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Nonbenzodiazepine Hypnosedatives

Nonbenzodiazepine Hypnosedatives. Tintinalli Chapter 165. Clinically used drugs Buspirone (Buspar) Zaleplon (Sonata) Zolpidem (Ambien) Others GHB Butanediol Chloral hydrate Uses Sleep, anxiety. Nonbenzo Hypnosedatives. Clinical CNS depression by functioning as neurotransmitter

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Nonbenzodiazepine Hypnosedatives

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  1. Nonbenzodiazepine Hypnosedatives Tintinalli Chapter 165

  2. Clinically used drugs Buspirone (Buspar) Zaleplon (Sonata) Zolpidem (Ambien) Others GHB Butanediol Chloral hydrate Uses Sleep, anxiety Nonbenzo Hypnosedatives

  3. Clinical CNS depression by functioning as neurotransmitter Absorption GI Peak 30 min Half life 30 min Clearance Liver Uses Anesthetic Xyrem is approved for cataplexy in narcolepsy. Illegal uses Rave parties Date rape GHB

  4. Symptoms overdose Labile level of consciousness Neuromuscular movements Vomiting, hypothermia Respiratory depression, apnea Effects are dose related Symptoms Euphoria Nystagmus, ataxia, dizzy Sedation Effects are dose related Toxicity

  5. Supportive Aspiration precautions Intubation No anesthetic agent needed – just paralyze! Nalaxone / Flumanazil ineffective (mostly) Overdose Treatment

  6. SANE exam Blood and urine samples if within 72 hours. Turn over to police Complete panel costs about $800. Record recreation drugs in patient chart Drug Facilitated Sexual Assault

  7. Dependence Can occur with high frequency dosing Withdrawal Life threatening Delirium, psychosis Withdrawal

  8. Buspirone Antianxiety Dose not affect GABA Less sedation, euphoria Wide safety margin Selected Drugs

  9. Oldest hypnosedative “Mickey” Useful in children in ER No respiratory suppression No circulatory compromise Narrow safety margin Minimal analgesic effect Pear like breath Chloral Hydrate

  10. High abuse potential Rapidly absorbed GI Clinical Vinyl breath Dyspnea, cough Nystagmus, lethargy Ethchlorvynol

  11. Insomnia Rapidly absorbed GI Renal excretion Symptoms No cognitive impairment Drowsiness Flumanazil effective to reduce CNS effects with Ambien Sonata and Ambien

  12. Questions?

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