Transcript Central Nervous System Depressants

Central Nervous System
Depressants
Alcohol
Barbiturates
Benzodiazepines
Prescription Medications
CNS Depressants (prescription)
Valium
Librium
Ativan
Serax
Xanax
Tranzene
Klonopin
General Symptoms of Users
“Drunken” Behavior (lack of coordination,
slurred speech, staggering
Confusion
Faulty Judgment
Emotional Lability
Irritability
Drowsiness
Hostility
Paranoid ideas
Route of Administration
Orally – pill (capsule or tablet)
Or mixed with water and injected
Physical Dependence
Potential for moderate to high
dependence
Tolerance
Low to Moderate
Psychological Dependence
Moderate to High Potential
Withdrawal
Must be monitored closely due to
potential fatalities
Risk of seizures and delirium tremens
Prolonged symptoms can last for
months, resolve, then reappear.
Especially with Benzodiazepines
(Valium, Librium, Tranzene, and
Zanax).
Depressant Withdrawal – Stage I
Tremors (shakes) occur in the morning
after heavy use the night before
Peak intensity is about 24-36 hours after
last dose
“Jitters”, irritability, nausea, vomiting,
easily startled, facial flushing, rapid heart
rate
Loss of appetite insomnia, inattention,
mildly disoriented, poor recent memory,
sense of uneasiness.
CNS Depressant Withdrawal
Stage II
Hallucinations (disordered
perceptions) vary in intensity
misinterpreted shadows and
movements
Objects seeming distorted and unreal
May occur when the rest of the
sensorium is clear, and seem
intensely real.
CNS Depressant Withdrawal
Stage III
Seizures (grand mal)
Bursts of 2-6 full body seizures
90% occur 7-48 hours after the last
drink
One third of patients with seizures will
go on to develop delirium tremens
CNS Depressant Withdrawal
Stage IV
Delirium Tremens (Profound Confusion,
Delusions, Vivid Hallucinations, Tremor,
Agitation, Sleeplessness, Dilated Pupils,
Fever, Tachycardia, Profuse Perspiration
Usually occurs 3-5 Days after the last dose
Most cases mild, and end abruptly
Severe cases considered a medical
emergency, and carry a 15% fatality rate
Single episode lasts 72 hours or less in
80% of the cases
Pharmacological Effects
Alcohol (Ethanol):
Alcohol as a drug
Alcohol is a psychoactive drug that is a
CNS depressant
Alcohol is the second most widely used
and abuse of all psychoactive drugs
Q. What drug is the most widely used and
abused drug?
A. Caffeine
Methyl alcohol
poisonous
Isopropyl alcohol
poisonous
Four types
of
alcohol
Ethylene glycol
poisonous
Ethanol
drinking alcohol
Physical effects of alcohol
The body is affected by alcohol in two
ways:
Direct contact with mouth, esophagus,
stomach,
and intestine
Influence on almost every organ system in
the
body after entering the bloodstream
Physical Effects of Alcohol
Absorption is the process in which the
drug molecules reach the
bloodstream
The effects of alcohol on the human
body depend on the amount of
alcohol in the blood (BAC)
Physical effects of alcohol
BAC produced depends on the:
1. Presence of food in the stomach
2. Rate of alcohol consumption
3. Concentration of alcohol
4. Drinker’s body composition
Alcohol beverages have almost no
vitamins, mineral, protein, or fat - just
large amount of carbohydrates
Physical effects of alcohol
Alcohol can cause severe physical and
psychological dependence
1. Cross-tolerance
2. Behavioral tolerance compensation of motor
impairments by chronic alcohol
users through behavioral
pattern modification
Blood alcohol level
Almost 95% of the consumed alcohol is
inactivated by liver metabolism.
The liver metabolizes alcohol at a slow
and constant rate and is unaffected by the
amount ingested.
Thus, if on can of beer is consumed each
hour, the blood alcohol level (BAL) will
remain constant.
Blood alcohol level
Blood alcohol level (BAL) is the
concentration of alcohol
expressed as a percentage.
How alcohol is absorbed in the body
Short-term effects of alcohol
Low to moderate doses
Disinhibition
Social setting and mental state
Euphoric, friendly, talkative
Aggressive and hostile
Interfere with motor activity, reflexes, and
coordination
Short-term effects of alcohol
Moderate quantities
Slightly increases in heart rate
Slightly dilates blood vessels in arms, legs,
skin
Moderately lowers blood pressure
Stimulate appetite
Increases production of gastric secretions
Increases urine output
Short-term effects of alcohol
At higher doses
Difficulty in walking, talking, and thinking
Induces drowsiness and cause sleep
In large amounts - severe depression of the
brain systems and motor control area of the
brain
Large Doses of Alcohol
Uncoordination, confusion, &
disorientation
Stupor, anesthesia, coma, and even
death
Lethal level of alcohol is between 0.4
and 0.6% by volume in the blood
?
