1. Chapter 9 Sedative-Hypnotic Drugs

2. SEDATIVE-HYPNOTICS SEDATIVE = SEDATION HYPNOTIC = SLEEP

3. Early Examples Bromides: Used as sedatives and anticonvulsants in 1800’s – potential for toxicity Paraldehyde: Used to treat alcohol withdrawal, highly addictive. Chloral hydrate: sedative and hypnotic – “knockout” drops

4. TYPES OF SEDATIVE- HYPNOTICS BARBITURATES NONBARBITURATES MINOR TRANQUILIZERS

5. BARBITURATES CLASSIFIED BY ONSET AND DURATION OF ACTION  ULTRASHORT  SHORT-INTERMEDIATE  LONG-ACTING

6. USES FOR BARBITURATES ULTRASHORT (ANESTHESIA)  EXAMPLE: THIOPENTAL INTERMEDIATE: (SLEEP)  EXAMPLE: SECONAL Referred to as ‘Solid Alcohol’ LONG-ACTING: (ANTIEPILEPTIC, HEADACHES:)  EXAMPLE: BUTABARBITAL, PHENOBARBITAL

7. PROBLEMS WITH BARBITURATES  WITHDRAWAL CAN BE LIFE THREATENING  IMPAIRMENT OF JUDGMENT AND COORDINATION (HANGOVER)  DECREASE IN RESPIRATORY RATE  TOXIC WITH ALCOHOL  STRONG POTENTIAL FOR ABUSE

8. Nonbarbiturates  Chloral Hydrate  Paraldehyde  Bromides  Meprobamate  Methaqualone

9. Chloral Hydrate, Paraldehyde, and Bromides  Chloral Hydrate: Induces sleep and once used as “knockout drops.”  Paraldehyde: Once used to treat mental and emotional problems. No longer used  Bromides: Rarely prescribed as a sleep agent

10. Meprobamate  Marketed in mid-1950s under the brand name Miltown  Extremely popular anti-anxiety drug  Concerns regarding physical and psychological dependence – withdrawal is severe  Low margin of safety

11. Methaqualone METHAQUALONE (QUAALUDES)  INTRODUCED IN 1965 AS A HYPNOTIC  THOUGHT TO DEPRESS RAS  USED AS AN ANTI-C0NVULSANT  STRONG DEPENDENCE POTENTIAL  QUAALUDES WERE RESCHEDULED (I)

12. Minor Tranquilizers  Referred to as anti-anxiety drugs  Benzodiazepines are the most commonly prescribed benzodiazepines.  Examples of benzodiazepines include Valium, Xanax, and Rohypnol.  Besides reducing anxiety, benzodiazepines induce sleep, reduce panic attacks, and control some seizures

13.  Benzodiazepines are addictive and produce tolerance and withdrawal symptoms  Benzodiazepines have a wider margin of safety and less severe side effects than barbiturates

14. DATE-RAPE DRUGS MOST DATE-RAPE DRUGS ARE BENZODIAZEPINES EXAMPLE: ROHYPNOL

15. ROHYPNOL  SIMILAR TO VALIUM  ALSO KNOWN AS “ROOFIES,” “ROPE,” AND “ROCHE”  ROHYPNOL’S EFFECTS ARE NORMALLY FELT 20-30 MINUTES AFTER INJECTION  EFFECTS CAN LAST FOR HOURS

16. ROHYPNOL AND ALCOHOL  SEDATION  MUSCLE RELAXATION  BLACKOUTS  DEATH

17. LEGAL STATUS  ROHYPNOL IS ILLEGAL IN THE UNITED STATES  IT IS AVAILABLE LEGALLY IN OTHER COUNTRIES USED TO TREAT ANXIETY, INSOMNIA, AND SEIZURE DISORDERS

18. OTHER DATE RAPE DRUGS  GAMMA y-hydroxybutyrate  KNOWN AS GHB  DEVELOPED IN THE 1980’S AS A SURGICAL ANESTHETIC  GHB IS BOTH A METABOLITE AND PRECURSOR TO GABA  Used illicitly by some bodybuilders as a growth hormone stimulant

19. GHB  ODORLESS  TASTELESS

20. GHB SIDE EFFECTS  NAUSEA  VOMITING  SEIZURES  MEMORY LOSS  HALLUCINATIONS  COMA  RESPIRATORY DISTRESS

21. GHB + ALCOHOL  LOSS OF MEMORY  UNCONSCIOUSNESS  AMNESIA  DEATH

22. Gamma butyl lactone  GBL is an active metabolite of GHB  Found in liquid paint stripper  Can be quickly formulated into an elixir and produce effects similar to GHB

23. Inhalants Inhalant abuse is also called “huffing” Inhalants have anesthetic-like properties Short term effects of inhalants include drooling, nausea, sneezing, hypersensitivity, loss of coordination and coughing

24. Long-term effects include frequent nosebleeds, liver and kidney damage, weight loss, depression, paranoia, hostility, and bone marrow abnormalities

25. Types of Inhalants Glue (toluene) Ether Nitrous Oxide (“laughing gas”) Nitrite Inhalants (amyl nitrite, butyl nitrite, and isobutyl

26. Summary  Sedative hypnotic drugs are capable of inducing sedation and sleep  Barbiturates, nonbarbiturates, and minor tranquilizers are types of sedative hypnotics  Barbiturates are classified by onset and duration of action

27.  Date rape drugs are drugs from the sedative hypnotic category  Rohypnol is a sedative hypnotic and used in date rapes  Rohypnol is illegal in the United States  GHB is another example of a date rape drug

28.  Inhalants can exert a sedative hypnotic effect and are extremely dangerous