Sedatives & Hypnotics

Sedatives

The perfect sedative reduces anxiety with little or no effect on motor or mental function within the therapeutic dosing range.

Hypnotics

The ideal hypnotic drug should produce drowsiness and encourage the onset of normal sleep.

Hypnotics cause a more rponounced depression of the central nervous system than do the sedatives.

Sedatives and Hypnotics

It is, however, a characteristic of these drugs as a group to depress central nervous system function in a dose dependent fashion.

Sedatives and Hypnotics

These drugs, as a function of dose, will produce :

SleepSedationRelief Of AnxietyAnesthesiaComa & Death

Classes Of Sedatives-Hypnotics

Benzodiazepines Barbituates

Benzodiazepines - Anxiolytics

Alprazolam (Xanax) Chlorazepate (Tranxene) Diazepam (Valium) Lorazepam (Ativan)

Anxiolytics cont…...

Oxazepam (Serax) Prazepam (Centrax) Chlordiazepoxide (Librium)

Benzodiazepines - The Sleepers

Triazolam (Halcion) Temazepam (Restoril) Flurazepam (Dalmane) Quazepam (Doral) Estazolam (ProSom)

Benzodiazepines

Production of amnesia• Midazolam (Versed)

ETOH withdrawal - DT control• Chlordiazepoxide (Librium)

Barbituates - Sedatives

Amobarbital (Amytal) Aprobarbital (Alurate) Butabarbital (Butisol)

Barbituates - Anesthesia

Thiopental (Pentothal)

Barbituates - Sleepers

Pentobarbital (Nembutal) Secobarbital (Seconal)

Barbituates - Anti-Seizure

Phenobarbital (Luminal)

Benzodiazepines & Barbituates

Mechanism of Action

Potentiates the effects of GABACauses synaptic inhibition by

membrane hyperpolarization

Clinical Considerations

Schedule the rehabilitation sessions when the drug is at its highest blood levels if sedation is required for an effective physical therapy treatment.

Clinical Considerations

Scheduling the patient for physical therapy before sedation is achieved may be important when the patient’s safety during gait or other high level activities requiring good posture, coordination or balance is a rehabilitation consideration.

Clinical Considerations

Aging reduces the liver’s ability to metabolize drugs and places the geriatric population at risk for drug toxicity secondary to compromised biotransformation.

Clinical Considerations

In elderly patients, diseases like heart failure and CHF may negatively effect liver function because of low hepatic blood flow (hepatomegaly) making drug toxicity a major physician concern.

Clinical Considerations

Fatigue Drowsiness Unable To Attend To Task Respiratory Depression Confusion & Unsafe Behaviors

Clinical Considerations

Patients have to be weaned slowly off of the benzodiazepines and the barbituates

Clinical Considerations

Withdrawal symptoms include :

Insomnia, delirium, hallucination, anxiety, restlessness, tremors, seizures, nausea, vomiting, muscle twitching, headache, hypotension