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WNCVAHCS Phenobarbital Protocol 2024

Naomi Roster-Romero

Created on February 6, 2024

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Transcript

Utilizing the current phenobarbital protocol, complete the following questions

2024 Ongoing competency

treating alcohol withdrawal with phenobarbital protocol

antiepileptic

A relative contraindication to phenobarbital in the treatment of alcohol withdrawal includes chronic use of phenobarbal as an _____________ agent .

consumption

Verify alcohol related history and most recent _____________ and quantity to determine risk for withdrawal.

FILL IN THE BLANKS GAME

antipsychotic

treatment

blood alcohol levels

antiepileptic

pain management

consumption

Provider will admit to the appropriate level of care (refer to Appendix _____________ and initiate the protocol.

Type & Screen

Which of these lab studies DO NOT necessarily need to be ordered per this protocol? _____________ .

FILL IN THE BLANKS GAME

Liver Function Test

CBC

Type & Screen

-1

RASS score must be at _________________ or greater to receive IV phenobarbital loading dose.

10mg/kg

When dosing phenobarbital, a loading dose of ____________ of ideal body weight should be infused over 30 minutes.

Addtionally, thiamine should be supplemented 100mg daily for _____________ days .

FILL IN THE BLANKS GAME

250

10mg/kg

+1

-1

5mg/kg

200

100

20mg/kg

100

Thiamine should be supplemented with _____________ mg orally ASAP.

15-30

Addtional dosing for RASS >0 after inital load dose include: 130mg IVP every _________________ minutes.

130 or 260

If Veteran does not meet 10mg/kg dosing criteria, consider administer a smaller dose of ____________ mg slow IV push, depending on severity of symptoms.

0 and -1

Goal RASS: Between _____________ .

FILL IN THE BLANKS GAME

60

130 or 260

+1 and 0

30-60

15-30

0 and -1

100 or 150

15

-1 and -2

20-30

30

150 or 200

30

Assess and document the RASS score prior to and _____________ minutes post administation to determine the need for additioanl dosing.

once per shift

Nursing to assess for signs and symptoms of delirium tremens utilizing CIWA-Ar at minimum of _____________ .

intramuscular

Oral or _____________ phenobarbital may be substituted if necessary. Follow protocol route dosing recommendations.

FILL IN THE BLANKS GAME

q 8 hrs

SQ

buccal

once per shift

q 4 hrs

intramuscular

30

Providers should NOT exceed _____________ mg/kg without critical care consultation.

20-30

Typical cumulative dose for treatment is between _____________ mg/kg of IDEAL BODY WEIGHT .

FILL IN THE BLANKS GAME

40

30-40

10-20

30

50

20-30

The CIWA-Ar Scoring Guidelinees can be found in Appendix _________________ of the current Phenobarbital Protocol PRO-NUR-07. I

+4 to -5

The Richmond Agitation Sedation Scale (RASS) ranges from ____________.

alternative etiologies

Veterans with persistent symptoms despite receiving maximum dosing should be evaluated for _____________ .

FILL IN THE BLANKS GAME

SSRI

+4 to -5

dementia

alternative etiologies

+2 to -2

H2 Blocker

schizophrenia

benzodiazepine

+5 to -5

benzodiazepine

Concurrent _____________ therapy is not recommended and may result in pardoxical agitation and/or delirium .

Withdrawal Protocol Competency 2024

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