True of False
?
Drinking black coffee, taking a cold
shower, or breathing pure oxygen will
hasten the sobering up process
The type of alcohol beverage you drink
can influence the hangover that results
Taking an aspirin-caffeine combination
before drinking helps the sobering up
process and the chances of having a
hangover
Long-term effects of alcohol
Light or moderate drinking does little
permanent harm (exception - FAS)
Heavy drinking
Seriously damages the heart
Kidney and liver damage
Mental disorders, irreversible damage to the
brain and peripheral nervous system
Lowers resistance to pneumonia and other
infectious diseases
Irritates the gastrointestinal tract
Principal control centers of the brain
affected by alcohol
Alcohol and pregnancy
Women who are alcoholics or who
drink heavily during pregnancy have
a higher rate of spontaneous
abortion.
Infants born to drinking mothers
have a
high probability of being
afflicted
with fetal alcohol
syndrome.
Effects of alcohol on organ
systems and bodily functions
Brain and nervous system
Liver
hepatotoxic effect
alcoholic hepatitis
cirrhosis
Digestive system
Effects of alcohol on organ
systems and bodily functions
Blood
Cardiovascular system
alcoholic cardiomyopathy
Sexual organs
Endocrine system
Effects of alcohol on organ
systems and bodily functions
Kidneys
Mental disorder and damage to the
brain
Wernicke-korsakorr’s syndrome
The fetus (FAS)
Malnutrition
Barbiturates
Derivatives of barbituric acid
First synthesized in 1868
Used as anticonvulsants and sedative
hypnotics
High abuse liability
High lethal dose rate
Barbiturates
Used with other analgesic
combinations (aspirin, codeine) for
treatment of tension and migraine
headaches
Phenobarbital and belladonna
alkaloid combinations used to treat
peptic ulcers and irritable bowel
syndrome
Barbiturates - Medical Uses
Used as an anticonvulsant
Sedative Hypnotic
Detoxification medication for alcohol
withdrawal syndrome
Route of Administration
Oral (pill form)
Intravenous
Intramuscular (shot)
Barbiturates - Short Term Effects
Relieve anxiety and restlessness,
relax muscles, induce sleep
Reduce lung function (breathing),
heart action, speech, and movement
Long-Term Effects
Cardiovascular – bradycardia,
hypertension
Digestive System – nausea, vomiting,
constipation
Nervous System – agitation, confusion,
hyperkinesia, ataxia, CNS depression,
nightmares, nervousness, psychiatric
disturbance, hallucination, insomnia,
anxiety, dizziness, thinking abnormalities
Barbiturate – Long Term Effects
Reproductive System – cross the
placental barrier and cause fetal
abnormalities
Newborn withdrawal symptoms
Respiratory System – hypoventilation,
apnea
Other Reactions - headache,
injection site reactions, fever, liver
damage, megablastic anemia (with
long term use)
Tolerance
Develops quickly
Psychological tolerance develops
more quickly than physical
Increased amounts approach lethal
dosage
Metabolize faster in the liver as
dosage increases
Half Life
Psychoactive chemicals have age
dependent metabolism
Younger people tolerate a higher
dose than older (over 50).
Half life = length of time in hours
required for one half of the dose taken
to be excreted from the body.
Toxicity/Overdose
Cold, clammy skin
Weak, rapid, shallow breathing
Combined with ETOH –suppression of
respiratory center of brain
Dependence defined by amounts taken 810 times normal taken daily for 30 days
Death will occur if drowsiness, loss of
consciousness, depressed breathing, and
coma are left untreated.
Psychological Effects
Early - calming, tension reduction,
Middle – Euphoria, hypnotizing,
impaired judgment, sense of “no
worry”
Later – mood swings, depression,
irritability, obnoxious behavior,
manipulation, drug seeking
Withdrawal from Sedative
Hypnotics
Within 6-8 hours of last dose
Can be life threatening if breathing
and blood pressure problems
untreated
Nausea, vomiting, increased heart
rate, excessive sweating, abdominal
cramps, tremors
Withdrawal deaths more frequent
than overdose deaths.
References - Material from this module was
Developed from the following sources, which are
recommended reading for the
LADAC exam:
Basics Of Addiction Counseling: Desk
Reference And Study Guide National Association
for Addiction Professionals
www.naadac.org
National Institute of Drug Abuse
http://www.nida.nih.gov/
National Institute of Alcohol Abuse
and Alcoholism
http://www.niaaa.nih.gov/