Amytal


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Amytal

 [am´ĭ-tal]
trademark for preparations of amobarbital, a short-acting sedative and hypnotic.

amobarbital

(am-oh-bar-bi-tal) ,

Amytal

(trade name)

Classification

Therapeutic: sedative hypnotics
Pharmacologic: barbiturates
Pregnancy Category: D

Indications

Preoperative sedative and in other situations in which sedation may be required.Hypnotic for short-term treatment of insomnia.Psychiatric interviews.Wada testing (intracarotid administration to determine hemispheric locus of language dominance prior to epilepsy surgery).

Action

Produces all levels of CNS depression:
  • Depresses sensory cortex,
  • Decreases motor activity,
  • Alters cerebral function.
Inhibits transmission in the CNS and raises seizure threshold.

Therapeutic effects

Hypnosis.
Sedation.

Pharmacokinetics

Absorption: Well absorbed after IM administration.
Distribution: Rapidly and widely distributed; concentrates in brain, liver, and kidneys. Readily crosses placenta; small amounts enter breast milk. Moderately bound to plasma proteins.
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: 16–40 hr.

Time/action profile (sedation)

ROUTEONSETPEAKDURATION
IM30–45 minrapid6–8 hr
IVseveral minrapid6–8 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Dyspnea or airway obstruction; Comatose patients; Pre-existing CNS depression; Severe hepatic dysfunction; Porphyria; Obstetric / Lactation: Not recommended.
Use Cautiously in: History of suicide attempts or substance abuse ; Debilitated patients (use smaller doses); Patients using alcohol or drugs that cause CNS depression; Patients with hepatic or renal impairment (dose should be reduced); Acute or chronic pain (paradoxical excitement may occur); Hypoadrenalism (↓ effects of corticosteroids); Pediatric: Safety not established in children <6 yr; Geriatric: Appears on Beers list. Geriatric patients are at increased risk for excitement, confusion, CNS depression; use smaller doses).

Adverse Reactions/Side Effects

Central nervous system

  • drowsiness (most frequent)
  • abnormal thinking
  • agitation
  • ataxia
  • CNS depression
  • confusion
  • dizziness
  • headache
  • nightmares
  • vertigo

Respiratory

  • bronchospasm (IV only) (life-threatening)
  • laryngospasm (IV only) (life-threatening)
  • apnea
  • respiratory depression

Cardiovascular

  • bradycardia
  • hypotension
  • syncope

Gastrointestinal

  • constipation
  • nausea
  • vomiting

Dermatologic

  • angioedema (life-threatening)
  • exfoliative dermatitis
  • purpura
  • rash

Local

  • pain or sterile abscess at IM site
  • phlebitis at IV site

Musculoskeletal

  • hyperkinesia

Miscellaneous

  • hypersensitivity reactions including Stevens-Johnson syndrome (life-threatening)
  • fever

Interactions

Drug-Drug interaction

Additive CNS depression with other CNS depressants including alcohol, antidepressants, antihistamines, opioid analgesics, and other sedative/hypnotics.Sedation may be prolonged with MAO inhibitors and valproic acid.Induces hepatic enzymes that metabolize other drugs, decreasing their effectiveness, including hormonal contraceptives,furosemide, disopyramide, propafenone, methadone, cimetidine, cyclosporine, tacrolimus, rifampin, estrogen, chloramphenicol, acebutolol, propranolol, metoprolol, timolol, doxycycline, corticosteroids, tricyclic antidepressants, warfarin, theophylline, and quinidine.Concomitant use of kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.St. John's wort may ↓ barbiturate effect.

Route/Dosage

Intramuscular Intravenous (Adults) Sedative—30–50 mg 2–3 times daily; hypnotic—65–200 mg at bedtime.
Intravenous (Adults) Psychiatric interviews (unlabeled use)50–100 mg/min for total dose of 200–1000 mg or until patient experiences drowsiness, impaired attention, slurred speech, or nystagmus.
(Adults) Wada test (unlabeled use)100 mg over 4–5 sec via percutaneous transfemoral catheter.
Intramuscular Intravenous (Children 6–12 yr) Sedative–65–500 mg (3–5 mg/kg), depending on response.
Intramuscular (Children ≥6 yr) Hypnotic—2–3 mg/kg/dose.

Availability (generic available)

Injection: 500-mg vials

Nursing implications

Nursing assessment

  • Monitor respiratory status, pulse, and BP frequently.
    • Prolonged therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient, especially if depressed, suicidal, or with a history of addiction.
  • Hypnotic: Assess sleep patterns before and periodically throughout therapy. Hypnotic doses of amobarbital suppress REM sleep. Patient may experience an increase in dreaming on discontinuation of medication. Monitor ambulation after administration.

