Depressants and Inhalants Chapter 7 Depressants and Inhalants

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

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

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

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

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

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 20-30 mins) Metabolize in the liver eliminated through kidneys

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

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

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

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

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)

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

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)

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

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

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

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

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

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

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

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

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)

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

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 14-15 year olds reported current use Life time use was down in 2004 among Americans 18-20 2004 National Survey on Drug Use and Health

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

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

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

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

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

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

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

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

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