1 sedative-hypnotics benzodiazepines megan trimble doctor of pharmacy candidate april 2006
TRANSCRIPT
11
Sedative-HypnoticsSedative-Hypnotics
BenzodiazepinesBenzodiazepinesMegan TrimbleMegan Trimble
Doctor of Pharmacy CandidateDoctor of Pharmacy Candidate
April 2006April 2006
22
What areWhat are Sedative-HypnoticsSedative-Hypnotics??
Tranquilizers may be a more familiar term Tranquilizers may be a more familiar term used to describe sedative-hypnotic agents used to describe sedative-hypnotic agents (1)(1)– ““Downer drugs” Downer drugs”
Drugs that take the edge offDrugs that take the edge off
– Calm your mood when you are feeling Calm your mood when you are feeling anxious anxious
– Induce sleep (1)Induce sleep (1)
33
BenzodiazepinesBenzodiazepines
Most frequent class of Most frequent class of
drugs that have a drugs that have a
tranquilizing-type effecttranquilizing-type effect
Prescription drugs (1)Prescription drugs (1)
http://www.drugfree.org/Portal/Drug_Guide/Prescription%20Sedatives%20Tranquilizers (2)
44
Taking the DrugsTaking the Drugs
This class of drugs is fairly safe when This class of drugs is fairly safe when taken for their intended use and not used taken for their intended use and not used in excess (1)in excess (1)
Most sedatives come in capsules or Most sedatives come in capsules or tabletstablets– Multi-coloredMulti-colored
Liquid and injection forms are also Liquid and injection forms are also available (2)available (2)
55
Taking the DrugsTaking the Drugs
The use of benzodiazepines can lead to The use of benzodiazepines can lead to abuse, whether they are taken properly or abuse, whether they are taken properly or for the wrong reasonsfor the wrong reasons
http://www.drugfree.org/Portal/DrugIssue/Features/Prescription_Medicine_Misuse Accessed May 2, 2006.
66
Prescription BenzodiazepinesPrescription Benzodiazepines
Chlordiazepoxide (Librium)Chlordiazepoxide (Librium)Diazepam (Valium)Diazepam (Valium)Temazepam (Restoril)Temazepam (Restoril)Triazolam (Halcion)Triazolam (Halcion)Clonazepam (Klonopin)Clonazepam (Klonopin)Lorazepam (Ativan)Lorazepam (Ativan)Alprazolam (Xanax) (1,3)Alprazolam (Xanax) (1,3)
77
Why Do People Use Why Do People Use Benzodiazepines?Benzodiazepines?
Reduce anxiety levels Reduce anxiety levels – Helps people to cope with stress (1)Helps people to cope with stress (1)
Trouble sleepingTrouble sleeping
In combination with amphetamine-like In combination with amphetamine-like drugsdrugs– Many people use sedatives to calm Many people use sedatives to calm
themselves back down from the rush themselves back down from the rush associated with amphetamine useassociated with amphetamine use
88
Why Do People Use Why Do People Use Benzodiazepines?Benzodiazepines?
To get away fromTo get away from
this!this!
http://images.google.com/imgres?imgurl=http://www.long-island-hypnotherapy.com/images/anxiety Accessed May 2, 2006.
