Central Nervous System Depressants

Central Nervous System Depressants

•Alcohol

•Barbiturates

•Benzodiazepines

•Prescription Medications

CNS Depressants (prescription)

Valium

Librium

Ativan

Serax

Xanax

Tranzene

Klonopin

General Symptoms of Users

“Drunken” Behavior (lack of coordination, slurred speech, staggeringConfusionFaulty JudgmentEmotional LabilityIrritabilityDrowsinessHostilityParanoid ideas

Route of Administration

Orally – pill (capsule or tablet)

Or mixed with water and injected

Physical Dependence

Potential for moderate to high dependence

Tolerance

Low to Moderate

Psychological Dependence

Moderate to High Potential

Withdrawal

Must be monitored closely due to potential fatalities

Risk of seizures and delirium tremens

Prolonged symptoms can last for months, resolve, then reappear. Especially with Benzodiazepines (Valium, Librium, Tranzene, and Zanax).

Depressant Withdrawal – Stage I

•Tremors (shakes) occur in the morning after heavy use the night before•Peak intensity is about 24-36 hours after last dose•“Jitters”, irritability, nausea, vomiting, easily startled, facial flushing, rapid heart rate•Loss of appetite insomnia, inattention, mildly disoriented, poor recent memory, sense of uneasiness.

CNS Depressant WithdrawalStage II

Hallucinations (disordered perceptions) vary in intensity

misinterpreted shadows and movements

Objects seeming distorted and unreal

May occur when the rest of the sensorium is clear, and seem intensely real.

CNS Depressant Withdrawal Stage III

Seizures (grand mal)

Bursts of 2-6 full body seizures

90% occur 7-48 hours after the last drink

One third of patients with seizures will go on to develop delirium tremens

CNS Depressant Withdrawal Stage IV

Delirium Tremens (Profound Confusion, Delusions, Vivid Hallucinations, Tremor, Agitation, Sleeplessness, Dilated Pupils, Fever, Tachycardia, Profuse Perspiration

Usually occurs 3-5 Days after the last dose

Most cases mild, and end abruptly

Severe cases considered a medical emergency, and carry a 15% fatality rate

Single episode lasts 72 hours or less in 80% of the cases

Pharmacological Effects Alcohol (Ethanol):

Alcohol as a drug

Alcohol is a psychoactive drug that is a CNS depressant

Alcohol is the second most widely used and abuse of all psychoactive drugs

Q. What drug is the most widely used and abused drug?

A. Caffeine

Four typesof

alcohol

Methyl alcoholpoisonous

Ethylene glycolpoisonous

Isopropyl alcoholpoisonous

Ethanoldrinking alcohol

Physical effects of alcohol

The body is affected by alcohol in two ways:

Direct contact with mouth, esophagus, stomach, and intestine

Influence on almost every organ system in the body after entering the bloodstream

Physical Effects of Alcohol

Absorption is the process in which the drug molecules reach the bloodstream

The effects of alcohol on the human body depend on the amount of alcohol in the blood (BAC)

Physical effects of alcohol

BAC produced depends on the:

1. Presence of food in the stomach

2. Rate of alcohol consumption

3. Concentration of alcohol

4. Drinker’s body composition

Alcohol beverages have almost no vitamins, mineral, protein, or fat - just large amount of carbohydrates

Physical effects of alcohol

Alcohol can cause severe physical and psychological dependence

1. Cross-tolerance

2. Behavioral tolerance - compensation of motor impairments by chronic alcohol users through behavioral

pattern modification

Blood alcohol level

Almost 95% of the consumed alcohol is inactivated by liver metabolism.

The liver metabolizes alcohol at a slow and constant rate and is unaffected by the amount ingested.

Thus, if on can of beer is consumed each hour, the blood alcohol level (BAL) will remain constant.

Blood alcohol level

Blood alcohol level (BAL) is the concentration of alcohol expressed as a percentage.

