SedativeHypnotics and Inhalants

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Sedative-Hypnotics and Inhalants

• PPR 130

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Sedative-Hypnotics

• Are drugs which decrease activity of the CNS,
  resulting in calming, drowsiness, and sleep. (CNS
  depressants)
• Depressants- decrease activity and reduce
  excitement.
• Includes barbiturates, non-barbiturate
  sedative-hypnotics, anti-anxiety minor
  tranquilizers, inhalants, and major tranquilizers
  (strictly regulated except inhalants and major
  tranquilizers).

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Sedative-Hypnotics

• Sedative effects calming, relax muscles, relieve
  feelings of tension, anxiety, and irritability,
  and sedation.
• Hypnotic effects sleep-inducing effects which
  resemble natural sleep.
• Sedative-hypnotic Any drug that calms, soothes,
  and reduces anxiety or insomnia.

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Sedative-Hypnotics

• Sedative-hypnotics are similar to narcotic
  analgesics.
• Sedative-hypnotics have no practical
  pain-relieving properties.
• Intoxication dosesimpaired judgment, slurred
  speech, and loss of motor coordination.

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Sedative-Hypnotics

• Generally used for
• Insomnia
• Relief of anxiety and tension
• Surgical anesthesia
• Major tranquilizers (anti-psychotics)
• Control seizures
• All of these have improved the lives of millions
  of people.

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Misuse and Abuse

• These drugs are often abused and misused because
• Search for sleep
• Coping with stress
• Appetite drug use- desire for pleasurable
  response
• Escape-avoidance drug use- desire for relief
• From an unpleasant sensation, tension, fear, or
  anxiety

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Misuse and Abuse cont.

• Sedative-hypnotics are often used to increase
  effects of narcotics.
• Moderate and offset jittery feelings from
  narcotic use
• Alcohol and minor tranquilizers are often taken
  together.
• Sedative-hypnotics are taken without much thought
  of adverse effects

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Abuse and Misuse cont.

• Adverse consequences do to
• Illicit prescribing
• Inadequate medical supervision of patient
• Patient manipulation of the prescriber
• Non-prescription channels
• Prescription forgeries
• Street sales
• Thefts at retail or wholesale

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General Characteristics

• Widespread CNS depression
• Progressive degrees of sedation relief from
  anxiety, euphoria, calmness, sleep, general
  anesthesia, coma, and death.
• Potentiating and/or synergistic drug interactions
  with other sedative-hypnotics, narcotics, and
  alcohol
• Inducement of sedative drug dependency

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General Characteristics

• Inducement of sedative drug dependency
• Psychological dependence
• Tolerance
• Physiological or physical dependence
• Sedativism common and widespread dependence on
  sedative-type psychoactive drugs
• Cross-tolerance and cross dependence

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History

• Use of depressant drugs originated in ancient
  times (Delphi-ancient Greece).
• Reserpine, the active ingredient of Rauwolfia
  serpentifla (Indian), first major tranquilizer
  used for mental illness in 1950s.
• Bromide (1860s)- first sedative-hypnotic.
• Barbiturates named barbital (induced sleep)

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History cont.

• Barbiturates replaced bromides in 1903.
• Bromide is a highly effective sedative and
  hypnotic.
• Minor tranquilizers-1960s as safer and less
  sedating than barbiturates.

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Barbiturates

• Prescribed today for conditions requiring CNS
  depression.
• Are being replaced slowly by minor tranquilizers.

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Barbiturates cont.

• Classification according to duration of action
• Ultrashort-acting-
• used as surgical anesthetics
• intravenous generally not abused
• rapid onset of effects with brief duration of
  effects

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Barbiturates cont.

• Short-intermediate-acting-
• - Onset of action, 15 to 40 minutes by
  mouth
• - Duration of action up to six hours
• - Preferred by abusers
• - Sold in liquid, tablets, and suppositories

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Barbiturates cont.

• Long-acting-
• - Onset of action are up to one hour
• - Duration of action can be 16 hours
• - Slow onset of action discourage abuse
• - Not sold illicitly
• - In medical practice utilized as sedatives,
  hypnotics, and anticonvulsants for epilepsy,
  usually no high

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Negative Effects

• Legitimate use can include effects
• A residual depression of the CNS (hangover)
• Motor in-coordination
• Listlessness
• Nausea
• Emotional disturbances
• Disruption of REM sleep

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Negative Effects

• Decline in use due to
• Fatal overdoes
• Rapid increase of tolerance
• Disruption of normal REM sleep
• Addictiveness
• Use of phenobarbital in pregnant women with
  seizure disorders lower intelligence scores in
  offspring

