USMLE

Barbiturates

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Mental Health Drugs
  1. Tricyclic Antidepressants
  2. SSRIs
  3. SNRIs
  4. Benzodiazepines
  5. Barbiturates
  6. Typical Antipsychotics
  7. Atypical Antipsychotics
  8. Lithium
  9. MAOIs
  10. Bupropion
  11. Buspirone
  12. Trazodone
  13. Zolpidem
  14. Amphetamines

Summary

Barbiturates are a class of drugs, easily recognizable with their “-barbital” ending, with the most common drug being phenobarbital. Barbiturates are CNS depressants, meaning they slow down brain and neural activity. This makes barbiturates useful in treating seizures and treating insomnia. Side effects of barbiturates include sedation, dependence, and respiratory depression. Barbiturates are not commonly prescribed anymore because of their high abuse potential and the risk of fatal overdose.

Key Points

  • Key Drugs
    • -barbital Ending
      • Phenobarbital
      • Butabarbital
      • Pentobarbital
      • Secobarbital
    • Thiopental
    • Mechanism
      • CNS Depressant
        • Enhances GABA activity, a neurotransmitter that slows down neural activity
    • Clinical Use
      • Seizures
        • Tonic-clonic
        • Partial
        • Myoclonic
        • Status epilepticus
      • Insomnia (Sedative)
        • Effective for helping sleep sustainment, however it is not useful in helping fall asleep
        • Thiopental may be used in setting of anesthesia to induce sedation
      • Anxiety
      • Procedure sedation
    • Side Effects and Adverse Reactions
      • Tolerance
        • Drug must be tapered off slowly and cannot be stopped abruptly
        • High risk of abuse        
          • Schedule II-IV Controlled Substance (depending on specific type of barbiturates)
        • Barbiturates are now rarely prescribed due to their high risk of dependency and abuse, as well as severity of overdose. Benzodiazepines are generally a safer option to use in place of barbiturates.
      • Sedation
        • Do not combine with alcohol, opioids, or any other CNS depressants
        • If possible, should be taken at night to avoid day-time sleepiness
      • Respiratory depression
        • Can be fatal in overdose