1. Depressants and Inhalants
Chapter 7
Depressants and Inhalants

2. Depressants Most widely-used and abused drugs in the U.S
Is popular for its stress and anxiety relieving properties

5. Benzodiazapines Introduced in 1960s 40 years drug of choice
Many properties – anxiolytic, sedatives, anticonvulsants, relaxant

6. Benzodiazapines Effects
Safer than barbiturates
Much less respiratory depression
Replaced barbiturates as the drug of choice
Doses rarely fatal
CNC toxicity in chronic use/high doses
Headaches, irritability, confusion, impaired memory, depression

7. Types of CNS Depressants
Benzodiazepines: Valium-Type drugs
Prescribed for anxiety and sleep
Four of the top-selling prescription drugs in the U.S.
Xanax, Halcion, Ativan, diazepam
Medical uses
Relief from anxiety, neurosis, muscle relaxation, alleviation of lower-back pain, treatment of convulsive disorders, induction of sleep, relief from withdrawal symptoms, induction of amnesia

8. Types of CNS Depressants
Types of benzodiazepines:
14 benzodiazepine compounds on the market
Distinguished primarily by their duration of action: short-acting (hypnotics), long-acting (sedatives)
Side effects:
Drowsiness to paradoxical effects (i.e. Rophynol, used to make victims vulnerable to sexual assault)
Tolerance, dependence, withdrawal, and abuse

9. Pharmacokinetics Wide range of half-life, 3 mins to 120 hrs
Redistribution
Fast acting – lipid (fat) soluble- results in seconds
Long acting p water soluble – slower to penetrate (CNS mins)
Metabolize in the liver eliminated through kidneys

10. History Before Barbiturates:
Chloral hydrate was first synthesized in1832 but not used clinically until 1870– for sleep
Paraldehyde was first synthesized in1829 but not used clinically until 1882 – very safe – very, very bad taste and odor
Bromides – to induce sleep in the 19th century, used until 1960s in OTC meds

11. History
In the 1950s 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

12. Action Sites and Mechanism
Early understanding
Depressed neuronal pathways in brain stem/cerebral cortex
Present day
Reduced metabolic and brain electrical activity

13. Neurotransmitters and Receptor Sites
Glutamate (excitatory)
Reduce excitatory activity
GABA (inhibitory)
Augment inhibitory activity
Barbiturates/benzodiazapines bind here

14. 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
GHB (gamma hydroxybutyrate)

15. EFFECTS ON THE CNS
The clinical value of CNS depressants is dose dependent
Low dose (sedatives, relieves anxiety and promote relaxation)
Higher doses (hypnotics, can cause drowsiness and promote sleep)
At even higher doses (anesthetics, can cause anesthesia and are used for patient management during surgery

16. Effects of CNS Depressants
The clinical value of CNS depressants is dose dependent:
Low dose (sedatives, relieve anxiety and promote relaxation)
Higher doses (hypnotics, can cause drowsiness and promote sleep)
At even higher doses (anesthetics, can cause anesthesia and are used for patient management during surgery)

17. EFFECTS OF CNS DEPRESSANTS
CNS depressants reduce CNS activity and diminish the brain’s level of awareness
Depressant drugs include:
Benzodiazapines Opiods
Barbiturates GHB (gamma hydroxy-
Alcohol butyrate
Antihistamines

18. Psychological Effects
Depressed Behavior
Cognitive/Motor inhibition akin to alcohol inebriation
Low dose – reduced anxiety or emotional withdrawal
High doses – general behavioral depression, sleep

19. Physiological Dependence
Wide range of effects
Low dose sleep difficulties
High dose- hallucinations, restlessness, disorientation, life-threatening convulsions

20. Psychological Dependence
Pleasurable effects
Reduced anxiety
Sedation
Euphoria
Leads to compulsive use and abuse

21. Mental Status Exam Used to evaluate mental functioning Five areas
Sensory - clouded, disorientation to time/place
Memory – forgetfulness
Intellect – depressed reasoning
Judgment – altered insight
Affect – wide mood swings

22. INHALANTS
Inhalants are breathable chemical vapors that produce psychoactive (mind-altering) effects.
They were never meant to be used to achieve an intoxicating effect

23. Inhalants falls into the following categories
Volatile Solvents – industrial or household solvents containing products, including paint thinners or removers, degreasers, dry cleaning fluids, gasoline and glue
Art or office supply solvents, including correction fluids, felt tip marker fluid, and electronic contact cleaners

24. Inhalants fall into the following categories
Aerosols – Household propellants and associated solvents in items such as spray paints, hair or deodorant sprays, fabric protector sprays

25. Inhalants fall into the following categories
Gases – used in household or commercial products, including butane lighters and propane tanks, whipping cream aerosols or dispensers, and refrigerant gases
Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide (laughing gas)

26. Inhalants fall into the following categories
Nitrites – organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as poppers. Amylnitrites is still used in certain diagnostic medical procedures. It has an unpleasant odor
Cyclohexyl, a nitrite drug use to treat heart angina, it’s a antiangina

27. Who Use Inhalants Among youths age 12 to 17 10.6% were current users
Among 12 or 13 year olds, 1.2% report current use
1,6% of year olds reported current use
Life time use was down in 2004 among Americans 18-20
2004 National Survey on Drug Use and Health

28. How are Inhalants Used Sniffing or snorting fumes from containers
Spraying aerosols directly into the nose or mouth
“Bagging,” sniffing or inhaling fumes from substances sprayed or deposited inside a plastic or paper bag
“Huffing” from an inhalant-soaked rag stuffed in the mouth
Inhaling from balloons filled with nitrous oxide

29. Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream and quickly distributed to the brain
Nearly all abused inhalants (other than nitrites) produce pleasurable effects by depressing the CNS

30. Gaseous Anesthetics Nitrites
Rapid dilation of the arteries, great for blood pressure
Unpleasant smell

31. Recognizing Inhalant Abuse
Chemical odor on clothing or breath
Drunk or disoriented appearance
Pain or other stains on face, hands, or clothes
Slurred speech
Hidden empty spray paint or solvent containers and chemical-soaked rags or clothing
Inattentiveness, lack of coordination, irritability and depression

32. Effects of Inhalants Slows body functions Intoxication Nausea
Cough/sneeze
Light-headedness
Damage heart, kidneys, brain
Hypoxia/death

33. Medical Consequences of Inhalant Abuse
Asphyxiation from repeated inhalations
Suffocation from blocking air from entering the lungs
Convulsions or seizures caused by abnormal electrical discharges in the brain
Coma
Choking from inhalation of vomit
Fatal injury from accidents

34. Dangers of Inhalants
Chronic long-term use can lead to brain damage, liver, kidney, heart, fetus
Accidents associated with “intoxication” and fires

35. Harmful Irreversible Effects
Hearing lost
Peripheral neuropathies, or limb spasms
Central nervous system or brain damage
Bone marrow damage

36. Side Effects of Depressants
Drowsiness to paradoxical effects (I.e. Rophynol, use to make victims vulnerable to sexual assault
Tolerance, dependence, withdrawal, and abuse