Modification of physical dependence on central depressants ...
Central Nervous System Depressants
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Transcript of Central Nervous System Depressants
Central Nervous System Depressants
•Alcohol
•Barbiturates
•Benzodiazepines
•Prescription Medications
CNS Depressants (prescription)
Valium
Librium
Ativan
Serax
Xanax
Tranzene
Klonopin
General Symptoms of Users
“Drunken” Behavior (lack of coordination, slurred speech, staggeringConfusionFaulty JudgmentEmotional LabilityIrritabilityDrowsinessHostilityParanoid ideas
Route of Administration
Orally – pill (capsule or tablet)
Or mixed with water and injected
Physical Dependence
Potential for moderate to high dependence
Tolerance
Low to Moderate
Psychological Dependence
Moderate to High Potential
Withdrawal
Must be monitored closely due to potential fatalities
Risk of seizures and delirium tremens
Prolonged symptoms can last for months, resolve, then reappear. Especially with Benzodiazepines (Valium, Librium, Tranzene, and Zanax).
Depressant Withdrawal – Stage I
•Tremors (shakes) occur in the morning after heavy use the night before•Peak intensity is about 24-36 hours after last dose•“Jitters”, irritability, nausea, vomiting, easily startled, facial flushing, rapid heart rate•Loss of appetite insomnia, inattention, mildly disoriented, poor recent memory, sense of uneasiness.
CNS Depressant WithdrawalStage II
Hallucinations (disordered perceptions) vary in intensity
misinterpreted shadows and movements
Objects seeming distorted and unreal
May occur when the rest of the sensorium is clear, and seem intensely real.
CNS Depressant Withdrawal Stage III
Seizures (grand mal)
Bursts of 2-6 full body seizures
90% occur 7-48 hours after the last drink
One third of patients with seizures will go on to develop delirium tremens
CNS Depressant Withdrawal Stage IV
Delirium Tremens (Profound Confusion, Delusions, Vivid Hallucinations, Tremor, Agitation, Sleeplessness, Dilated Pupils, Fever, Tachycardia, Profuse Perspiration
Usually occurs 3-5 Days after the last dose
Most cases mild, and end abruptly
Severe cases considered a medical emergency, and carry a 15% fatality rate
Single episode lasts 72 hours or less in 80% of the cases
Pharmacological Effects Alcohol (Ethanol):
Alcohol as a drug
Alcohol is a psychoactive drug that is a CNS depressant
Alcohol is the second most widely used and abuse of all psychoactive drugs
Q. What drug is the most widely used and abused drug?
A. Caffeine
Four typesof
alcohol
Methyl alcoholpoisonous
Ethylene glycolpoisonous
Isopropyl alcoholpoisonous
Ethanoldrinking alcohol
Physical effects of alcohol
The body is affected by alcohol in two ways:
Direct contact with mouth, esophagus, stomach, and intestine
Influence on almost every organ system in the body after entering the bloodstream
Physical Effects of Alcohol
Absorption is the process in which the drug molecules reach the bloodstream
The effects of alcohol on the human body depend on the amount of alcohol in the blood (BAC)
Physical effects of alcohol
BAC produced depends on the:
1. Presence of food in the stomach
2. Rate of alcohol consumption
3. Concentration of alcohol
4. Drinker’s body composition
Alcohol beverages have almost no vitamins, mineral, protein, or fat - just large amount of carbohydrates
Physical effects of alcohol
Alcohol can cause severe physical and psychological dependence
1. Cross-tolerance
2. Behavioral tolerance - compensation of motor impairments by chronic alcohol users through behavioral
pattern modification
Blood alcohol level
Almost 95% of the consumed alcohol is inactivated by liver metabolism.
The liver metabolizes alcohol at a slow and constant rate and is unaffected by the amount ingested.
Thus, if on can of beer is consumed each hour, the blood alcohol level (BAL) will remain constant.
Blood alcohol level
Blood alcohol level (BAL) is the concentration of alcohol expressed as a percentage.
How alcohol is absorbed in the body
Short-term effects of alcohol
Low to moderate doses Disinhibition
Social setting and mental state
Euphoric, friendly, talkative
Aggressive and hostile
Interfere with motor activity, reflexes, and coordination
Short-term effects of alcohol
Moderate quantities Slightly increases in heart rate
Slightly dilates blood vessels in arms, legs, skin
Moderately lowers blood pressure
Stimulate appetite
Increases production of gastric secretions
Increases urine output
Short-term effects of alcohol
At higher doses Difficulty in walking, talking, and thinking
Induces drowsiness and cause sleep
In large amounts - severe depression of the brain systems and motor control area of the brain
Large Doses of Alcohol
Uncoordination, confusion, & disorientation
Stupor, anesthesia, coma, and even death
Lethal level of alcohol is between 0.4 and 0.6% by volume in the blood
? True of False ?
