Sedative-hypnotic drugs produce central nervous system depression and can induce sedation or hypnosis depending on dosage. There are several classes of sedative-hypnotic drugs including benzodiazepines, barbiturates, and others. These drugs are well absorbed from the gastrointestinal tract and distributed to the brain where they facilitate the inhibitory effects of the neurotransmitter GABA. Their effects range from sedation and anxiety relief to hypnosis, anesthesia, and even respiratory depression at high doses. Tolerance and dependence can develop with chronic use of sedative-hypnotic drugs.
Sedative-hypnotic drugs produce central nervous system depression and can induce sedation or hypnosis depending on dosage. There are several classes of sedative-hypnotic drugs including benzodiazepines, barbiturates, and others. These drugs are well absorbed from the gastrointestinal tract and distributed to the brain where they facilitate the inhibitory effects of the neurotransmitter GABA. Their effects range from sedation and anxiety relief to hypnosis, anesthesia, and even respiratory depression at high doses. Tolerance and dependence can develop with chronic use of sedative-hypnotic drugs.
Sedative-hypnotic drugs produce central nervous system depression and can induce sedation or hypnosis depending on dosage. There are several classes of sedative-hypnotic drugs including benzodiazepines, barbiturates, and others. These drugs are well absorbed from the gastrointestinal tract and distributed to the brain where they facilitate the inhibitory effects of the neurotransmitter GABA. Their effects range from sedation and anxiety relief to hypnosis, anesthesia, and even respiratory depression at high doses. Tolerance and dependence can develop with chronic use of sedative-hypnotic drugs.
The sedative-hypnotic produce dose dependent CNS depressant effect Sedation : Reduction of anxiety Hypnosis : Induction of sleep Subgroup : - Benzodiazepine (Chlordiazepoxide, diazepam, temazepam) - Barbiturat (Phenobarbital, pentobarbital, thiopental) - Others (buspirone, zolpidem, chloralhydrate, zaleplon) Sedative Hypnotic Drugs Benzodiazepine : - short acting (triazolam) - intermediate acting (estazolam, temazepam) - long acting (flurazepam, quazepam)
Sedative Hypnotic Drugs Barbiturates : - Ultra short acting - Short acting - Long acting Sedative Hypnotic Drugs (Pharmacokkinetics)
All sedative hypnotic are lipid soluble and absorbed well from GI tract Good distribution to the brain in oral administration Sedative Hypnotic Drugs (Metabolism and Excretion)
Metabolized mainly by hepatic enzymes Many benzodiazepine are converted to active metabolites Accumulation of active metabolites can lead to excessive sedation The barbiturates are extensively metabolized,except phenobarbital Sedative Hypnotic Drugs (Mechanisms of Action) BENZODIAZEPINES Receptors for benzodiazepines (BZ receptors) are present in the thalamus,limbic structures,and the cerbralcortex. Binding of Benzodiazepines facilitates the inhibitory actions of GABA,which are exerted through increased chloride ion conductance. GABA is the major inhibitoric neurotransmitter in the CNS Sedative Hypnotic Drugs (Mechanisms of Action) Barbiturates Barbiturates depress neuronalactivity in the midbrain reticular formation, facilitating and prolonging the inhibitory effects of GABA Other drugs Mechanism of anxiolytic effect of buspirone is unknown, but buspirone interact with the 5- HT as partial agonist Zolpidem & zaleplon interact with BZ1 bind selectively with GABAA receptor Sedative Hypnotic Drugs (Pharmacodynamics) The CNS effect depend on dose Effects : sedation & relief of anxiety, through hypnosis (facilitation of sleep) to anesthesia and coma When 2 or more drugs are given togetherdepressant effect +++ Sedation : sedative action with relief of anxiety Hypnosis : promote sleep onset and duration of the sleep state Sedative Hypnotic Drugs (Pharmacodynamics) Anesthesia : conscious with amnesia & supressions of reflexes (at highdose). Can produce by most barbiturates (eg,thiopental) & certain benzodiazepines (eg,midazolam) Anticonvulsant actions : supression of seizure activity (high dose),usually accompany by sedation effect. Selective anticonvulsant (supression of convulsion at dose that do not cause severe sedation is Phenobarbital, clonazepam Sedative Hypnotic Drugs (Pharmacodynamics) Muscle relaxation : relaxation of skeletal muscle (at high dose) Diazepam at sedative dose effective for spasticity states Selective muscle relaxant : Meprobomate Medullary depression : High dose can cause depression of medullarry neurons,leading to respiratory arrest, hypotension & CV collapse death Sedative Hypnotic Drugs (Pharmacodynamics) Tolerance& dependence : tolerance a decrease in responsiveness, occurs when used chronically or in high dose
physiologic dependence an altered state that leads to an abstinence syndrome (withdrawal state) when the drug is discontinued Sign : anxiety, tremors,hyperreflexia, seizure Sedative Hypnotic Drugs (Clinical Uses) Anxiety states (alprazolam, clonazepam, buspirone) The anxiolityc effect of buspirone occur without sedation or cognitive impairment Sleep disorder (estazolam,flurazepam, triazolam) Induction of anesthesia (thiopental, diazepam, midazolam) Management of seizure disorders (clonazepam,phenobarbital) Sedative Hypnotic Drugs (Clinical Uses) Management of withdrawal states in persons physiologically dependent on ethanol & sedative hypnotics (chlordiazepoxide, diazepam) Sedative Hypnotic Drugs (Toxicity) Cognitive impairment Decreased psychomotor skills Unwanted daytime sedation Anterograde amnesia Additive CNS depression when used with other drugs in the class (antihistamines,antipsychotic drugs, opioid analgesics, tricyclic antidepressants) Overdosage severe respiratory & CV depression Flumazenil may reverse CNS depressant effect of benzodiazepines, zolpidem & zaleplon