AGENDA v Quiz Discussions v Chapter 6 depressants

AGENDA v Quiz Discussions v Chapter 6, depressants https: //www. youtube. com/watch? v=k. Tc. RRa. XV-fg 1

AJ-15 Riverside City College CNS Depressants Benzodiazepines Instructor Ed Ramirez Barbiturates Tranquilizers 2

Introduction Central Nervous System (CNS) depressants are some of the most widely used and abused drugs in the United States. They relieve stress and anxiety and induce sleep These effects appeal to many people that are struggling with emotional problems and looking for a break! 3

What other reasons? People think they are safe, after all they receive them from a DOCTOR Rest, relax, sleep, calmness Relieve Stress 4

The History of CNS Depressants Before the era of modern drugs, the most common depressant used to ease tension, cause relaxation, and help forget problems was alcohol. 5

CNS DEPRESSANTS Alcohol temporarily relieves anxiety and stress because of its central nervous system depressant effects. 6

CNS Depressants There are two main classifications, or groups, of CNS depressants: Barbiturates- give relief from anxiety, tension, sleeping difficulties, and seizures; they have been used to treat these conditions for over 100 years. Benzodiazepines, developed in the late 1950 s, are used in cases of anxiety, stress, muscle spasms, and to provide short-term relief for sleep disorders. 7

The History of CNS Depressants (continued) The first benzodiazepines were marketed as substitutes for barbiturates Relatively safe when used for short periods Long-term use can cause dependence and withdrawal problems Unfortunately, benzodiazepines have since been found to be less than ideal anti-anxiety drugs 8

The History of CNS Depressants (continued) Benzodiazepines were routinely prescribed for stress, anxiety, or apprehension • In 1973 100 million prescriptions were written for benzodiazepines • Twice as many women as men taking them • “Mother’s Little Helper” by the Rolling Stones As medical community became aware of the problem, use of depressants declined https: //www. youtube. com/watch? v=tf. GYSHy 1 j. Qs 9

DEPRESSANTS What are they? Depressants such as Xanax, Klonopin, Halcion and Librium are often referred to as “benzos” (short for benzodiazepines 1). Other depressants, such as Amytal, Numbutal and Seconal, are classed as barbiturates—drugs that are used as sedatives and sleeping pills. 10

Dose-dependent effects of CNS Depressants Death - Fatal The downward overdose continuum of arousal levels, as induced by Inadvertent depressants overdose Normal Coma General - anesthesia Anesthesia Coma For surgery Death - Increasing Dose of Hypnosis drug Sedation Low - To treat insomnia To treat anxiety Dose High 11

Seconal Sodium is used in the treatment of insomnia; sedation; light sedation and belongs to the drug class barbiturates. 12

Clonazepam Klonopin (clonazepam) is a benzodiazepine. Clonazepam affects chemicals in the brain that may be unbalanced. Clonazepam is also a seizure medicine, also called an anti-epileptic drug. 13

Why are CNS Depressants PROBLEMATIC? In contrast to most other substances of abuse, CNS depressants are usually not obtained illicitly and self-administered but rather are prescribed under the direction of a physician. What other reasons? 14

Problematic cont’d CNS depressants can cause very alarming and even dangerous behavior if not monitored, and Other drug groups cause CNS depression and if combined, bizarre and dangerous interactions can result 15

CNS Depressants What is it they do? Central nervous system depressants slow down the operation of the brain. They first affect those areas of the brain that control a person’s conscious, voluntary actions. As dosage increases, depressants begin to affect the parts of the brain controlling the body’s automatic, unconscious processes, such as heartbeat and respiration. 16

Attempts to find CNS Depressants other than alcohol 1800 s- The introduction of Bromides Very popular until the discovery of their toxicities. a dose of bromide taken usually as a sedative a drug that makes a person calm Page 186 17

History Cont’d Physicians began using bromide in the 1800 s to treat epilepsy in humans. Most doctors stopped using it when phenobarbital was invented because bromide caused psychological problems. Phenobarbital is a barbiturate and bromides were replaced by barbiturates in the 1900 s 18

The Effects of CNS Depressants CNS depressants reduce CNS activity and diminish the brain’s level of awareness • • • Depressant drugs include: Benzodiazepines Barbiturate-like drugs Alcohol Antihistamines Opioid narcotics like heroin 19

The Effects of CNS Depressants (continued) Depressants are usually classified according to the degree of their medical effects on the body. For example: § Sedatives cause mild depression and relaxation § Anxiolytic—drugs that relieve extreme Anxiolytic anxiety Many sedatives also have muscle-relaxing properties 20

