Psychosocial Integrity Q 13
A client with a history of abusing barbiturates abruptly stops taking the medication. The nurse should give priority to assessing the client for:
A. Depression and suicidal ideation
B. Tachycardia and diarrhea
C. Muscle cramping and abdominal pain
D. Tachycardia and euphoric mood
Correct Answer: B. Tachycardia and diarrhea
Barbiturates create a sedative effect. When the client stops taking barbiturates, he will experience tachycardia, diarrhea, and tachypnea. When given in IV anesthetics, barbiturates will produce a reduction in blood pressure and an increase in heart rate. Respiratory depression and apnea may occur. Given the potential for severe adverse events including death, a pharmacist should verify the dosing, and perform a thorough medication reconciliation to ensure there are no drug interactions, in particular, additive CNS depression effects.
Option A: Ehough depression and suicidal ideation go along with barbiturate use; it is not the priority. Barbiturates cause postsynaptic enhancement of GABA, interacting with alpha and beta subunits of the GABA-A receptor. Barbiturates increase chloride ion flux which results in GABA-induced postsynaptic inhibition. Phenobarbital and pentobarbital affect the GABA-A receptors with a dose-dependent response.
Option C: Muscle cramps and abdominal pain are vague symptoms that could be associated with other problems. Barbiturate classification is according to the duration of their action, IV formulations of thiopental and methohexital are in the ultra short-acting class. The short and intermediate-acting have an effect lasting 2 to 6 hours. This classification includes sleeping medications pentobarbital, secobarbital, amobarbital, and butabarbital. Long-acting barbiturates have an effect of longer than 6 hours and include barbital and phenobarbital.
Option D: Tachycardia is associated with stopping barbiturates, but euphoria is not. At higher micromolar concentrations associated with anesthetic levels, these drugs directly activate chloride channels. Both barbiturates and benzodiazepines interact with GABA-A receptors, but barbiturates are unique in that they potentiate GABA-A receptors while increasing chloride ion influx even with very low concentrations of the GABA neurotransmitter.