1. Sedatives & Hypnotics

2. Sedatives The perfect sedative reduces anxiety with little or no effect on motor or mental function within the therapeutic dosing range.

3. Hypnotics The ideal hypnotic drug should produce drowsiness and encourage the onset of normal sleep. Hypnotics cause a more rponounced depression of the central nervous system than do the sedatives.

4. Sedatives and Hypnotics It is, however, a characteristic of these drugs as a group to depress central nervous system function in a dose dependent fashion.

5. Sedatives and Hypnotics These drugs, as a function of dose, will produce : l Sleep l Sedation l Relief Of Anxiety l Anesthesia l Coma & Death

6. Classes Of Sedatives- Hypnotics u Benzodiazepines u Barbituates

7. Benzodiazepines - Anxiolytics u Alprazolam (Xanax) u Chlorazepate (Tranxene) u Diazepam (Valium) u Lorazepam (Ativan)

8. Anxiolytics cont…... u Oxazepam (Serax) u Prazepam (Centrax) u Chlordiazepoxide (Librium)

9. Benzodiazepines - The Sleepers u Triazolam (Halcion) u Temazepam (Restoril) u Flurazepam (Dalmane) u Quazepam (Doral) u Estazolam (ProSom)

10. Benzodiazepines u Production of amnesia Midazolam (Versed) u ETOH withdrawal - DT control Chlordiazepoxide (Librium)

11. Barbituates - Sedatives u Amobarbital (Amytal) u Aprobarbital (Alurate) u Butabarbital (Butisol)

12. Barbituates - Anesthesia u Thiopental (Pentothal)

13. Barbituates - Sleepers u Pentobarbital (Nembutal) u Secobarbital (Seconal)

14. Barbituates - Anti-Seizure u Phenobarbital (Luminal)

15. Benzodiazepines & Barbituates Mechanism of Action l Potentiates the effects of GABA l Causes synaptic inhibition by membrane hyperpolarization

16. Clinical Considerations u Schedule the rehabilitation sessions when the drug is at its highest blood levels if sedation is required for an effective physical therapy treatment.

17. Clinical Considerations u Scheduling the patient for physical therapy before sedation is achieved may be important when the patient’s safety during gait or other high level activities requiring good posture, coordination or balance is a rehabilitation consideration.

18. Clinical Considerations u Aging reduces the liver’s ability to metabolize drugs and places the geriatric population at risk for drug toxicity secondary to compromised biotransformation.

19. Clinical Considerations u In elderly patients, diseases like heart failure and CHF may negatively effect liver function because of low hepatic blood flow (hepatomegaly) making drug toxicity a major physician concern.

20. Clinical Considerations u Fatigue u Drowsiness u Unable To Attend To Task u Respiratory Depression u Confusion & Unsafe Behaviors

21. Clinical Considerations u Patients have to be weaned slowly off of the benzodiazepines and the barbituates

22. Clinical Considerations u Withdrawal symptoms include : Insomnia, delirium, hallucination, anxiety, restlessness, tremors, seizures, nausea, vomiting, muscle twitching, headache, hypotension