Figure 06. 01: Dose-dependent effects of CNS depressants. The therapeutic outcome may change according to the dose administered. Page 187 Figure 6. 1

Depressants are also used to promote sleep and are frequently prescribed. Approximately 43 million sleeping pills were distributed in the United States in 2005. Pharmacists in the United States filled more than 56 million prescriptions for sleeping pills in 2008 at a cost of $4. 5 billion, a startling 70 percent increase from 2002. http: //www. drugfreeworld. org/drugfacts/prescription/abuseinternational-statistics. html 22

Hypnotics induce drowsiness and encourage sleep Amnesiac effects can cause the loss of memory 23

The Effects of CNS Depressants (continued) Hypnotics (from the Greek god of sleep, Hypnos) are CNS depressants that encourage sleep by inducting drowsiness. 24

The Effects of CNS Depressants (continued) The same drug can cause different effects based on dose • Low dose (sedatives—relieve anxiety and promote relaxation) • Higher doses (hypnotics—can cause drowsiness and promote sleep) • Even higher doses (anesthetics—can cause anesthesia and are used for patient management during surgery) 25

Types of CNS Depressants All CNS depressants are not “created equal” Some have wider margins of safety, others have a greater potential for non-medical abuse To treat epilepsy or acute seizure activity 26

Types of CNS Depressants Benzodiazepines: Valium-Type Drugs Prescribed for anxiety and sleep 4 of the 40 top-selling prescription drugs in the U. S. in 2003 were benzodiazepines Wide margin of safety (death from overdose is rare) Benzodiazepines were originally referred to as minor tranquilzers 27

Types of CNS Depressants (continued) The first true benzodiazepine, chlordiazepoxide (Librium), was developed for medical use and marketed about 1960 The very popular drug “Valium” came on the market about from about 1972 to 1978, Valium was the top-selling prescription drug in the United States. 28

Figure 06. UN 01: CNS depressants can be used as hypnotics to initiate sleep. © auremar/Shutter. Stock, Inc.

Figure 06. B 01: Prescription Drug Abuse: Too Much of a Good Thing

Benzodiazepines Valium-Type Drugs Because of dependence problems, the benzodiazepines are now classified as Schedule IV drugs. (see Appendix B) Cause psychological dependence 31

Benzodiazepines (Valium, Temazepam, Librium, Mogadon) are one of the most commonly prescribed drugs, for sleeping and anxiety problems. They come in a wide variety of different colored tablets and capsules of various shapes and sizes, bearing various trade names and markings. They are usually taken orally, but may be injected. 32

Half Way Benzodiazepines are used for an array of therapeutic objectives(“Relief of”) 1. Anxiety 2. Treatment of neurosis 3. Relaxation of muscles 4. Alleviation of lower back pain 5. Treatment of some convulsive disorders 6. Induction of sleep 7. Relief from withdrawal symptoms associated with narcotic and alcohol 8. Induction of amnesia (preoperative administration 33

Types of CNS Depressants (continued) Types of benzodiazepines About 14 benzodiazepine compounds available in the U. S. Distinguished primarily by their duration of action: short-acting (hypnotics), longacting (sedatives) 34

Side Effects Drowsiness, lightheadedness, lethargy, impairment of mental and physical activities, skin rashes, nausea, diminished libido, irregularities in the menstrual cycle, blood cell abnormalities and increased sensitivity to alcohol and other CNS depressants Page 180 35

Side Effects Cont’d REM Sleep Restful and satisfying Paradoxical effects- nightmares, irritability, sweating, restlessness A sleep cycle consists of five steps, which are in turn divided into two categories: REM sleep and non-REM sleep, or rapid eye movement sleep, occurs toward the end of each cycle and is typically the stage for our most lucid dreams. https: //www. google. com 36

Tolerance, dependence, withdrawal, and abuse As with most CNS depressants, if used frequently, can cause 1. Tolerance 2. Dependency, and 3. Withdrawal 37

Club Drug Rohypnol (sometimes called Rophie, Roche, or Forget Me) Rohypnol is outlawed in the U. S. Tablet can be dissolved in beverages without leaving an odor or taste Makes victims unable to recall details of the assault (Drug used at all-night raves, parties, dance clubs, and bars) flu·ni·traz·e·pam 38

