Classes/Types of Depressants

1. Anesthetics 2. Barbiturates3. Benzodiazepines (anxiolytics - _____ )

Many labels have been used to describe them, which can be confusing:

-tranquilizers -anti-anxiety pills -sleeping pills -sedatives

DepressantsDepressants

Mechanism of action:Mechanism of action:• GABA: acts mainly on inhibitory receptorsGABA: acts mainly on inhibitory receptors

– taking off the brakestaking off the brakes– e.g. GHB (gamma hydroxy butyrate)e.g. GHB (gamma hydroxy butyrate)

• Separate receptors identified for Separate receptors identified for barbiturates and benzosbarbiturates and benzos

EtherdomeEtherdome

History / Development of Depressants

Nitrous oxide (1776) (laughing gas)• development of ether, (MGH-etherdome) a flammable liquid which vaporizes at room

temperature

Chloral hydrate, bromides, paraldehyde Barbiturates came next in 1860s

• ___________________________• ___________________________• ___________________________

BarbituratesBarbiturates

USES:USES:• some used as anesthetics if they work some used as anesthetics if they work

quickly and then wear offquickly and then wear off• others used to prevent seizures because others used to prevent seizures because

their sedating effects lasted longertheir sedating effects lasted longer• often used as sleeping pills and anxiolyticsoften used as sleeping pills and anxiolytics

Barbiturate Use 2010Barbiturate Use 2010

For example, Nembutal®, Pentobarbital, Seconal®, Secobarbital, or Butalbital.Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health.

BARBITURATE USE declined due to their unwanted effects:- ____________________________

- ____________________________

- ____________________________

- ____________________________

____________________________

withdrawal SX similar to alcohol:

____________________________

____________________________

____________________________

Quaaludes (Methaqualone)

came next in the 50s and 60s and were developed as alternatives to barbs for sleep/anxiety disorders they became a street drug; now a schedule I drug no longer produced for medical reasons

Depressants (con’t)

Benzodiazepines• classic anti-anxiety drugs• synthesized initially in 1950s• more potent in 1960s with the advent of

______________________• similar to barbs but less dangerous in that:

– ____________________________________– ____________________________________

_____________________________________

DepressantsBenzodiazepines

• Withdrawal symptoms: increased anxiety, insomnia, tremors, sweating

• Dangers: ___________________

___________________ what are the clinical implications of

treating anxiety with drugs? difficult to estimate non-medical misuse

or abuse of sedatives and tranquilizers

Benzodiazepine Misuse? Benzodiazepine Misuse?

20102010

Includes Klonopin® or clonazepam, Xanax®, or alprazolam, Ativan®, or lorazepam, Valium® or diazepam, Librium®, Limbitrol®, Rohypnol®, Serax®, and Tranxene®.

The case of Rohypnol (flunitrazepam)

a.k.a. roofies, rib, circles, wolfies, rope, ropies, ruffies, roach-2, “roaches” after drug company Hoffman-La Roche• a Benzodiazepine used in the short-term

treatment of insomnia and as a pre-anesthetic medication

• similar to valium in effect but 10 times stronger• effects begin within 30 minutes, may last for

8 hours or more

Rohypnol

made in Europe and Latin America and sold by prescription there, not in U.S. so it is usually smuggled via mail into country, or comes across Mexican border

distribution and abuse especially in southwest & south

low cost < $5 per tab popularity among young people; “Said to be

south Florida’s fastest growing drug problem”

Rohypnol

2 COMMON MISPERCEPTIONS:

• ________________________________

• ________________________________

Adverse Effects of Rohypnol

memory impairment, drowsiness, dizziness, confusion; can induce excitability or aggressiveness in some users

can cause dependence: tolerance may develop; withdrawal symptoms include - headaches, anxiety, muscle pain, confusion, restlessness, numbness, tingling of extremities, convulsions and cardiac problems

Rohypnol used in date rape situations….WHY?

• ___________________________________

• __________________________________

• __________________________________

used to augment an alcohol high without elevating BAL

used as a “parachute” or remedy for depression that follows a stimulant high

InhalantsInhalants

Use varies as products “huffed” or sniffed include Use varies as products “huffed” or sniffed include gasoline, glues, aerosol cans, paint solvents and lighter gasoline, glues, aerosol cans, paint solvents and lighter fluidfluid

Mostly young kids, adolescentsMostly young kids, adolescents highly destructive to brain with OD potentialhighly destructive to brain with OD potential can cause cardiac arrest, known as "sudden sniffing can cause cardiac arrest, known as "sudden sniffing

death."death."

InhalantsInhalants

Sniffing has been a fairly steady trend among 12-Sniffing has been a fairly steady trend among 12-year-olds in recent years, with lifetime rate between year-olds in recent years, with lifetime rate between 7.7 percent and 6.1 percent since 2002. 7.7 percent and 6.1 percent since 2002.

1.1 % of children ages 12 to 17 engaged in sniffing 1.1 % of children ages 12 to 17 engaged in sniffing in 2008, compared with 6.7 % who smoked in 2008, compared with 6.7 % who smoked marijuana. marijuana.