Chapter 6 CNS Depressants:

1. Chapter 6CNS Depressants: Sedatives – Hypnotics

2. Why are cns depressants problematic? • 1) CNS depressants are usually not obtained illicitly and self-administered but rather are prescribed under the direction of a physician. • 2) CNS depressants if not monitored correctly could be potentially dangerous and harmful; most problems stem from inadequate professional supervision and chronic use. • 3) Several drug groups have the ability to cause CNS depression and the major reason of death and drug overdose (Hansen, Venturelli, Fleckenstein, 2012).

3. Effects of CNS Depressants CNS depressants are a diverse group of drugs that share an ability to reduce CNS activity and diminishes the brain’s levels of awareness. Depressant drugs include: • Antihistamines: drugs that often cause CNS depression, used to treat allergies, and are often found over-the-counter drugs. • Sedatives- to relieve anxiety, fear, and apprehension. • Anxiolytic- drugs that relieves anxiety. • Hypnotics- used to induce drowsiness and encourage sleep. • Amnesic- causing the loss of memory. • Anesthesia- a state characterized by loss of sensation or consciousness (Hansen, Venturelli, Fleckstein, 2012).

4. Dose-Dependent effects of cns depressants (Hansen, Venturelli, Fleckenstein, 2012)

5. Types of cns Depressants Benzodiazepines: prescribed for anxiety and sleep. They were originally referred as minor tranquilizers but over time this terminology conflicted with the pharmacological properties similar to the antipsychotic drugs which were major tranquilizers when they were very different. Examples of benzodiazepines include: • Alprazolam (Xanax) • Chlordiazepoxide (Librium) • Clonazepam (Klonopin)

6. Types of cns depressants continued: • Diazepam (Valium) • Estazolam(ProSom) • Lorazepam (Ativan) • Midazolam (Versed) • Oxazepam (Serax) • Quazepam (Doral) • Temazepam (Restoril) • Triazolam (Halcion) • Zolpidem (Ambien; not a true benzodiazepine

7. Side effects of Benzodiazepines Reported side effects include drowsiness, lightheadedness, lethargy, impairment of mental and physical activities, skin rashes, nausea, diminished libido, irregularities in menstrual cycle, blood cell abnormalities, and increased sensitivity to alcohol and other CNS depressants (Charney, 2006). Benzodiazepines, are also known to be a short acting drug and are used as hypnotics to treat insomnia which allows patients to wake in the morning with few after effects. They are also popular and affordable to get by prescription only (Hansen, Venturelli, Fleckenstein, 2012).

8. other types of cns depressants Another type of CNS depressant is Barbiturates, a barbituric acid component that is used in medicine as sedatives and hypnotics. Examples of some known barbiturates that are used is as follows: • Allobarbital • Amobarbital • Barbital • Pentobarbital • Phenobarbital • Secobarbital

9. Types of Depressants Continued Barbiturates can become uncontrollable because of their addictive agents to one’s body. It has been known to be replaced by Benzodiazepine’s which is safer to use and less abuse liability. Uncontrolled use of Barbiturates can cause a state of acute or chronic intoxication. Moreover, people that use Barbiturates can have some loss of inhibition, euphoria, and behavioral stimulation.

10. Causes and effects of barbiturates • Depressed activity of nerves and skeletal, smooth, and cardiac muscles and affect CNS in several ways, from mild sedation to coma. • At sedative or hypnotic dosage levels can be the only level that the CNS is significantly affected. • Higher anesthetic doses can increase high blood pressure, heart rate and flow of urine. Can also affect liver at a level that can damage it.

11. Causes and effects of barbiturates continued • Low doses relieve tension and anxiety, effects that give several Barbiturates substantial abuse potential. • Drawbacks of Barbiturates are extensive and severe, for example; 1) They lack selectivity and safety 2) They have substantial tendency to create tolerance, dependence, withdrawal, and abuse 3) They cause problems with drug interaction (Hansen,Venturelli,Fleckenstein,2012)

12. Treatment and information on withdrawal of cns depressants Withdrawal from any drug or alcohol is by far a very hard and difficult situation to obdure. Many signs and symptoms are different in many people because of the distribution of the drug and it’s components. Withdrawal symptoms may include anxiety, tremors, nightmares, insomnia, anorexia, vomiting, seizures, delirium, and maniacal activity (Hansen, Venturelli, Fleckenstein, 2012). As a counselor, we face many people with many difficulties. We trigger the problems by helping clients confront their problems and find solutions that are concrete for them to live healthy lives.

13. Treatment of cns depressants continued In either case, patients addicted to barbiturates and benzodiazaphines should not stop taking them on their own because of the high-risk withdrawal state. Client’s rather should be seen by a professional, whether it’s a family doctor, psychologist, psychiatrist or any counselor that is experienced with drug and alcohol addictions. In most cases addmitted to a rehab facility that can monitor the dependence and give the help needed for recovery.

14. Treatment of cns depressants continued It is important to remember the elimination of physical dependence is not a cure. If an individual is abusing a CNS depressant because of emotional instability, personal problems, or a very stressful environment, eliminating physical dependence alone will not solve the problem and drug dependence is likely to reoccur. Without psychological support at this stage, the detoxification will only be temporary and therapy will fail (Hansen, Venturelli, Fleckenstein, 2012).

15. References: 1)Textbook- Hansen, Venturelli, Fleckenstein, 2012. 2)You tube video-Sedative Hypnotics  3)You tube slide- "Benzodiazepines and How They Work” 4) You tube slide-"Benzodiazepine Withdrawal Symptoms“ 5) PowerPoint presentation-Chapter 6,CNS Depressants: Sedative-Hypnotics 6) AnotherPowerPoint Presentation on CNS Depressants 7) http://psychology.about.com/od/bindex/f/barbiturates.htm 8) http://www.nimh.nih.gov/index.shtml 9)http://www.addictionrecov.org/Addictions/index.aspx?AID=3 10) http://www.drugs.com/enc/barbiturate-intoxication-and-overdose.html 11) Websites on Anxiety Disorders Association of America,The Anxiety Network International and "Freedom from Fear"