Rohypnol is not approved for medical use or manufactured in the United States and is not available legally. However, it is legally prescribed in over 60 other countries and is widely available in Mexico, Colombia, and Europe where it is used for the treatment of insomnia and as a preanesthetic. 39

Club Drug cont’d Rohypnol is a tranquilizer about ten times more potent than Valium. The drug is available as a white or olive-green pill and is usually sold in the manufacturer’s bubble packaging. Users crush the pills and snort the powder, sprinkle it on marijuana and smoke it, dissolve it in a drink or inject it. Rohypnol has been used to commit sexual assaults because it renders the victim incapable of resisting 40

Barbiturates are barbituric acid derivatives that are used in medicine as sedatives and hypnotics. Barbituric acid was first synthesized by A. Bayer (of aspirin fame) in Germany in 1864 ****The reason that he chose the name barbituric acid is not known. However, there are two often told stories about how the compound got its name 41

Barbiturates A girl named Barbara Day of St. Barbara(Friday Dec 4 th is the Feast Day of St. Barbara, patron saint of artillerymen. ) 1 st barbiturate, barbital was used medically in 1903. Routinely used to treat anxiety, agitation, and insomnia 42

Barbiturates More history In 1864, the German chemist Adolf Von Baeyer combined a waste product in urine called urea and an apple extract called malonic acid to form a new chemical compound called barbituric acid 43

Barbiturates When taken in large doses or in combination with other CNS depressants, barbiturates may cause death from respiratory or cardiovascular depression. Because of this toxicity, barbiturates have been involved in many drug-related deaths, both accidental and suicidal. 44

Barbiturates Cont’d Consequently, the short acting barbiturates such as pentobarbital and secobarbital, are classified as Schedule II drugs, whereas the long acting barbiturates, such as phenobarbital, are less rigidly controlled as Schedule IV drugs. 45

Phenobarbital is a barbiturate. It works by depressing the central nervous system. This aids you in relaxing and going to sleep. 46

Phenobarbital They wore their 18 kilogram full-suit body armor, which Phillips had stitched together, as well as metal trauma plates to protect vital organs, and they took the barbiturate phenobarbital to calm their nerves 47

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North Hollywood film clip https: //www. youtube. com/watch? v=-E 4_w. DQFky 0 https: //www. youtube. com/watch? v=dtyx. Ci. Ppk. HQ #27 minutes 49

Weapons used by suspects The Weapons Larry Phillips and Emil Matasareanu had a large array of firearms, which included: • HK 91: Used by Phillips as he fired at officers on the left side of the bank, the rifle itself took a hit to the bolt guide rails, which caused little damage. • Type 56 (China) Assault Rifle: Used by Phillips after discarding the HK 91, as he started the escape. The rifle jammed. • AK 47 s: Both Phillips and Matasareanu used these rifles during the robbery. • Bushmaster AR 15: Matasareanu retrieved this rifle from the trunk of their getaway car after sustaining a leg wound. He then waited in the car for Phillips, while shooting through the windows. This was also the rifle used by Matasareanu as he was engaged in his last shootout with SWAT officers. • Beretta 92 9 mm pistol: Phillips committed suicide with this weapon after sustaining several gunshot wounds. 50

Mechanism of action and elimination The precise mechanism of action for barbiturates is unclear. Do not seem to act at a specific receptor site Enhance the activity of the inhibitory transmitter GABA 51

Other Types of CNS Depressants Drugs with barbiturate-like properties Chloral hydrate also known as “Knock out drops” In the late 1800 s when mixed with alcohol, they were given the name “Mickey Finn” on the Barbary Coast of San Francisco 52

“Slip em a Mickey” The full term is "a mickey finn". If someone "slips you a mickey" it means that they secretly slip a drug (usually a sedative) into your drink. In slang, a Mickey Finn — or simply a Mickey — is a drink laced with a psychoactive drug or incapacitating agent given to someone without their knowledge, with intent to incapacitate them 53

Nonbarbiturate drugs with Barbiturate like properties Methaqualone. Few drugs have become so popular so quickly Was first introduced in India in the 1950 s Its sedative properties were soon discovered and it made its way to the U. S. and was known in the U. S. as Quaalude, Mequin, and Parest. Methaqualone is Schedule I in the United States. This means it is illegal to manufacture, buy, possess, or distribute (sell, trade or give) without a DEA license. Methaqualone is Schedule III in Canada meaning it requires a prescription or license to legally possess. 54

