Snapshot A 3-hour-old boy presents with asynchronous distal limb muscle twitching, followed by generalized myoclonus. The neonate appears encephalopathic. Airway, breathing, and circulation are secured. Blood tests are obtained, and EEG testing is performed. He is started on phenobarbital. (Early myoclonic encephalopathy) Introduction Examples phenobarbital, pentobarbital, thiopental, and secobarbital Mechanism binds to allosteric sites on GABAA receptor increases GABAA action by ↑ duration of Cl- channel opening resulting in ↓ neuron firing barbitDURATE Clinical use CNS depressant for anxiety and seizures induction of anesthesia (thiopental) Toxicity dependance additive CNS depression effects with other CNS depressants (EtOH and benzodizepines) respiratory or CV depression drug interactions owing to induction of liver P-450 contraindicated in porphyria can decrease concentration of other drugs may inhibit complex I of the electron transport chain treat overdose with symptom management assist respiration BP maintenance