Secobarbital

INTRODUCTION

Indications

Short-term treatment of insomnia. Adjunctive agent for anesthesia.

Action

Produces CNS depression through gammaaminobutyric acid (GABA)–like effects. Therapeutic Effects: Induction of sleep, sedation, or anesthesia.

Adverse Reactions/Side Effects

CNS: abnormal thinking, behavior changes, delirium, excess sedation, excitation, hallucinations, mental depression, vertigo, sleep disorders, sleep—driving. Resp: respiratory depression. GI: nausea, vomiting. Derm: photosensitivity, rashes, urticaria. MS: arthralgia, myalgia. Neuro: neuralgia. Misc: physical dependence, psychologic dependence.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess symptoms of respiratory depression (dyspnea, cyanosis). Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

• Monitor daytime drowsiness. Repeated or excessive drowsiness may require change in dose or medication.

• Assess dizziness 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.

• Report any personality and behavioral changes, including excitation, hallucinations, mental depression, delirium, or expression of abnormal thoughts.

• Assess any muscle, joint, or nerve pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by biomechanical or neurophysiologic problems.

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).

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

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

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Remind patient that this drug is typically recommended for only occasional use as a preoperative sedative or short-term use (2 wk or less) to treat insomnia. Long-term use can cause tolerance and dependence.

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.

• Caution patient and family/caregivers about the risk of other bizarre or complex somnolent behaviors, such as driving while asleep.

• Instruct patient or family/caregivers to report other severe or prolonged side effects such as sleep disorders, skin reactions (rash, hives), or GI problems (nausea, vomiting).

Pharmacokinetics

Absorption: Well absorbed following ...