99
Short-Term EffectsShort-Term Effects(Low Doses)(Low Doses)
Euphoria Euphoria – ““Being in a happy world”Being in a happy world”
Fatigue Fatigue – Feeling drowsyFeeling drowsy
Shallow breathingShallow breathing– Not being able to take full, deep, normal Not being able to take full, deep, normal
breaths (2)breaths (2)
Trouble coordinating your movementsTrouble coordinating your movements
1010
Short-Term EffectsShort-Term Effects(High Doses)(High Doses)
Paranoia Paranoia – Having an unrealistic perception of Having an unrealistic perception of
something, someone, or some place in something, someone, or some place in relationship to the world and yourelationship to the world and you
AggressionAggression
Easily agitatedEasily agitated
Difficulty remembering Difficulty remembering
Irritability (2)Irritability (2)
1111
Effects in OverdoseEffects in Overdose
UnconsciousnessUnconsciousness
Respiratory depressionRespiratory depression
Collapse of heart and heart functionsCollapse of heart and heart functions
Walking difficultyWalking difficulty
CNS depressionCNS depression
Shallow breathingShallow breathing– Not being able to take full, deep, normal Not being able to take full, deep, normal
breaths (1,2)breaths (1,2)
1212
Long-term EffectsLong-term Effects
““Rebound effects”Rebound effects”– Over use of these drugs can cause a reversal effectOver use of these drugs can cause a reversal effect– Seizures can occur; calm and relaxed feelings dissipateSeizures can occur; calm and relaxed feelings dissipate
Tolerance develops, resulting in dependenceTolerance develops, resulting in dependence– Must have more and more of the drug to feel an even minor Must have more and more of the drug to feel an even minor
effectseffects– Higher risk of overdoseHigher risk of overdose
WithdrawalWithdrawal– This leads to dependence as well This leads to dependence as well – No one wants to feel the unpleasant withdrawal effects, so No one wants to feel the unpleasant withdrawal effects, so
continues use (2)continues use (2)
1313
Cognitive EffectsCognitive Effects
Memory impairment/AmnesiaMemory impairment/Amnesia
ConfusionConfusion
Sleepiness (1)Sleepiness (1)
http://images.google.com/images?svnum=10&hl=en&lr=&q=sleeping+cartoon Accessed May 2, 2006.
http://images.google.com/images?svnum=10&hl=en&lr=&q=cognitive Accessed May 2, 2006.
1414
Psychological EffectsPsychological Effects
RelaxationRelaxation– Helps with the daily stresses of life/relieves tensionHelps with the daily stresses of life/relieves tension– Anxiety from school and peer stressesAnxiety from school and peer stresses
DrowsyDrowsy– Easier to sleep/induces sleep (1,2)Easier to sleep/induces sleep (1,2)
Distracts you from other problems going on Distracts you from other problems going on around you and in your own lifearound you and in your own life– Just a temporary fix; the problem never goes awayJust a temporary fix; the problem never goes away
1515
Benzodiazepine PharmacologyBenzodiazepine Pharmacology
CNS Depressant (1)CNS Depressant (1)– The major action of the benzodiazepine drug The major action of the benzodiazepine drug
class is focused in the brainclass is focused in the brain– Can cross the blood brain barrier (BBB)Can cross the blood brain barrier (BBB)
Easy access to the brain where the drugs exert Easy access to the brain where the drugs exert their effecttheir effect
Affects other body systems as wellAffects other body systems as well– HeartHeart
Acts on different sites (receptors) of the heart (1)Acts on different sites (receptors) of the heart (1)
1616
Benzodiazepine PharmacologyBenzodiazepine Pharmacology
Benzodiazepines act Benzodiazepines act
on the GABA system inon the GABA system in
the brainthe brain– Increase function (1)Increase function (1)
http://www.stayinginshape.com/3chsbuffalo/libv/m02.shtml Accessed May 2, 2006.
1717
Duration of BenzodiazepinesDuration of Benzodiazepines
These prescription drugs are long acting These prescription drugs are long acting
Even after the effects wear off, the drug is Even after the effects wear off, the drug is still in your system for a long period of timestill in your system for a long period of time– Hours Hours – DaysDays– Weeks Weeks
During this lengthy period of time, these drugs will During this lengthy period of time, these drugs will show up in blood tests and drug screens (1, 2)show up in blood tests and drug screens (1, 2)
1818
Danger: CautionDanger: Caution
It is extremely dangerous to use these It is extremely dangerous to use these drugs in combination with alcoholdrugs in combination with alcohol– Since these drugs stay in your Since these drugs stay in your
body for a long period of time, drinking body for a long period of time, drinking
can effect your body even when you can effect your body even when you
are not feeling the effects of the sedativeare not feeling the effects of the sedative
type drug.type drug.Slowed breathing/decrease lung functionSlowed breathing/decrease lung function
Decrease heart rate (1,2)Decrease heart rate (1,2)http://images.google.com/images?q=alcohol&hl=en Accessed May 2, 2006.
