Classes/Types of Depressants1. 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 2002-2003Barbiturate Use 2002-2003TotalTotal 12-1712-17 18-2518-25 26+26+

20022002 1.4%1.4% .1%.1% .4%.4% 1.8%1.8%

20032003 1.4%1.4% .2%.2% .3%.3% 1.7%1.7%

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?

TotalTotal 12-1712-17 18-2518-25 26+26+

20062006 __%__% %% %% %%

20072007 __%__% %% %% %%

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

Patterns in Non-medical Use of Specific RX Drugs

http://www.oas.samhsa.gov/prescription/Ch3.htm#3.2.2

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

USES: varied as products “huffed” USES: varied as products “huffed” include gasoline, glues, solvents, paint..include gasoline, glues, solvents, paint..

Mostly young kids, adolescentsMostly young kids, adolescents highly destructive to brain with OD highly destructive to brain with OD

potentialpotential