Older adults who take long-acting sedatives or hypnotics are likely to experience:
A. Hallucinations
B. Ataxia
C. Alertness
D. Dyspnea
Correct Answer: B. Ataxia
If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits. Long-acting barbiturates have an effect of longer than 6 hours and include barbital and phenobarbital. Barbiturate classification is according to the duration of their action, IV formulations of thiopental and methohexital are in the ultra short-acting class.
Option A: Age-related changes have been demonstrated in pharmacokinetics due to slower intercompartmental clearance in the elderly, resulting in higher serum concentrations with smaller drug doses.
Option C: Thiopental and thiamylal have been shown to release histamine, while methohexital and pentobarbital have minimal histamine release. Withdrawal symptoms may occur: nervousness, tremor, agitation, and hypotension may develop 2 to 8 days after the abrupt discontinuation of barbiturates. Additionally, the patient may develop delirium or grand mal seizures.
Option D: 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. Absolute contraindications for any barbiturate include status asthmaticus and acute and intermittent variegate porphyria.