Transcript Depressants
Classes/Types of Depressants
1. Anesthetics
(ex. ether, nitrous oxide)
2.
Barbiturates
3. Benzodiazepines (anxiolytics - ex. ? )
4. Buspar
Many
labels have been used to describe
them, which can be confusing:
-tranquilizers
-anti-anxiety pills
-sleeping pills
-sedatives
Depressants
Mechanism
of action:
• GABA: acts mainly on inhibitory receptors
– taking off the brakes
– e.g. GHB (gamma hydroxy butyrate)
• Separate receptors identified for
barbiturates and benzos
History / Development
of Depressants
Nitrous oxide (1776)
(laughing gas)
• development of ether
(MGH-etherdome)
• flammable liquid which vaporizes at room
temperature
Chloral hydrate, bromides, paraldehyde
Barbiturates came next in 1860s
• developed in Germany
• drug names end with ‘-al’ (phenobarbital)
• On street, named for color of pills
– “blues”, “reds”
Barbiturates
USES:
• some used as anesthetics if they work
quickly and then wear off
• others used to prevent seizures because
their sedating effects lasted longer
• often used as sleeping pills and anxiolytics
Barbiturate Use 2002-2003
Total
12-17 18-25 26+
2002
1.4%
.1%
.4%
1.8%
2003
1.4%
.2%
.3%
1.7%
For example, Nembutal®, Pentobarbital, Seconal®,
Secobarbital, or Butalbital.
Source: SAMHSA, Office of Applied Studies, National
Survey on Drug Use and Health, 2002 and 2003.
BARBITURATE USE declined due to
their unwanted effects:
-drunken euphoria and loss of behavioral and
emotional control
- respiratory depression
- tolerance and addiction develop rapidly
- lethal dose is low and nearer to drug’s ED
compared with other drugs, so potential for
overdose is high
withdrawal SX similar to alcohol:
– rebound insomnia
– rebound in REM sleep > vivid dreams/nightmares
Quaaludes (Methaqualone)
came next in the 50s and 60s and were
developed as alternatives to barbs for
sleep/anxiety disorders
they became a street drug; not much
different than barbiturates
now a schedule I drug
no longer produced for medical reasons
Depressants (con’t)
Benzodiazepines
• classic anti-anxiety drugs
• synthesized mainly in 1950s
• more potent in 1960s with the advent of
Valium
• similar to barbs but less dangerous in that:
– tolerance develops more slowly, and to primarily
the sedative not anxiolytic effects
– need higher doses for tolerance to occur
Benzodiazepine Use 20032004
Total
12-17 18-25 26+
2003
.18%
.14%
30%
.22%
2004
.20%
14%
29%
.25%
Includes Klonopin® or clonazepam, Xanax®, alprazolam, Ativan®, or lorazepam,
Valium® or diazepam, Librium®, Limbitrol®, Rohypnol®, Serax®, and
Tranxene®.
Depressants
Benzodiazepines
• Withdrawal symptoms: increased anxiety,
insomnia, tremors, sweating
• Dangers: cross tolerance and potentiation
what are the clinical implications of treating
anxiety with drugs?
difficult to estimate non-medical misuse or
abuse of sedatives and tranquilizers
NHSDA 2001: (9.6, 2.0, .7%)
The case of Rohypnol
(flunitrazepam)
a.k.a.
roofies, rib, circles, wolfies, rope,
ropies, ruffies, roach-2, “roaches” after
drug company Hoffman-La Roche
• a Benzodiazepine used in the short-term
treatment of insomnia and as a preanesthetic medication
• similar to valium in effect but 10 times
stronger
• effects begin within 30 minutes, may last for
8 hours or more
Rohypnol
made in Europe and Latin America and sold
by prescription there, not in U.S. so it is
usually smuggled via mail into country, or
comes across Mexican border
distribution
and abuse especially in
southwest & south (Texas & Florida most)
low cost < $5 per tab
popularity among young people; “Said to be
south Florida’s fastest growing drug problem”
Rohypnol
2
COMMON MISPERCEPTIONS:
• the drug is safe and “pure” because it
comes in pre-sealed bubble packages
• can’t be detected through urinalysis
Adverse Effects of Rohypnol
memory impairment, drowsiness, dizziness,
confusion; can induce excitability or
aggressiveness in some users
can cause dependence: tolerance may develop;
withdrawal symptoms include - headaches,
anxiety, muscle pain, confusion, restlessness,
numbness, tingling of extremities, convulsions
and cardiac problems
Rohypnol
used
in date rape situations….WHY?
• it’s odorless, (initially) colorless, tasteless and
produces drunkenness, stupor, and blackout
• Federal law, since 1996, dictates a 20-year
sentence for use of this drug in connection with
sexual assault or other violence
used
to augment an alcohol high without
elevating BAL
used as a “parachute” or remedy for depression
that follows a stimulant high
Inhalants
USES:
varied as products “huffed”
include gasoline, glues, solvents, paint..
Mostly young kids, adolescents
highly destructive to brain with OD
potential
NHSDA data:
• 2001: 8.1%, 0.9%, 0.2%