Depressants

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