Anxiolytics And Sedatives (Hypnotics)

(Hypnotics)

Anxiolytics and sedatives include benzodiazepines, barbiturates and related drugs. High doses can cause dizziness and respiratory depression that needs to be treated with intubation and mechanical ventilation. After chronic intake withdrawal symptoms with agitation and seizures (h i. E. With pentobarbital and phenobarbital) may occur, so that a withdrawal should be done by a slow tapering with or without substitution.

The therapeutic use of anxiolytics and sedatives is well established, but its importance in alleviating stress and anxiety is probably the reason that they are so often abused. Among the most commonly abused anxiolytics and sedatives include benzodiazepines, barbiturates and sleeping pills.

Anxiolytics and sedatives include benzodiazepines, barbiturates and related drugs. High doses can cause dizziness and respiratory depression that needs to be treated with intubation and mechanical ventilation. After chronic intake withdrawal symptoms with agitation and seizures (h i. E. With pentobarbital and phenobarbital) may occur, so that a withdrawal should be done by a slow tapering with or without substitution. The therapeutic use of anxiolytics and sedatives is well established, but its importance in alleviating stress and anxiety is probably the reason that they are so often abused. Among the most commonly abused anxiolytics and sedatives include benzodiazepines, barbiturates and sleeping pills. Pathophysiology benzodiazepines and barbiturates potentiate gamma-aminobutyric acid (GABA) to specific receptors located in the vicinity of GABA receptors. The exact mechanism of this amplification process remains unclear but may be related to the opening of chloride channels, whereby a hyperpolarized state is caused inside the postsynaptic neuron that inhibits the cellular excitation. Chronic effects in patients taking sedatives often in high doses, suffer thinking, memory and attention deficits, lack of judgment and emotional lability; they speak slowly and difficult to understand (low dysarthria). In susceptible patients, a psychological dependence on the substance can develop rapidly. The extent of physical dependence depends on the dose and duration of use. So the months-long administration of pentobarbital has (n. D. Übers .: not available in Germany) do not result in a dose of 200 mg / day to a significant tolerance. But a dose of 300 mg / day for more than 3 months or 500 to 600 mg daily for 1 month may cause a withdrawal syndrome when stopping the drug. Tolerance and tachyphylaxis develop irregular and incomplete; therefore, even when taken regularly persist significant behavioral disorders, mood and cognitive function of the dosage and the pharmacodynamic effects of the drug. There is some cross-tolerance between alcohol, barbiturates and non-barbiturathaltigen anxiolytics and sedatives, incl. The benzodiazepines. (Barbiturates and alcohol have in terms depending Development, withdrawal symptoms and chronic intoxication an amazing similarity.) Pregnancy Prolonged use of barbiturates during pregnancy can lead to withdrawal symptoms in the newborn of barbiturates. The perinatal administration of benzodiazepines may also be a neonatal abstinence syndrome or toxicity cause (z. B. apnea, hypothermia, hypotension). Symptoms and complaints toxicity or overdose The symptoms of a progressive intoxication with anxiolytics and sedatives are weakening superficial skin reflexes discrete lateral nystagmus, slight dizziness with grobschlägigem or rapid nystagmus, ataxia, slurred speech, and postural instability. An advanced intoxication leads to nystagmus in the middle position, somnolence, ataxia clear with a tendency to fall, confusion, deep sleep, small pupils, respiratory depression, and ultimately death. The overdose of a benzodiazepine rarely causes hypotension, and these drugs do not cause Arrhythmien.Entzug If the therapeutic administration of anxiolytics and sedatives below a critical level lowered, there arises a self-limiting withdrawal syndrome. Even after just a few weeks Absetzversuche can worsen insomnia and result in restlessness, nightmares, frequent awakenings and tension feelings in the early morning. The withdrawal from benzodiazepines is rarely life-threatening. Typical symptoms include tachypnea, tachycardia, tremors, hyperreflexia, confusion and seizures. Symptoms can use slower because the substances remain in the body for long. The withdrawal symptoms are particularly pronounced in taking