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Sedative-HypnoticsSedative-Hypnotics

BenzodiazepinesBenzodiazepinesMegan TrimbleMegan Trimble

Doctor of Pharmacy CandidateDoctor of Pharmacy Candidate

April 2006April 2006

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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)

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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)

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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)

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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.

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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)

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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

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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.

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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

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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)

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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)

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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)

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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.

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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

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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)

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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.

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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)

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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.

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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.

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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)

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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.

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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].