1. Anxiolytics

2. Anxiolytics/Hypnotics/Sedatives
Benzodiazepines
Trichloroethanol derivatives
Barbiturates
Chlormethiazole

3. Benzodiazepines Potentiates the effects of GABA
Metabloised in the liver

4. Benzodiazepines- actions
Hypnotic
Sedative
anxiolytic
anticonvulsant
muscle relaxant

5. Clinical indications for the use of Benzodiazepines
Anxiety states/panic attacks
Insomnia
Alcohol/Drug withdrawal states
night terrors, somnambulism in children
muscle spasms
Epilepsy
Anaesthesia and sedation for minor surgical procedures-endoscopies

6. Problems associated with the use of benzodiazepines
tolerance
amnesia
dependence
Overdose

7. Adverse effects Drowsiness lightheadedness amnesia
impaired psychomotor function( driving or operating machinery)
addiction

8. Interactions
additive effect with other CNS depressants

9. Benzodiazepines in pregnancy
Regarded unsafe in pregnancy
Diazepam is teratogenic in mice.
Benzodiazepines cross the placenta
poor suckling in the new born

10. Examples of benzodiazepines in commom clinical use
Diazepam t1/ hr
Chlordiazepoxide
Temazepam
Midazolam

11. Benzodiazepine antagonists
Flumazenil(anexate)
Clinically useful in the reversal of the effects of benzodiazepines after endoscopies ect
Self poisonig

12. Chloral hydrate
induces sleep in 1/2 an hr and lasts 6-8 hrs with little hang over
irritant to stomach
used in children

13. Chlormethiazole Has hypnotic sedative and anticonvulsant properties
Frequently used in the management of alcohol withdrawal
also used in senile psychosis and confusion

14. Barbiturates Obsolete as hypnotics and sedatives low therapeutic index
Physical dependence occurs

15. Insomnia Treat the cause eg Depression
No currently available drug induces normal sleep
Benzodiazepines are the first choice
As they alter the sleep pattern least
Relatively safe in over dosage
A drug with shorter t 1/2 and inactive metabolites are preferred eg temazepam

16. Anxiety Benzodiazepines preferred A drug with long halflife preferred
Should not be used for more than 4 weeks
Beta blockers have a role to play