Welcome to our series on CNS drugs.
We're gonna look at sedative-hypnotics in this series. So, what are sedative-hypnotics?
Well, these are drugs that depress the central nervous system.
They're most often used to people with anxiety or difficulty sleeping.
We call that insomnia. So sedative-hypnotic drugs are used for people who have anxiety
or difficulty sleeping because they depress the central nervous system.
So we have 3 main groups of sedative-hypnotics.
There is benzodiazepines, benzodiazepine-like drugs, and barbiturates.
So I have a question for you. You've got a 50-50 chance of getting this one right, right?
I like those odds. Which group of drugs are safer for patients: benzodiazepines or barbiturates?
Okay, now, no looking. Make sure you pick your answer first
and then we'll walk through the right one.
Okay, I'll tell you why benzodiazepines are safer. Let's look at the risk of barbiturates.
Now, there are general CNS depressant but that's not surprising
because those are the types of medications that we're talking about -- sedative hypnotics.
But the barbiturates have a significant risk for respiratory suppression
or depression so it's gonna make them breathe slower and more shallow.
These are often seen in fatal overdoses.
I'm sure you have seen news report of a celebrity that mix barbiturates and alcohol and other types of medications.
It's a really dangerous combination.
So if you take these barbiturates over a long period of time, you have a high risk of developing tolerance
which means you take more and more and more and you can develop a physical dependence.
Now, physical dependence means unless I take this medication,
I'm gonna have really uncomfortable withdrawal symptoms.
So that kinda helps you understand why people end up overdosing on this medication.
They develop a physical dependence so they really need to have it otherwise they feel miserable.
But they also develop tolerance meaning it takes more and more and more of this medication
which could easily lead to the fatal overdose.
So, let's go to benzodiazepines, why they are safer.
Benzodiazepines are safer than barbiturates. Just kinda star that.
So we're talking about patients with an expected -- they would likely to be on this type of medication.
There's less risk of developing tolerance and physical dependence.
Not zero risk but there's a lot less risk than with barbiturates.
And you also have a lower risk of respiratory depression
unless they are kicking back their benzodiazepines with a CNS depressant like alcohol.
So alcohol and a CNS depressant is never a good idea
but we have less risk with benzodiazepines of tolerance,
physical dependence, and respiratory depression or suppression. So how do these work?
Well, benzodiazepines enhance the action of GABA in your brain.
Every time I see GABA, I think of like Fred Flintstone.
It sounds like something from the Stone Age but it's actually Gamma-Amino Butyric Acid in your brain.
So GABA is this neurotransmitter in your central nervous system and inhibits nerve transmission in the brain.
So benzodiazepine enhance the action of this neurotransmitter.
That helps us calm nervous activity, right? Because it inhibits nerve transmission.
We have less nerve transmission then we are calmer.
And that's how these meds work. So they -- what do they do with gamma? They -- right.
They enhance the action of GABA and it inhibits the nerve transmission in the brain.
So it helps us calm that nervous activity. That's how benzodiazepines work.
Now, we've got lots of examples of benzodiazepines: alprazolam, clonazepam, diazepam
that you probably know as Valium, lorazepam, and temazepam.
So who could benefit from benzodiazepines?
Well, somebody who has difficulty sleeping or insomnia.
Someone who has anxiety. Remember it enhances GABA so that will calm the nervousness.
If you have a seizure disorder.
Remember it's gonna calm those signals so sometimes that would really help with seizure disorders.
They have muscle spasms or panic disorder or even alcohol withdrawal.
We use benzodiazepines for patients who are going through significant alcohol withdrawal.
Remember you don't have alcohol withdrawal unless you have a dependence or an abuse of alcohol.
Now, size does matter and I'll just leave it at that.
Let's go on and talk about how it matters with benzodiazepines.
The higher the dose, the more hypnotic or sleep-inducing the drug will be.
Now if I have a lower dose, we use those for anxiety
because we are expecting those patients to be functioning, doing activities of daily living
and their job -- if we want somebody to sleep, we give them a higher dose
because that's what we need for them to be really sleeping. Kind of ease into a full night sleep.
Now the anti-anxiety applications, these are some disorders that we use this for.
Now, there's general anxiety disorder, GAD.
That's a persistent and excessive worry about many things.
Huh, kinda sounds like nursing school, doesn't it? What about social anxiety disorder?
If the antidepressants don't work, it's an intense fear of being judged or negatively evaluated.
Huh, sounds like finals week in nursing school.
And what about panic disorder?
If again if the antidepressants aren't effective, they have these reoccurring, unexpected panic attacks.
Again, sounds like waiting for your grades during finals week.
So, anxiety obviously is something lots of nursing students face but so do our patients
and these are actual diagnosis.
General anxiety disorder, social anxiety disorder, and panic disorder.
These medications can really help patients handle their activities of daily living.