fast resorbable substances and rapid drop of the serum level (eg., Alprazolam, lorazepam, triazolam). Many people who abuse benzodiazepines, or have been, are also heavy drinkers, and is used for delayed Benzodiazepinentzugssyndrom can lead to complications during alcohol withdrawal. A withdrawal from barbiturates that have been taken in high doses, caused a potentially life-threatening withdrawal syndrome, similar to the delirium tremens. Occasionally, after a properly conducted withdrawal over 1-2 weeks to an epileptic seizure itself. Without treatment, the removal of a short-acting barbiturate leading to these findings: Within the first 12 to 20 hours: increasing restlessness, tremors and weakness After Day 2: Further significant tremors, sometimes increased deep tendon reflexes and increased weakness 2nd – 3rd day: seizures (in 75% of patients ? 800 mg daily took to himself), sometimes boost to the status epilepticus and death. 2.-fifth Tag: delirium, insomnia, confusion, frightening visual and auditory hallucinations and often high fever and dehydration Diagnosis Clinical evaluation Diagnosis is clinically usually. The drug levels can for some drugs (eg. As phenobarbital) are measured, but usually hospital laboratories can measure not contain levels of most hypnotics and sedatives. Benzodiazepines and barbiturates are usually contain in routine immunoassay based qualitative urine drug investigation. However, as a rule, the discovery of drugs does not change in such screening tests in the clinical management; even if the results are positive – if patients really have not taken any drug for erectile dysfunction, other causes should be excluded. Treatment Supportive treatment Rarely flumazenil for benzodiazepines Sometimes urine alkalization and / or activated carbon for barbiturates toxicity or overdose Acute intoxication requires nothing more than observation in general, although the airway and breathing should be carefully examined. If ingestion within a day was the gag reflex is obtained, and the patient can protect the airway. 50 g of activated charcoal can be given to reduce further absorption, but this measure has shown no reduction in morbidity and mortality. Occasionally intubation and ventilation are necessary. The Bezodiazepin receptor antagonist flumazenil can reverse a severe sedation and respiratory depression following an overdose of Bezodiazepin. Dosage: 0.2 mg i.v. over 30 seconds; 0.3 mg can be given after 30 seconds, followed by 0.5 mg every minute up to a total weight of 3 mg. However, the clinical benefit has yet to be defined, since most people with a benzodiazepine overdose also recover without intervention. Possibly. but is necessary even without supportive treatment flumazenil to prevent cramps. Contraindications for flumazenil are long-term use of benzodiazepines (because flumazenil may speed up the withdrawal), underlying seizure disorders, convulsions and other motor disorders, simultaneous epileptogenic drug overdose (particularly antidepressants) and cardiac arrhythmias. Because many of these contraindications are usually in “street overdoses” unknown, flumazenil is best for patients with respiratory depression during a medical procedure (d. E. When the history is clearly known) are used. When a Pheobarbital overdose is diagnosed, the urine with sodium bicarbonate should be alkalized to increase the excretion. The administration of multiple dose activated carbon is also contemplated in the event of life-threatening amount of phenobarbital overdose. Urinary alkalization by adding 150 mmol of sodium bicarbonate diluted in 1 liter of D5W and infused at a rate of 1 to 1.5 liters per hour. pH of urine should be as close as possible to 8, to be an effective alkalizing aufrechtzuerhalten.Entzug and detoxification severe acute withdrawal requires hospitalization, preferably in an intensive care unit, as well as the use of suitable doses of i.v. Benzodiazepines. One approach to obtain the dependence of sedatives in the handle is a withdrawal of the drug according to a strict schedule, during the withdrawal symptoms to be monitored closely. Often it is better to switch to the drug slow-release medication which is better to reduce. As with the alcohol withdrawal require patients who have to go through a withdrawal of anxiolytics or sedatives, a close observation, preferably in a stationary environment when moderate are expected to severe withdrawal symptoms.

Health Life Media Team

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