2. DEFINITION
Barbiturates have been popular hypnotics and
sedatives of the last century upto 1960s, but are
not used now to promote sleep or to calm patients.
However, they are described first because they
are the prototype of CNS depressants.
4. Mechanism of Action
Barbiturates potentiate the effect of GABA by binding to the GABA-A
receptor at a nearby site and increasing the chloride flow through the
channel. Barbiturates also block the AMPA (2-amino-3-(5-methyl-3-oxo-
1,2- oxazol-4-yl) propanoic acid) receptor which is sensitive to
glutamate,
the excitatory neurotransmitter. Glutamate performs the opposite effect
from GABA restricting ion flow and increasing the transmembrane
action potential of the neuron. By blocking this action Barbiturates serve
to
increase the duration of the receptor response to GABA and extend the
depressed condition of the cell.
5. PHARMACOLOGICAL ACTIONS
A. On CNS
1.Mild degree of sedation to general anaesthesia.
2.Anticonvulsant effect.
3.Respiratory centre depression
B. On CVS
1.Hypotension
2.Decrease heart rate
3.Circulatory collapse
C. On liver
1.Enzyme induction,so increase metabolism of itself &
other drugs.
2.Stimulate glucoronyl transferase.
D. On kidney
1.Antidiuretic effect (increase ADH)
2.Decrease urinary output by depressing GFR
8. Uses
Barbiturates have been use in the past to treat a
variety of symptoms from insomnia and dementia to
neonatal jaundice
They have largely been replaced with drugs such
as benzodiazepine due to their propensity for
addiction and reduced effect over the extended use
Still used widely to treat seizures particularily
neonatal seizures
Used when benzo class drugs fail
Cannot be used for treatment of absence seizures
9. ADVERSE EFFECT OF BARBITURATES
1.Pain;Localized or diffuse myalgic,neuralgic or arthritic
pain especially in psychoneurotic patient.
2.Allergic skin lessions
3.After effects
drowsiness
Hangover effect
Over excitement
Night mares & night terrors
weakness & lethargy
4.Drug automatism
5.Enzyme induction (so tolerance develops rapidly)
6.Idiosyncratic reaction:barbiturates precipitate attacks
of acute porphyria in sussceptible individual
10. Doses of barbiturates
The typical dose of phenobarbital use as
anticonvulsant,,
For adult:50-100 mg,2/3 times per day
For newborn:2-4 mg per kilogram of body weight per
day
For infant:5-8 mg per kilogram pf body weight
For sedation before surgery 100-200 mg,one hour
before surgery