the sedative hypnotic drugs are among the most commonly ....... and ...... drugs in our society
recreational , abused
alcohol (ethanol) is the most used and abused ....... sedative hypnotic drugs and barbiturates and benzodiazepines are among the most frequently ......prescription sedative hypnotics
alcohol is readily absorbed from all components of the
alcohol is highly
onset of action
duration of action
its ........ is rather quick and its .......rather short
the rate of metabolism is at a fairly ...... rate (not ....to concentration)
first pass metabolism
there is NOT a considerable.....in the liver
the alcohol content of beverages is generally specified in terms of ..... which is exactly doble the actual % of ethanol they contain
90 proof wiskey is ......% ethanol
set and expectancy
some of the effects are due to pharmacology but a great many of the "effects" of alcohol are due to ...
the apparent stimulation is due to the loss of inhibitory control by the ........ the part of the brain involved in the most highly integrated mental function
complete amnesia regarding events that took place over much of the period of intoxication
state dependent learning
often long term memory (LTM) is affected primarily with respect to ones ability to retrieve information from storage possibly because of ...
antidiuretic hormone (ADH)
inhibits the release of.... causeing H20 to be eliminated at a high rate
functional unit of the kidney
carbonated alcoholic beverages tend to enhance the absorbtion of alcohol because the carbination forces the alcohol in the ..... where there is greater surface area for the absorption to take place and thus, more rapid accumilation of alcohol in the brain
18 ML/ hour, 80 proof vodka/hour
alcohol is metabolized at a rate of approx. 12 ML to ......or 1.0 to 1.5 ounces of ......
90% , oxidation
a small amount of alcohol may be eliminated from the body unchanged but over, ....of all alcohol consumed is metabolized by .... most of which takes place in the liver
the first step alcohol is converted to.....
acetaldehyde is converted by the enzyme ....
rate limiting enzyme
this is the slowest step in alcohol metabolism and consequently the rate at which this conversion takes place limits the speed of the entire process.
amount , alcohol dehydrogenase
the conversion rate of alcohol to acetaldehyde is determined by the ....... of ........available ( this may vary from individual to individual
in the next step the acetaldedyde is converted to acetyl coenzyme A by several enzymes the most important of which .......
citric acid cycle
Acetyl coenzyme A is converted mainly into H2O and CO2 through a series of reactions known as the........ during which usable energy is released to the body
releases complex fats
Alcohol reduces the rate at which the liver:
formation of fibrous connective tissue, nonfunctional
some individuals eventually develop.....severe hardening of the liver
the fact that the same brain concentration of ethanol during the rising and falling portions of the tine-concentration gradient produces different effects suggest the development of ......
one suggestion has been that alcohol when dissolved in membrane alters the ....... of the membrane ( the change in the physical characteristic of the membrane can be thought of as a swelling which interferes with the ability of the neuron to generate and conduct action potentials .
some alcoholics suddenly develop the potentially lethal condition callled.......... characterized by celluar death and organ inflammation
impairment in learning and memory
a low to moderate degree of tolerance develops to most of the behavioral and mood altering effects of alcohol such that the chronic user must take larger and larger amount in order to obtain the desired effects
occurs between alcohol and all the sedative hypnotic drugs
alcohol dehydrogenase (specific enzyme) and drug metabolizing enzymes (nonspecific enzymes)
one effect of heavy drinking is the stimulation of both ....... and,............. in the liver
can develop in both animals and humans (e.g. driving)
psychological and physiological
alcohol has a strong potential for inducing both .... and .....dependance
alcoholism , alcoholic
when either or both of these occur with alcohol the term...... is used and the individual is reffered to as an
hallucinations clouded senses seizures and delirium
delirium tremens (DTS)
sometimes used to describe a stage of alcohol withdrawal experienced by some alcoholics characterized by profound disorientation severe tremors restlessness and vivid hallucinations
a single days exposure can induce an abstinence syndrome which is commonly experienced as a
blocks the action of the enzyme aldehyde dehydrogenase therefore actetaldehyde levels go up
an opiate antagonist that reduces alcohol-induced euphoria and dampons the craving for another drink.
benzodiazepines, buspironem and antidepressants
are frequently prescribed for alcoholics in the belief that the individuals drink because of anxiety or stress or because they are depressed and the alcohol relieves these conditions
psychodynamic, bahavior modification, and group therapies
treatment centers for chemical dependency
3 types of psychologically based treatments
Fetal Alcohol Syndrome (FAS)
the use of alcohol during pregnancy can harm the fetus and result in....
how much drinking, what stages of pregnancy
it is not clear yet ........is harmful or at ........the harm is done
brief, high concentrations , continuous consumption at low doses
it is also not clear whether the damage results from ....... of alcohol or by ........
