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Updated: Jun 3 2020


  • Snapshot
    • A 56-year-old man with a history of non-small cell lung cancer presents with approximately 8 minutes of tonic-clonic convulsions. He is not accompanied by anyone. Medical records suggest no recent changes in medications or drug history. Physical examination is significant for impaired consciousness and prolonic tonic-clonic convulsive episodes. Necessary laboratory tests are obtained and sent for analysis. He is given intravenous (IV) lorazepam, with a second IV line administering fosphenytoin. His convulsive symptoms are refractory to appropriate treatment. Continuous EEG monitoring is commenced after intubation and mechanical ventilation. He is infused with pentobarbital over 10 minutes.
  • Introduction
    • Examples
      • phenobarbital, pentobarbital, thiopental, and secobarbital
    • Mechanism
      • increases GABAA action by ↑ duration of Cl- channel opening resulting in ↓ neuron firing
        • barbitDURATE
    • Clinical use
      • CNS depressant for anxiety and seizures
      • induction of anesthesia (thiopental)
    • Toxicity
      • dependance
      • additive CNS depression effects with other CNS depressants (EtOH and benzodizepines)
      • prolonged respiratory or CV depression
      • drug interactions owing to induction of liver P450
        • contraindicated in porphyria
        • can decrease concentration of other drugs
      • may inhibit complex I of the electron transport chain
      • treat overdose with symptom management
        • assist respiration
          • doxapram
        • BP maintenance
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