© 2006 McGraw-Hill Higher Education. All rights reserved. Chapter 7 Depressants and Inhalants.

© 2006 McGraw-Hill Higher Education. All rights reserved.

Chapter 7Chapter 7

Depressants and InhalantsDepressants and Inhalants

© 2006 McGraw-Hill Higher Education. All rights reserved.

DepressantsDepressants

Most widely-used and abused drugs in Most widely-used and abused drugs in the U.Sthe U.S

Is popular for its stress and anxiety Is popular for its stress and anxiety relieving propertiesrelieving properties

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© 2006 McGraw-Hill Higher Education. All rights reserved.

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Benzodiazapines

Introduced in 1960s 40 years drug of choice Many properties – anxiolytic, sedatives,

anticonvulsants, relaxant

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BenzodiazapinesEffects

Safer than barbiturates Much less respiratory depression Replaced barbiturates as the drug of choice Doses rarely fatal CNC toxicity in chronic use/high doses

Headaches, irritability, confusion, impaired memory, depression

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Types of CNS DepressantsTypes of CNS Depressants

Benzodiazepines: Valium-Type drugsBenzodiazepines: Valium-Type drugs Prescribed for anxiety and sleepPrescribed for anxiety and sleep Four of the top-selling prescription drugs in the U.S.Four of the top-selling prescription drugs in the U.S.

Xanax, Halcion, Ativan, diazepamXanax, Halcion, Ativan, diazepam

Medical usesMedical uses Relief from anxiety, neurosis, muscle relaxation, Relief from anxiety, neurosis, muscle relaxation,

alleviation of lower-back pain, treatment of convulsive alleviation of lower-back pain, treatment of convulsive disorders, induction of sleep, relief from withdrawal disorders, induction of sleep, relief from withdrawal symptoms, induction of amnesiasymptoms, induction of amnesia

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Types of CNS DepressantsTypes of CNS Depressants

Types of benzodiazepines:Types of benzodiazepines: 14 benzodiazepine compounds on the market14 benzodiazepine compounds on the market Distinguished primarily by their duration of action: Distinguished primarily by their duration of action:

short-acting (hypnotics), long-acting (sedatives)short-acting (hypnotics), long-acting (sedatives)

Side effects:Side effects: Drowsiness to paradoxical effects (i.e. Rophynol, Drowsiness to paradoxical effects (i.e. Rophynol,

used to make victims vulnerable to sexual assault)used to make victims vulnerable to sexual assault)

Tolerance, dependence, withdrawal, and Tolerance, dependence, withdrawal, and abuseabuse

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PharmacokineticsPharmacokinetics

Wide range of half-life, 3 mins to 120 hrsWide range of half-life, 3 mins to 120 hrs RedistributionRedistribution

Fast acting – lipid (fat) soluble- results in Fast acting – lipid (fat) soluble- results in secondsseconds

Long acting p water soluble – slower to Long acting p water soluble – slower to penetrate (CNS 20-30 mins)penetrate (CNS 20-30 mins)

Metabolize in the liver eliminated through Metabolize in the liver eliminated through kidneyskidneys

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HistoryHistory

Before Barbiturates:Before Barbiturates: Chloral hydrate was first synthesized in1832 Chloral hydrate was first synthesized in1832

but not used clinically until 1870– for sleepbut not used clinically until 1870– for sleep Paraldehyde was first synthesized in1829 but Paraldehyde was first synthesized in1829 but

not used clinically until 1882 – very safe – not used clinically until 1882 – very safe – very, very bad taste and odorvery, very bad taste and odor

Bromides – to induce sleep in the 19th Bromides – to induce sleep in the 19th century, used until 1960s in OTC medscentury, used until 1960s in OTC meds

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HistoryHistory

In the 1950s the first benzodiazepines In the 1950s the first benzodiazepines were marketed as substitutes for were marketed as substitutes for barbituratesbarbiturates Relatively safe when used for short periodsRelatively safe when used for short periods Long-term use can cause dependence and Long-term use can cause dependence and

withdrawal problemswithdrawal problems

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Action Sites and Mechanism

Early understanding Depressed neuronal pathways in brain

stem/cerebral cortex Present day

Reduced metabolic and brain electrical activity

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Neurotransmitters and Receptor Sites

