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WNCVAHCS Phenobarbital Protocol 2024
Naomi Roster-Romero
Created on February 6, 2024
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2024 Ongoing competency
treating alcohol withdrawal with phenobarbital protocol
Utilizing the current phenobarbital protocol, complete the following questions
FILL IN THE BLANKS GAME
Verify alcohol related history and most recent _____________ and quantity to determine risk for withdrawal.
consumption
consumption
blood alcohol levels
treatment
A relative contraindication to phenobarbital in the treatment of alcohol withdrawal includes chronic use of phenobarbal as an _____________ agent .
pain management
antiepileptic
antiepileptic
antipsychotic
FILL IN THE BLANKS GAME
Which of these lab studies DO NOT necessarily need to be ordered per this protocol? _____________ .
Liver Function Test
CBC
Type & Screen
Type & Screen
Provider will admit to the appropriate level of care (refer to Appendix _____________ and initiate the protocol.
FILL IN THE BLANKS GAME
100
Thiamine should be supplemented with _____________ mg orally ASAP.
200
100
250
Addtionally, thiamine should be supplemented 100mg daily for _____________ days .
20mg/kg
When dosing phenobarbital, a loading dose of ____________ of ideal body weight should be infused over 30 minutes.
5mg/kg
10mg/kg
10mg/kg
-1
RASS score must be at _________________ or greater to receive IV phenobarbital loading dose.
-1
+1
FILL IN THE BLANKS GAME
15
Assess and document the RASS score prior to and _____________ minutes post administation to determine the need for additioanl dosing.
30
30
60
-1 and -2
0 and -1
Goal RASS: Between _____________ .
+1 and 0
0 and -1
If Veteran does not meet 10mg/kg dosing criteria, consider administer a smaller dose of ____________ mg slow IV push, depending on severity of symptoms.
150 or 200
130 or 260
100 or 150
130 or 260
20-30
Addtional dosing for RASS >0 after inital load dose include: 130mg IVP every _________________ minutes.
15-30
15-30
30-60
FILL IN THE BLANKS GAME
Oral or _____________ phenobarbital may be substituted if necessary. Follow protocol route dosing recommendations.
intramuscular
intramuscular
buccal
SQ
Nursing to assess for signs and symptoms of delirium tremens utilizing CIWA-Ar at minimum of _____________ .
q 4 hrs
once per shift
q 8 hrs
once per shift
FILL IN THE BLANKS GAME
Typical cumulative dose for treatment is between _____________ mg/kg of IDEAL BODY WEIGHT .
20-30
20-30
10-20
30-40
Providers should NOT exceed _____________ mg/kg without critical care consultation.
30
50
30
40
FILL IN THE BLANKS GAME
benzodiazepine
Concurrent _____________ therapy is not recommended and may result in pardoxical agitation and/or delirium .
benzodiazepine
H2 Blocker
SSRI
schizophrenia
Veterans with persistent symptoms despite receiving maximum dosing should be evaluated for _____________ .
alternative etiologies
alternative etiologies
dementia
+4 to -5
The Richmond Agitation Sedation Scale (RASS) ranges from ____________.
+2 to -2
+4 to -5
+5 to -5
The CIWA-Ar Scoring Guidelinees can be found in Appendix _________________ of the current Phenobarbital Protocol PRO-NUR-07. I