1. CNS Depressants: Sedative-Hypnotics Chapter 6

2. Introduction to CNS Depressants
Why are CNS depressants problematic?
Usually prescribed under physician direction
Second most frequently abused prescription drug and sometimes contributes to death due to accidental overdoses
Can cause very alarming and dangerous behavior if not closely monitored
Most problems associated with these drugs due to inadequate professional supervision

3. Introduction to CNS Depressants

4. Discussion
In your small group, discuss why you think physicians may be careless when prescribing depressants for patients suffering from anxiety. Discuss what you believe are the dangers of this practice and what other alternate therapies may exist

5. Introduction to CNS Depressants (continued)
Why are CNS depressants problematic?
Seemingly unrelated drug groups can cause CNS depression (see case in point, p.162)
Combination use can cause dangerous drug interactions
Can cause disruptive personality changes

6. The History of CNS Depressants
Attempts to find CNS depressants other than alcohol began in the 1800s.
Bromides were introduced to treat nervousness and anxiety in the 1800s.
Very popular but toxic
In the early 1900’s, bromides were replaced by barbiturates.
Initially heralded as safe and effective
Apparent problems with tolerance, dependence, and safety

7. The History of CNS Depressants (continued)
In the 1950’s the first benzodiazepines were marketed as substitutes for barbiturates.
Relatively safe when used for short periods
Long-term use can cause dependence and withdrawal problems
Article – “The history of barbiturates a century after their clinical introduction”

8. The History of CNS Depressants (continued)
Benzodiazepines were routinely prescribed for stress, anxiety, or apprehension.
In 1973, 100 million prescriptions were written for benzodiazepines.
Twice as many women as men taking them.
As medical community became aware of the problem, use of depressants declined, but benzodiazepines remained still very popular.
Classified as Schedule V drugs.

9. The Effects of CNS Depressants
CNS depressants reduce CNS activity and diminish the brain’s level of awareness.
Depressant drugs include:
Benzodiazepines
Barbiturate-like drugs
Alcohol
Antihistamines
Opioid narcotics like heroin

10. The Effects of CNS Depressants (continued)
Depressants are usually classified according to the degree of their medical effects on the body. For example:
Sedatives cause mild depression and relaxation, treat fear, apprehension
Anxiolytic—drugs that relieve anxiety
Hypnotics induce drowsiness and encourage sleep
Amnesiac effects can cause the loss of memory

11. The Effects of CNS Depressants (continued)

12. The Effects of CNS Depressants (continued)
The same drug can cause different effects based on dose.
Low dose (sedatives—relieve anxiety and promote relaxation)
Higher doses (hypnotics—can cause drowsiness and promote sleep)
Even higher doses (anesthetics—can cause anesthesia and are used for patient management during surgery)

14. Types of CNS Depressants
Benzodiazepines: Valium-Type Drugs
Prescribed for anxiety, relaxation and sleep
Medical uses
Relief from anxiety, treatment of neurosis, relaxation of muscles, alleviation of lower-back pain, treatment of convulsive disorders, induction of sleep, relief from withdrawal symptoms, induction of amnesia

15. Types of CNS Depressants (continued)
Mechanisms of action for benzodiazepine
Affect neurons that have receptors for the neurotransmitter GABA
GABA—most common inhibitory transmitter in brain regions
Limbic system (alter mood)
RAS (cause drowsiness)
Motor cortex (relax muscles)

16. Types of CNS Depressants (continued)
Types of benzodiazepines
Many benzodiazepine compounds available in the United States
Distinguished primarily by their duration of action: short-acting (hypnotics), long- acting (sedatives)
See Table 6-1 for Half –lives of various benzodiazepines- next slide…
Side effects include drowsiness to paradoxical effects (e.g. increased restlessness), tolerance, dependence, withdrawal, and abuse

17. Types of CNS Depressants (continued)

18. Types of CNS Depressants (continued)
Barbiturates played an important historical role as sedative-hypnotic agents.
However, due to their narrow margin of safety and their abuse liability, they were replaced by benzodiazepines.
Caused many negative side effects, from nausea to death, from respiratory or cardiovascular depression
Discussion on Whitney Houston and Michael Jackson

19. Other Types of CNS Depressants
Drugs with barbiturate-like properties:
Chloral hydrate
Glutethimide
Methyprylon
Methaqualone
Antihistamines
Propofol (abused general anesthetic)
GHB (gamma hydroxybutyrate)

20. Patterns of Abuse with CNS Depressants (continued)
People most likely to abuse CNS depressants include individuals who
Use drugs to relieve continual stress
Paradoxically feel euphoria and stimulation from depressants
Use depressants to counteract the unpleasant effects of other drugs of abuse
Combine depressants with alcohol and heroin to potentiate the effects

21. Patterns of Abuse with CNS Depressants (continued)

22. Patterns of Abuse with CNS Depressants (continued)
Detoxification: The elimination of a toxic substance, such as a drug, and its effects
With CNS depressants, this is achieved by substituting a longer-acting barbiturate for the offending CNS depressant and gradually reducing the dose to avoid unpleasant withdrawal effects. Withdrawal from CNS depressants, if not managed properly, can be very dangerous, or even fatal
The American Psychiatric Association considers dependence on CNS depressants a psychiatric disorder.

23. End of Presentation