Potential Nursing Diagnoses

 (Indications)
Risk for injury (Side Effects)

Implementation

  • Intramuscular: Intravenous: Reconstitute with sterile water for injection Rotate vial to mix; do not shake. Do not use if solution does not become absolutely clear within 5 min after reconstitution or if precipitate forms after the solution clears. Solution should be used within 30 min of reconstitution.
  • Intramuscular: Do not administer subcut. Administer IM injections deep into gluteal muscle to minimize tissue irritation. IM doses should not exceed 500 mg or 5 mL.
  • Intravenous Administration
  • Intravenous: Diluent: May be further diluted in D5W, D10W, D20W, D5/0.9% NaCl, D5/LR, 0.9% NaCl, or LR. Concentration: Not to exceed of 100 mg/mL.
  • Use the largest vein possible to prevent thrombosis. Solution is highly alkaline; avoid extravasation, which may cause tissue damage and necrosis. If extravasation occurs, infiltration of 5% procaine solution into affected area and application of moist heat may be ordered.
  • Rate: Do not exceed the rate of 50 mg/min. Titrate slowly for desired response. Rapid administration may result in respiratory depression, apnea, laryngospasm, bronchospasm, or hypotension. Equipment for resuscitation should be readily available.

Patient/Family Teaching

  • Discuss the importance of preparing environment for sleep (dark room, quiet, avoidance of nicotine and caffeine).
  • May cause daytime drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
  • Advise patient to make position changes slowly to minimize orthostatic hypotension.
  • Caution patients to avoid taking alcohol or other CNS depressants concurrently with this medication.
  • Advise patient to use a nonhormonal method of contraception while taking amobarbital and to notify health care professional promptly if pregnancy is planned or suspected.
  • Instruct patient to contact health care professional immediately if sore throat, fever, mouth sores, unusual bleeding or bruising, or petechiae occur.

Evaluation/Desired Outcomes

  • Improvement in sleep pattern without excessive daytime sedation. May take 2 days for effects to become evident. Therapy is usually limited to a 2-wk period.
  • Sedation.

Amytal

A brand name for AMYLOBARBITONE (amobarbital), a barbiturate hypnotic drug of medium duration of action.
References in periodicals archive ?
Measurements were performed in the presence of 5 mM glutamate + 5 mM malate or 15 mM succinate (+2 mM amytal) as substrates.
1979b) have suggested that the effects of sodium amytal interviews are due to non-drug factors and that the barbiturate is nothing more than a placebo.
Dr Kerr, who had a surgery at the Williamwood Medical Centre in Clarkston, Glasgow, for 30 years, prescribed sodium amytal to five other patients, although four of them did not suffer from insomnia.
Hence, drugs such as sodium pentothal and sodium amytal hardly
Chemical and surgical techniques seemed to offer real possibilities for lessening the mental disorders of war: either by barbiturate sedatives such as sodium amytal, coma-inducing insulin injections, electroconvulsive therapy and surgical intervention by leucotomy (William Sargant at Belmont), or by psychoanalytically inspired sessions of drug therapy (Michael Foulkes at Northfield).
Fisher said that the child denied that Jackson abused him until he was administered the drug sodium amytal which is known to induce false memory.
We took morphine, diamorphine, cyclozine, codeine, temazepam, nitrezepam, phenobarbitone, sodium amytal dextropropoxyphene, methadone, nalbuphine, pethidine, pentazocine, buphrenorphine, dextromoramide chlormethiazole.
It is small credit to Zopaclone, which I now take (after Sodium Amytal, Mogadon, Mandrax and Halcion were, each in turn, considered too dangerous) that, come 2.30am, I am still groping for the last one or two courses, and it is strange how often the ones I forget are in the Midlands: Towcester, Stratford, Hereford, Worcester, Ludlow, Wolverhampton, Uttoxeter, Southwell, Nottingham .
An 'improved version', phenobarbital (Luminal) followed in 1912 and was later joined by the likes of pentobarbital (Nembutal), secobarbital (Seconal) and amobarbital (Amytal).
The cases proceeded under the belief that when people are repeatedly brutalized, their memories can be completely repressed into the unconscious and later reliably recovered with hypnosis, dream interpretation, sodium amytal, or other therapeutic "memory work." In fact, no credible scientific support has been found for such claims.
Donald Cooper, M.D., wrote to the editor in the July/August issue to "correct" the chronology of sodium amytal related to an article about him in the preceding Saturday Evening Post issue.