• 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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