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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