Depressants

Rapid development of tolerance and dependence
Commonly used with alcohol
Commonly types used:
- Sedative-hypnotics
  - Barbiturates
  - Benzodiazepines
  - Barbiturate-like drugs
    - Depress CNS
    - Tolerance develops to drug’s effects but not brainstem-depressant effects
- Opioids
  - Misuse of illegal street drugs and prescription opioids
    - Cause sedation and analgesia
    - Frequently abused
Toxicity
- Unintentional overdose occurs frequently
- Death can occur from CNS and respiratory depression
- Care includes support of respiratory and cardiovascular function
- Sedative-Hypnotics toxicity
  - Benzodiazepine antagonist (flumazenil)
  - No antagonists for barbiturates or other sedative-hypnotics
  - Promote drug elimination
    - Dialysis – used to decrease the drug level and to prevent irreversible CNS effects and death
    - Gastric lavage with activated charcoal
- Opioids – reverse effect
  - Naloxone (opioid antagonist)
    - Reverses respiratory depression and coma
    - Monitor closely
    - May need repeated doses
Withdrawal
- Sedative-Hypnotics
  - May be life threatening
  - Manifestations mimic alcohol withdrawal
    - Delirium, seizures, respiratory and cardiac arrest within 24 hours of last dose
- Opioids
  - Symptoms depend on opioid used, route of administration, duration of use
  - Uncomfortable but not life threatening
  - Can occur within hours after last dose
  - Treatment often requires medications

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