Glutamate (excitatory) Reduce excitatory activity

GABA (inhibitory) Augment inhibitory activity

Barbiturates/benzodiazapines bind here

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Effects of CNS DepressantsEffects of CNS Depressants

CNS depressants reduce CNS activity and CNS depressants reduce CNS activity and diminish the brain’s level of awarenessdiminish the brain’s level of awareness

Depressant drugs include:Depressant drugs include: BenzodiazepinesBenzodiazepines Barbiturate-like drugsBarbiturate-like drugs AlcoholAlcohol AntihistaminesAntihistamines Opioid narcotics like heroinOpioid narcotics like heroin GHB (gamma hydroxybutyrate)GHB (gamma hydroxybutyrate)

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EFFECTS ON THE CNS The clinical value of CNS depressants is

dose dependent Low dose (sedatives, relieves anxiety and

promote relaxation) Higher doses (hypnotics, can cause

drowsiness and promote sleep) At even higher doses (anesthetics, can cause

anesthesia and are used for patient management during surgery

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The clinical value of CNS depressants is dose The clinical value of CNS depressants is dose dependent:dependent: Low dose (sedatives, relieve anxiety and promote Low dose (sedatives, relieve anxiety and promote

relaxation)relaxation) Higher doses (hypnotics, can cause drowsiness and Higher doses (hypnotics, can cause drowsiness and

promote sleep)promote sleep) At even higher doses (anesthetics, can cause At even higher doses (anesthetics, can cause

anesthesia and are used for patient management anesthesia and are used for patient management during surgery)during surgery)

Effects of CNS DepressantsEffects of CNS Depressants

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EFFECTS OF CNS DEPRESSANTS

CNS depressants reduce CNS activity and diminish the brain’s level of awareness

Depressant drugs include: Benzodiazapines Opiods Barbiturates GHB (gamma

hydroxy- Alcohol -butyrate Antihistamines

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Psychological Effects

Depressed Behavior Cognitive/Motor inhibition akin to alcohol

inebriation Low dose – reduced anxiety or emotional

withdrawal High doses – general behavioral

depression, sleep

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Physiological Dependence

Wide range of effects Low dose sleep difficulties High dose- hallucinations, restlessness,

disorientation, life-threatening convulsions

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Psychological Dependence

Pleasurable effects Reduced anxiety Sedation Euphoria

Leads to compulsive use and abuse

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Mental Status Exam

Used to evaluate mental functioning Five areas

Sensory - clouded, disorientation to time/place Memory – forgetfulness Intellect – depressed reasoning Judgment – altered insight Affect – wide mood swings

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INHALANTSINHALANTS

• Inhalants are breathable chemical Inhalants are breathable chemical vapors that produce psychoactive (mind-vapors that produce psychoactive (mind-altering) effects. altering) effects.

• They were never meant to be used to They were never meant to be used to achieve an intoxicating effectachieve an intoxicating effect

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Inhalants falls into the following categoriesInhalants falls into the following categories

• Volatile Solvents – industrial or household Volatile Solvents – industrial or household solvents containing products, including solvents containing products, including paint thinners or removers, degreasers, paint thinners or removers, degreasers, dry cleaning fluids, gasoline and gluedry cleaning fluids, gasoline and glue

• Art or office supply solvents, including Art or office supply solvents, including correction fluids, felt tip marker fluid, and correction fluids, felt tip marker fluid, and electronic contact cleanerselectronic contact cleaners

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Inhalants fall into the following categoriesInhalants fall into the following categories

Aerosols – Household propellants and Aerosols – Household propellants and associated solvents in items such as spray associated solvents in items such as spray paints, hair or deodorant sprays, fabric paints, hair or deodorant sprays, fabric protector spraysprotector sprays

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Inhalants fall into the following categoriesInhalants fall into the following categories

Gases – used in household or commercial Gases – used in household or commercial products, including butane lighters and products, including butane lighters and propane tanks, whipping cream aerosols propane tanks, whipping cream aerosols or dispensers, and refrigerant gasesor dispensers, and refrigerant gases

Medical anesthetic gases, such as ether, Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide chloroform, halothane, and nitrous oxide (laughing gas)(laughing gas)

