
Ultra short acting gp: Thiopental
onset 30 sec , duration 20 min
Properties:
Long& intermediate acting gp:
Short side chain, less potent, less
toxic, mostly ionized, less bound to
p.p, less lipid soluble
Short & ultra short acting gp:
Long side chain, highly potent, highly
toxic, less ionized, highly bound to
p.p, highly lipid soluble
 Circumstances of poisoning
Accidental:
- Children.
- Automatism in old age.
- Overdose in anaesthesia.
- Idiosyncrousy.
- With alcohol (synergism)
Suicidal .
Homicidal. rare
 Toxicokinetics:
Rabidly abs from GIT, slow in O.D
(concretion)
Rapidly distributed to the brain (short),
slowly distributed in (long)
Metabolism & excretion:
Long: less degraded in the liver (micro-
somal enz), exc unchanged in urine
Short: rapidly degraded in liver, exc as
inactive metabolites
Pathophysiology (depression)
1- CNS:
- C. cortex: sleep, coma.
- R.C: resp. dep, F, cyanosis, dil.pupils
- Heat reg C : hypothermia
- Vasomotor C: hypotension
2- GIT
Depress smooth m f

prystalsis, constipation, ileus

 3- CVS
Depression of myocardium
Inhibition of vascular m tone

central hypotension, shock

4- kidneys: depress k function, R.F

hypotension & anoxia

direct action on tubules
5- Skin: bullae
Action on epidermis
Clinical picture & complication
Deep prolonged coma:
- Cyanosis, dil pupils.
- Hypothermia.
- Slow shallow resp ( pn, atelectasis,
edema)
- Shock, (ventr fibrill, arrest)
- Oligoria( tubular necrosis , renal F )
- Constipation (ileus)
- Skin bullae
 Management
(diagnosis, D.D, treatment)
(Diagnosis= hist, C.P, investigation)
Investigation:
1- Colour test.
2- Serum level (HPLC).
3- acid base status.
4- Chest X- ray.
5- ECG
6- kidney function
Treatment:
I-General:
1- ABC
2- Decontamination:
Lavage (NaCO3), repeated
doses Ac. charcoal & cathartics
3- Elimination:
Alkalinization, hemodialysis ( long)
Hemoperfusion ( short)
 II-Symptomatic
- - Nursing care .
- Treat hypothermia,
- Treat hypotention
- Treat complications.
- Treat acidosis.

N.B. hypovent & acidosis crossing BBB

III- Specific:
 Barbiturate dependence
(addiction)
(tolerance, dependence, withdrawal)
Common with short acting gp
Psychic dependence:
Personality changes, confusion,
amnesia, impaired judgment of time
& place.
Physical dependence:
Ataxia, tremors, nystagmus, vertigo,
anorexia, anaemia, constipation
 Withdrawal manifestations:
- N, V, colics.
- M . Twitches, tremors, convulsions.
- Fever.
- Headache, insomnia, delusion,
hallucination
Treatment:
- Gradual withdrawal
- Supportive therapy