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Introduction What are Sedatives?? “A drug that subdue excitement and calms the patient without inducing sleep. Though the drowsiness may be produced.” ► It also refers to the decrease in responsiveness to stimulation, along with this ,it also decrease the alertness,ideation, and motor activities. What are Hypnotics??? ► “ These are the drugs that causes the sleep which resembles with the natural sleep”. ► These are having quicker action,shorter duration and steeper DRC while sedatives having slow on set of action with flatter DRC ► Hypnotics at lower dose sedative ► There are different grades of CNS depressants ► Sedation Hypnosis General anaesthesia Difference between Sedative & Hypnotics Sedative ► A drug that reduces excitement,calms the patient without inducing sleep ► Sedative in therapeutic doses are anxiolytics ► At larger doses causes hypnosis ► Site of action is on limbic system ► Examples- diazepam,lorazepam,etc. Hypnotics ► Sleep producing drugs ► Used for inititation or maintain the sleep ► At high doses causes general anaesthesia ► Site of action is in midbrain & acending RAS which maintains wakefullness ► Examples – zopiclone,phenobarbitone DRC for two hypothetical sedative - Hypnotics • Drug A – An increase in dose higher than that needed for hypnosis may lead to state of general anaesthesia. • With higher doses , the durg will depresses the respiratory and vasomotor centers which leads to coma. • Steeper DRC, Narrow margin of safety • Drug A is an example of alcohol and Barbiturates. • Drug B – Needs greater dose to achieve CNS depression • Drug B is an example of benzodiazepine and newer hypnotics • Flatter DRc, greater margin of safety ► Sleep 1. NREM – In this there is no fast movement of eyes.It occurres between stage 0 to 4 2. REM – In this eye movements are very fast. ► Stage of NREM- ► Stage 0 [ awake]- It is condition from lying down to falling a sleep(1-2%) ► Stage 1 [dosing]– Eye movement decrease,body muscles relax (5-10%) ► Stage 2 [unequivocal sleep]– more decrease in eye movements, person may arousable.(50%) ► Stage 3 deep sleep transition]– Deeper sleep with minimum eye movements,not easily arousal. ► Stage 4[cerebral sleep] – deepest level of sleep, GH secretion increased, no eye movements, muscles are fully relaxed, if awakened causes disorientation.(20%) ► REM – dreaming, HR,breathing rate, brain activity increases and relaxation of voluntary muscles. Classification ► Benzodizepines1. Hypnotics-Diazepam,flurazepam,Nitrazepam,Alprazolam,Lorazepam,Templepatrick,Triazolam 2. Antianxiety-Diazepam, Chlordiazeperoxide, Oxazepam, Lorazepam, Alprazolam, Clonazepam 3. Anticonvulsant- Clonazepam, clobazam, Diazepam, Loranzepam ► Barbiturates1. Long acting- phenobarbitone 2. Short acting- butobarbitone, Phenobarbitone 3. Ultrashort acting- Thiopentone, Methohexitone Non- benzodiazepines- Zopiclone, Eszopiclone, Zolpidem, Zaleplon, Etisalat ► Other Hypnotics- Triclofos, Melatonin, Ramelteon, Suvorexant
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SEDATIVE/HYPNOTICS ANXIOLYTICS www.freelivedoctor.com
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