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Inhalants fall into the following categoriesInhalants fall into the following categories

Nitrites – organic nitrites are volatiles that Nitrites – organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, include cyclohexyl, butyl, and amyl nitrites, commonly known as poppers. Amylnitrites commonly known as poppers. Amylnitrites is still used in certain diagnostic medical is still used in certain diagnostic medical procedures. It has an unpleasant odorprocedures. It has an unpleasant odor

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Who Use InhalantsWho Use Inhalants

Among youths age 12 to 17 10.6% were current Among youths age 12 to 17 10.6% were current usersusers

Among 12 or 13 year olds, 1.2% report current Among 12 or 13 year olds, 1.2% report current useuse

1,6% of 14-15 year olds reported current use1,6% of 14-15 year olds reported current use Life time use was down in 2004 among Life time use was down in 2004 among

Americans 18-20Americans 18-20

2004 National Survey on Drug Use and Health2004 National Survey on Drug Use and Health

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How are Inhalants UsedHow are Inhalants Used

Sniffing or snorting fumes from containersSniffing or snorting fumes from containers Spraying aerosols directly into the nose or mouthSpraying aerosols directly into the nose or mouth ““Bagging,” sniffing or inhaling fumes from substances Bagging,” sniffing or inhaling fumes from substances

sprayed or deposited inside a plastic or paper bagsprayed or deposited inside a plastic or paper bag ““Huffing” from an inhalant-soaked rag stuffed in the Huffing” from an inhalant-soaked rag stuffed in the

mouthmouth Inhaling from balloons filled with nitrous oxideInhaling from balloons filled with nitrous oxide

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Inhaled chemicals are rapidly absorbed through Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream and quickly the lungs into the bloodstream and quickly distributed to the braindistributed to the brain

Nearly all abused inhalants (other than nitrites) Nearly all abused inhalants (other than nitrites) produce pleasurable effects by depressing the produce pleasurable effects by depressing the CNSCNS

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Gaseous Anesthetics

Nitrites Rapid dilation of the arteries, great for blood

pressure Unpleasant smell

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Recognizing Inhalant AbuseRecognizing Inhalant Abuse

Chemical odor on clothing or breathChemical odor on clothing or breath Drunk or disoriented appearanceDrunk or disoriented appearance Pain or other stains on face, hands, or clothesPain or other stains on face, hands, or clothes Slurred speechSlurred speech Hidden empty spray paint or solvent containers and Hidden empty spray paint or solvent containers and

chemical-soaked rags or clothingchemical-soaked rags or clothing Inattentiveness, lack of coordination, irritability and Inattentiveness, lack of coordination, irritability and

depressiondepression

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Effects of InhalantsEffects of Inhalants

Slows body functionsSlows body functions IntoxicationIntoxication NauseaNausea Cough/sneezeCough/sneeze Light-headednessLight-headedness Damage heart, kidneys, brainDamage heart, kidneys, brain Hypoxia/deathHypoxia/death

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Medical Consequences ofMedical Consequences of Inhalant Abuse Inhalant Abuse

Asphyxiation from repeated inhalationsAsphyxiation from repeated inhalations Suffocation from blocking air from entering the Suffocation from blocking air from entering the

lungslungs Convulsions or seizures caused by abnormal Convulsions or seizures caused by abnormal

electrical discharges in the brainelectrical discharges in the brain Coma Coma Choking from inhalation of vomitChoking from inhalation of vomit Fatal injury from accidentsFatal injury from accidents

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Dangers of InhalantsDangers of Inhalants

Chronic long-term use can lead to brain Chronic long-term use can lead to brain damage, liver, kidney, heart, fetusdamage, liver, kidney, heart, fetus

Accidents associated with “intoxication” Accidents associated with “intoxication” and firesand fires

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Harmful Irreversible EffectsHarmful Irreversible Effects

Hearing lostHearing lost Peripheral neuropathies, or limb spasmsPeripheral neuropathies, or limb spasms Central nervous system or brain damageCentral nervous system or brain damage Bone marrow damageBone marrow damage

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Side Effects of Depressants

Drowsiness to paradoxical effects (I.e. Rophynol, use to make victims vulnerable to sexual assault

Tolerance, dependence, withdrawal, and abuse