2nd and 3rd trimesters
1st, 2nd, and 3rd trimesters
8 to 16 weeks
critical period when alcohol consumption may produce mental retardation (during this time period, neurons in the brain are migrating to their genetically predetermined destinations)
Alcohol should ...... not be consumed at anytime during pregnacy
these and other drugs in the sedative hypnotic class have effects similar to alcohol
how quickly the drugs act
their intensity of action
their duration of action
barbituarates differ from each other primarily in terms of pharmocokinetics the durgs act ...
fast-acting, ultrashort-duration anesthetics
approx 15 mins
short-duration sleep inducers
approx 1.5 hours
short-to intermediate-duration hypnotics or sedatives
approx 4 hours
long-acting sedatives or anticonvulsants
approx 6 hours
barbiturates tend to ...... throughout the nervous system
although barbiturates depolarize some neurons their predominant action throughout the nervous system is to ......neurons
enhanced GABA activity
the inhibitory influence of barbiturates is due to ........ at its receptors
one of the most popular uses of the short and intermediate acting barbiturates has been in ......
the barbiturates depress the percentage of time spent in .......
a period of several days when the REM increases to as high as 40% of sleep time and may remain elevated above normal for several weeks
minimal effects of REM sleep
less psychological dependence
less physical dependence and withdrawal effects
flurazepam (Dalmane) advantages
increased arousal threshold (may not hear smoke alarm or baby crying)
disrumption of deep stages of sleep
accumulation producing daytime aftereffects
flurazepam (Dalmane) disadvantages
a nonbenzodiazepine this is the prescribed hypnotic in the United States
it has demonstrated efficacy equal to that of the benzodiazepines it terms of shortening sleep latency and prolonging total sleep time in insominacs and has actions resembling the later class of drug but its advantages are that it appears to have low potential for inducing rebound insomnia or tolerance and withdrawal effects with chronic use.
potentiate GABA-ergic transmission
zolpidem (Ambien) appears to ...........
inhalants, gases and industrial solvents
.....consists of a wide variety of .....(e.g. ether, nitrous, oxide, chloroform) and .......(e.g. toluene, a component of some glues) that have sedative-hypnotic properties
some of these are used as general anesthetics to put patients to sleep before surguery
others are used for their intoxicating and euphoric properties
most of these drugs are believed to work indiscriminately by dissolving in neutral membranes because their potency is highly correlated with their lipid solubility
involve unrealistic irrational fears, or anxiety of disabling intensity
collectively these disorders are the most frequently observed type of mental disorders in adults
anti-anxiety drugs, minor tranquilizers
anxiolytics are often referred to as.....
have very different pharmacological and behavioral properties (e.g. higher efficacy rate, less potential for abuse, and minimal potential for inducing death through overdose
Fear of snakes, spiders and heights
fear of public speaking
anxiety accompanied by physical symptoms
generalized anxiety disorder
chronic excessive worry over just about everything
fear about being in places where escape would be difficult
was introduced into clinical use and it ushered in the era of a new class of drugs called the ......
diazepam (Valium) alprazolam (Xanax)
other benzodiazepines that are most commonly prescribed for the treatment of anxiety are.....2
they are more specific in affecting the limbic system at doses that do not effect the recticular formation and the cerebral cortex
have a high TI
have minimal effect of the drug metabolizing enzymes of the liver and therefore do not enhance the hepatic metabolism of themselves or other drugs.
tolerance develops to some of the pharmacological actions and cross tolerance may occur
have moderate psychological dependence liability physical dependence may also occur when doses considerably above therappeutic levels are administered
have only mildly suppressive effects on REM sleep although they tend to depress the deeper stages of sleep (stages 3 and 4)
means "physician caused" and is utilized to explain the drug induced confusion in the elderly which commonly induced by those components and these states may be incorrectly attributed to senility
benzodiazepines , synergistic , alcohol
the .... have a ....... effect with....
an antipsychotic properties effective with mixed anxiety/depression
it appears to be more useful in anxious patients for whom daytime alertness is particularly important and in the elderly in whom the benzodiazepines may exacerbate cognitive impairment and cause adverse psychomotor effects
lacks hypnotic, anticonvulsants and muscle relaxant properties
takes 1 or 2 weeks of daily treatment before the onset of its anxiolytic effects are noted
is much less likely to induce drowsiness and fatigue
does not impair psychomotor or cognitive function
has NO SYNERGISTIC effect with alcohol
lacks affinity for the benzodiazepines receptor and does not appear to act VIA GABA-mechanisms
is not cross tolerant with benzodiazepines and does not help reduce benzodiazepines withdrawal.
have been used in the treatment of patients with anxiety with some degree of success
selective serotonin reuptake inhibitors
have come into clinical use in the treatment of depression and a wide variety of disorders in the anxiety category