1919
Caution: OverdosingCaution: Overdosing
Due to the tolerance that develops with Due to the tolerance that develops with benzodiazepines and the lengthy duration benzodiazepines and the lengthy duration in the body, overdosing can have an “all of in the body, overdosing can have an “all of a sudden” effecta sudden” effect– Overdose symptoms may not be felt until 12-Overdose symptoms may not be felt until 12-
36 hours after overdose has already occurred 36 hours after overdose has already occurred (1,2)(1,2)
http://images.google.com/images?svnum=10&hl=en&lr=&q=overdosing Accessed May 2, 2006.
2020
Withdrawal SymptomsWithdrawal Symptoms
Tachycardia – increase in heart rateTachycardia – increase in heart rate
Severe headachesSevere headaches
Panic attacks can occurPanic attacks can occur
TremorsTremors
Changes in perception – not fully in tune with, or Changes in perception – not fully in tune with, or aware of, everything going on around youaware of, everything going on around you
Weight lossWeight loss
ParasthesiasParasthesias– Pins and needles/tingling feeling (1)Pins and needles/tingling feeling (1)
2121
SummarySummary
Benzodiazepines is a class of drugs that have an effect Benzodiazepines is a class of drugs that have an effect on the brain that, in turn, induces sleep and causes on the brain that, in turn, induces sleep and causes feelings of relief, relaxation and a state of euphoria.feelings of relief, relaxation and a state of euphoria.Benzodiazepines should only be taken as prescribed by Benzodiazepines should only be taken as prescribed by your physician. Although this class of drugs is one of the your physician. Although this class of drugs is one of the safest classes of prescription drugs, consuming these safest classes of prescription drugs, consuming these drugs should not be taken lightly. If anything, greater drugs should not be taken lightly. If anything, greater caution should be taken.caution should be taken.Although the initial and intended feelings from use are Although the initial and intended feelings from use are almost always addicting. Continuing and exceeding use almost always addicting. Continuing and exceeding use for this reason can only lead to trouble. Respiratory, for this reason can only lead to trouble. Respiratory, heart and psychological problems can occur, as well as heart and psychological problems can occur, as well as withdrawal, overdosing and even death.withdrawal, overdosing and even death.
2222
ReferencesReferences
(1) Goldfrank’s Toxicologic Emergencies. 7th ed. c2002. The McGraw-Hill (1) Goldfrank’s Toxicologic Emergencies. 7th ed. c2002. The McGraw-Hill Companies, Inc. “Chapter 63 Sedative-Hypnotic Agents” April 10th 2006 Companies, Inc. “Chapter 63 Sedative-Hypnotic Agents” April 10th 2006 [Date accessed]. Available from STAT!Ref [database on the Internet][Date accessed]. Available from STAT!Ref [database on the Internet]
(2) “Prescription Sedatives and Tranquilizers.” [about 2 screens] (2) “Prescription Sedatives and Tranquilizers.” [about 2 screens] The The Partnership for a Drug-Free AmericaPartnership for a Drug-Free America. [Internet Website] c2006. Partnership . [Internet Website] c2006. Partnership for a Drug-Free America. [in association with] 10 April 2006 [date accessed] for a Drug-Free America. [in association with] 10 April 2006 [date accessed] <http://www.drugfree.org/Portal/Drug_Guide/Prescription%20Sedatives<http://www.drugfree.org/Portal/Drug_Guide/Prescription%20Sedatives%20Tranquilizers>%20Tranquilizers>
(3) Drug facts and comparisons. St. Louis: Facts and Comparisons, c2005 (3) Drug facts and comparisons. St. Louis: Facts and Comparisons, c2005 [cited 2006 May 1]. Diazepam; [about 7 screens]. Available from: Facts & [cited 2006 May 1]. Diazepam; [about 7 screens]. Available from: Facts & Comparisons 4.0 [proprietary database on in Internet].Comparisons 4.0 [proprietary database on in Internet].