When was methaqualone banned? Finally, Congress banned domestic production and sales of the prescription version of Quaalude, which was made by just one company, and President Reagan signed the legislation into law in 1984. An original ad for Quaaludes. . Quaalude was the party drug of the 1970 s. A depressant, Quaalude (methaqualone) was known as “disco biscuits” because it released users' sexual inhibitions, making it a nightlife mainstay 55

Common or street names : Bandits, Beiruts, Blou Bulle, Disco Biscuits, Ewings, Flamingos, Flowers, Genuines, Lemmon 714, Lemons, Lennons, Lovers, Ludes, Mandies, Quaaludes, Quack, Quad, Randy Mandies, 714, Soaper, Sopes, Sporos, Vitamin Q, Wagon Wheels Why 714? ? 56

Quaaludes (methaqualone) are a synthetic, barbiturate-like, central nervous system depressant. Methaqualone is an anxiolytic and a sedativehypnotic drug. Quaaludes were introduced as a safe barbiturate substitute, but they later showed that the possibility of addiction and withdrawal symptoms were similar to those of barbiturates 57

Antihistamines An antihistamine is a type of pharmaceutical drug that opposes the activity of histamine receptors in the body. 58

Side effects: Fatigue, dizziness, anorexia, nausea, vomiting, diarrhea, sweating, dryness of mouth, depersonalization, headache, and paresthesis of the extremities Paresthesis is defined as is a sensation of tingling, tickling, pricking, or burning of a person's skin with no apparent long-term physical effect. 59

GHB Gamma-Hydroxybutyrate (The natural depressant) It is colorless, tasteless, and odorless This substance is found naturally in the body resulting from the metabolism of the inhibitory neurotransmitter GABA It was first synthesized nearly 30 years ago by a French researcher who intended to study the CNS effects of GABA https: //www. drugs. com/illicit/ghb. html 60

Figure 06. UN 04: GHB is often stored as a clear, colorless, odorless liquid. Courtesy of Orange County Police Department, Florida

GHB cont’d GHB is a CNS depressant used as an intoxicant. It has many street names, including Gina, Georgia Home Boy, G, GBH, Juice, Fantasy, Liquid Ecstasy, Liquid X, Gamma-OH and Jungle Juice. The drug is often represented as a date rape drug. It is sometimes referred to as liquid ecstasy due to its tendency to produce euphoria and sociability and its use in the dance party scene, however the effects of GHB are quite different from those of MDMA. https: //www. dea. gov/druginfo/drug_data_sheets/GHB. pdf 62

Patterns of Abuse with CNS Depressants The American Psychiatric Association considers dependence on CNS depressants a psychiatric disorder 63

Patterns of Abuse with CNS Depressants (continued) Detoxification—the elimination of a toxic substance, such as a drug, and its effects With CNS depressants, this is achieved by substituting a longer-acting barbiturate for the offending CNS depressant and gradually reducing the dose Almost done! 64

Detoxification Wean out a user from CNS depressants Elimination of a toxic substance, such as a drug, and its effects from the body Barbiturate Detox and Withdrawal Over time, barbiturates cause dependence, which means detoxing from barbiturates is particularly challenging. Barbiturate detox should be done gradually under professional care, ideally in a residential facility. Withdrawal can cause seizures, hallucinations, hostility, aggression, and psychosis—without adequate treatment, hypothermia can also occur, as well as circulatory failure, and death. 65

Treatment for Withdrawal All sedative-hypnotics including alcohol and benzodiazepines can produce physical dependence and a barbiturate like withdrawal syndrome if taken in sufficient dosage over a long period. Treatment for Barbiturate Addiction Continued recovery from barbiturate addiction also involves psychological and spiritual healing. Longterm barbiturate users don’t only develop a physical dependence, but psychological dependence as well. Residential addiction treatment for barbiturates, including psychological treatment and counseling, ensures the best chance for long-term abstinence. 66

Natural Substances Kava kava (Piper methysticum) has been used as a ceremonial drink in the Pacific Islands for hundreds of years. It has been reported to have an effect similar to an alcoholic drink. The roots are chewed or ground into a pulp and added to cold water. Is Kava illegal? The misinformation circulating about kava, a South Pacific herb, may leave you questioning its legality in the United States. . In the United States, kava is legal for personal use as a dietary supplement. The U. S Food and Drug Administration has expressed concerns regarding its safety and efficacy, however. 67

Side effect, liver damage Kava has been used for anxiety and stress. The US Food and Drug Administration (FDA) has issued a public safety alert about kava and liver problems. 68

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