NCLEX Review Guide: Barbiturates and Sedative-Hypnotics

Barbiturates

• Phenobarbital, pentobarbital, secobarbital - Central nervous system depressants that enhance GABA activity by prolonging chloride channel opening time.
• Used for seizure control, anesthesia induction, and severe insomnia when other medications have failed.
• Classified by duration: ultra-short (thiopental), short (pentobarbital), intermediate (butalbital), and long-acting (phenobarbital).

Non-Barbiturate Sedative-Hypnotics

• Benzodiazepines (lorazepam, diazepam), Z-drugs (zolpidem, zaleplon), and miscellaneous agents (chloral hydrate) provide safer alternatives to barbiturates.
• Benzodiazepines enhance GABA by increasing frequency of chloride channel opening, while Z-drugs selectively target GABA-A receptor subtypes.

Critical Monitoring Parameters

1. Assess respiratory rate, depth, and oxygen saturation before and after administration
2. Monitor blood pressure and heart rate for hypotensive effects
3. Evaluate level of consciousness using standardized scales
4. Check liver function tests for long-term barbiturate users

Essential Teaching Points

• Avoid alcohol and other CNS depressants while taking these medications - risk of fatal respiratory depression.
• Take medications exactly as prescribed; never stop abruptly due to withdrawal seizure risk.
• Use safety measures at home including removing throw rugs, ensuring adequate lighting, and avoiding driving until effects are known.
• Report signs of toxicity: excessive drowsiness, confusion, difficulty breathing, or unsteady gait.