Drinking black coffee, taking a cold shower, or breathing pure oxygen will hasten the sobering up process
The type of alcohol beverage you drink can influence the hangover that results
Taking an aspirin-caffeine combination before drinking helps the sobering up process and the chances of having a hangover
Long-term effects of alcohol
Light or moderate drinking does little permanent harm (exception - FAS)
Heavy drinking Seriously damages the heart
Kidney and liver damage
Mental disorders, irreversible damage to the brain and peripheral nervous system
Lowers resistance to pneumonia and other infectious diseases
Irritates the gastrointestinal tract
Principal control centers of the brain affected by alcohol
Alcohol and pregnancy
Women who are alcoholics or who drink heavily during pregnancy have a higher rate of spontaneous abortion.
Infants born to drinking mothers have a high probability of being afflicted
with fetal alcohol syndrome.
Effects of alcohol on organ systems and bodily functions
Brain and nervous system
Liver hepatotoxic effect
alcoholic hepatitis
cirrhosis
Digestive system
Effects of alcohol on organ systems and bodily functions
Blood
Cardiovascular system alcoholic cardiomyopathy
Sexual organs
Endocrine system
Effects of alcohol on organ systems and bodily functions
Kidneys
Mental disorder and damage to the brain
Wernicke-korsakorr’s syndrome
The fetus (FAS)
Malnutrition
Barbiturates
Derivatives of barbituric acid
First synthesized in 1868
Used as anticonvulsants and sedative hypnotics
High abuse liability
High lethal dose rate
Barbiturates
Used with other analgesic combinations (aspirin, codeine) for treatment of tension and migraine headaches
Phenobarbital and belladonna alkaloid combinations used to treat peptic ulcers and irritable bowel syndrome
Barbiturates - Medical Uses
Used as an anticonvulsant
Sedative Hypnotic
Detoxification medication for alcohol withdrawal syndrome
Route of Administration
Oral (pill form)
Intravenous
Intramuscular (shot)
Barbiturates - Short Term Effects
Relieve anxiety and restlessness, relax muscles, induce sleep
Reduce lung function (breathing), heart action, speech, and movement
Long-Term Effects
Cardiovascular – bradycardia, hypertension
Digestive System – nausea, vomiting, constipation
Nervous System – agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucination, insomnia, anxiety, dizziness, thinking abnormalities
Barbiturate – Long Term Effects
Reproductive System – cross the placental barrier and cause fetal abnormalitiesNewborn withdrawal symptomsRespiratory System – hypoventilation, apneaOther Reactions - headache, injection site reactions, fever, liver damage, megablastic anemia (with long term use)
Tolerance
Develops quickly
Psychological tolerance develops more quickly than physical
Increased amounts approach lethal dosage
Metabolize faster in the liver as dosage increases
Half Life
Psychoactive chemicals have age dependent metabolism
Younger people tolerate a higher dose than older (over 50).
Half life = length of time in hours required for one half of the dose taken to be excreted from the body.
Toxicity/Overdose
Cold, clammy skin
Weak, rapid, shallow breathing
Combined with ETOH –suppression of respiratory center of brain
Dependence defined by amounts taken 8-10 times normal taken daily for 30 days
Death will occur if drowsiness, loss of consciousness, depressed breathing, and coma are left untreated.
Psychological Effects
Early - calming, tension reduction,
Middle – Euphoria, hypnotizing, impaired judgment, sense of “no worry”
Later – mood swings, depression, irritability, obnoxious behavior, manipulation, drug seeking
Withdrawal from Sedative Hypnotics
Within 6-8 hours of last dose Can be life threatening if breathing and blood pressure problems untreatedNausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremorsWithdrawal deaths more frequent than overdose deaths.
References - Material from this module was Developed from the following sources, which are recommended reading for the LADAC exam:
Basics Of Addiction Counseling: Desk Reference And Study Guide National Association for Addiction Professionalswww.naadac.org
National Institute of Drug Abusehttp://www.nida.nih.gov/
National Institute of Alcohol Abuse and Alcoholismhttp://www.niaaa.nih.gov/