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Non-Medical Usage

• Barbiturates (depressant) amphetamines
  (stimulants) super mood elevation.
• Alternating cycle of sedation and stimulation
• Day (amphetamines) to get over hangover from
  barbiturates to help with insomnia
• Speed freaks use barbiturates to produce
  sleep after several days of using amphetamines
• Sold on the streets, mixed and lack quality
  control dangerous

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Overdose

• Overdose can result in
• Respiratory depression
• Collapse of the circulatory system
• Kidney failure
• Coma
• Death

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Dose

• Hypnotic dose-10 X can be toxic and 15-20 X is
  usually fatal.
• Maximum tolerance level- never known until it is
  too late.
• Usual dose usually close to lethal dose.
• Tolerance developed quickly possible overdose
• Withdrawal is a serious medical emergency

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Nonbarbiturate sedative-Hypnotics

• Chloral Hydrate
• Sleep inducer
• Prescribed but rarely abused today
• Knock drops
• Glutethimide
• Long duration of action
• Difficult to reverse overdoses and cause death
• Rarely prescribed by doctors

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Nonbarbiturate cont.

• Methaqualone
• Relatively safe replacement for barbiturates
• Popular recreational drug of abuse
• Euphoric, alcohol-like high
• Feeling of relaxation
• No medical supervision loss of inhibitions,
  dizziness, sleep, hangover, drug dependence
• Legal production halted in 1983, still available
  illegally

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Non-barbiturate cont.

• Ethchlorvynol- is a non-barbiturate drug used for
  sleeplessness
• Triazolam and Temazepam- (antianxiety agents)
  prescribed as hypnotics
• Halcion- widely used for sleep
• Serious adverse reactions recorded in U.S. and
  U.K. banned
• Flurazepam- relatively safe hypnotic, belongs to
  the bensodiazepine drug abuse
• Hypnotic or minor tranquilizer, prescribed for
  sleep

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Self-Care

• Sleep without drugs
• Regular bedtime routines
• Quiet and dark bedroom
• No caffeine
• Regular physical activity
• Hot bath before bedtime
• Rise early on regular basis
• Dont watch the clock!!

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Minor Tranquilizers

• These drugs are not minor league major
  tranquilizers
• Utilized for treatment of anxiety and neurotic
  conditions not mental disorders
• Include meprobamate and benzodiazepines

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Minor Tranquilizers

• Meprobamate
• Introduced in the 1950s
• Calmed patients without producing sleep
• Relief from anxiety without heavy sedation
• Heavy use produced psychological and physical
  dependence

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Minor Tranquilizers

• Benzodiazepines
• Introduced in the 1960s
• Valium most frequently prescribed
• Xanax just surpassed Valium
• Effective to reduce psychic tension, anxiety
  disorders, panic attacks, and phobias
• Less sedation
• Continued use tolerance with dependence and
  severe withdrawal

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Other Antianxiety Medications

• Beta-blockers- drugs used primarily for
  cardiovascular disorders, sometimes used for
  anxiety reduction.
• Certain antidepressant drugs may be used for
  treatment of anxiety.
• Buspirone (BuSpar)- a prescribed drug not
  scheduled as a controlled substance, relieves
  anxiety without sedation, abuse, or dependency.

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Inhalants

• Breathable chemicals that produce mind-altering
  vapors
• Intoxicants of the young and young adults
• Reasons for using
• Peer-group influence
• Cost effectiveness and legal chemicals
• Easy availability and convenient packaging
• Attractive high

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Inhalants cont.

• General effects
• CNS depression
• Dreamlike high
• Giddy feeling
• Numbing of senses
• Hallucinations
• Loss of consciousness

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Inhalants cont.

• Categories of abused inhalants
• Commercial solvents
• Aerosols
• Anesthetics

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Inhalants cont.

• Health hazards
• Acute intoxication
• Delirium/ loss of motor coordination
• Impulsive behavior
• Sedation
• Hallucinations
• Paralysis
• Nausea and vomiting
• Coma-fatal accidents

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Inhalants cont.

• Prevention of inhalant abuse
• Reducing the availability of volatile substances
• Changing product composition
• Better warning labels
• More effective educational campaigns
• Federal law now forbids butyl nitrate

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Flunitrazepam

• Also known as Rohypnol
• Appeared in the early 1990s
• Now banned due to abuse potential
• Powerful sleeping pill and short term amnesia
• Roofie Rape-combined with alcohol
• Since 1996-enhanced legal penalties for using
  drug for assaults

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Discussion

• Are sedatives always necessary?
• What protections are needed and warnings provided
  for products with inhalants as ingredients?
• Is there over-prescription and over-use of minor
  tranquilizers in society and what can reduce
  their use?
• Pros and cons of restricting the sale of
  inhalants?