How alcohol is absorbed in the body

Short-term effects of alcohol

Low to moderate doses Disinhibition

Social setting and mental state

Euphoric, friendly, talkative

Aggressive and hostile

Interfere with motor activity, reflexes, and coordination

Short-term effects of alcohol

Moderate quantities Slightly increases in heart rate

Slightly dilates blood vessels in arms, legs, skin

Moderately lowers blood pressure

Stimulate appetite

Increases production of gastric secretions

Increases urine output

Short-term effects of alcohol

At higher doses Difficulty in walking, talking, and thinking

Induces drowsiness and cause sleep

In large amounts - severe depression of the brain systems and motor control area of the brain

Large Doses of Alcohol

Uncoordination, confusion, & disorientation

Stupor, anesthesia, coma, and even death

Lethal level of alcohol is between 0.4 and 0.6% by volume in the blood

? True of False ?

Drinking black coffee, taking a cold shower, or breathing pure oxygen will hasten the sobering up process

The type of alcohol beverage you drink can influence the hangover that results

Taking an aspirin-caffeine combination before drinking helps the sobering up process and the chances of having a hangover

Long-term effects of alcohol

Light or moderate drinking does little permanent harm (exception - FAS)

Heavy drinking Seriously damages the heart

Kidney and liver damage

Mental disorders, irreversible damage to the brain and peripheral nervous system

Lowers resistance to pneumonia and other infectious diseases

Irritates the gastrointestinal tract

Principal control centers of the brain affected by alcohol

Alcohol and pregnancy

Women who are alcoholics or who drink heavily during pregnancy have a higher rate of spontaneous abortion.

Infants born to drinking mothers have a high probability of being afflicted

with fetal alcohol syndrome.

Effects of alcohol on organ systems and bodily functions

Brain and nervous system

Liver hepatotoxic effect

alcoholic hepatitis

cirrhosis

Digestive system

Effects of alcohol on organ systems and bodily functions

Blood

Cardiovascular system alcoholic cardiomyopathy

Sexual organs

Endocrine system

Effects of alcohol on organ systems and bodily functions

Kidneys

Mental disorder and damage to the brain

Wernicke-korsakorr’s syndrome

The fetus (FAS)

Malnutrition

Barbiturates

Derivatives of barbituric acid

First synthesized in 1868

Used as anticonvulsants and sedative hypnotics

High abuse liability

High lethal dose rate

Barbiturates

Used with other analgesic combinations (aspirin, codeine) for treatment of tension and migraine headaches

Phenobarbital and belladonna alkaloid combinations used to treat peptic ulcers and irritable bowel syndrome

Barbiturates - Medical Uses

Used as an anticonvulsant

Sedative Hypnotic

Detoxification medication for alcohol withdrawal syndrome

Route of Administration

Oral (pill form)

Intravenous

Intramuscular (shot)

Barbiturates - Short Term Effects

Relieve anxiety and restlessness, relax muscles, induce sleep

Reduce lung function (breathing), heart action, speech, and movement

Long-Term Effects

Cardiovascular – bradycardia, hypertension

Digestive System – nausea, vomiting, constipation

Nervous System – agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucination, insomnia, anxiety, dizziness, thinking abnormalities

Barbiturate – Long Term Effects

Reproductive System – cross the placental barrier and cause fetal abnormalitiesNewborn withdrawal symptomsRespiratory System – hypoventilation, apneaOther Reactions - headache, injection site reactions, fever, liver damage, megablastic anemia (with long term use)

Tolerance

Develops quickly

Psychological tolerance develops more quickly than physical

Increased amounts approach lethal dosage

Metabolize faster in the liver as dosage increases

Half Life

Psychoactive chemicals have age dependent metabolism

Younger people tolerate a higher dose than older (over 50).

Half life = length of time in hours required for one half of the dose taken to be excreted from the body.

Toxicity/Overdose

Cold, clammy skin

Weak, rapid, shallow breathing

Combined with ETOH –suppression of respiratory center of brain

Dependence defined by amounts taken 8-10 times normal taken daily for 30 days

Death will occur if drowsiness, loss of consciousness, depressed breathing, and coma are left untreated.

Psychological Effects

Early - calming, tension reduction,

Middle – Euphoria, hypnotizing, impaired judgment, sense of “no worry”

Later – mood swings, depression, irritability, obnoxious behavior, manipulation, drug seeking

Withdrawal from Sedative Hypnotics

Within 6-8 hours of last dose Can be life threatening if breathing and blood pressure problems untreatedNausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremorsWithdrawal deaths more frequent than overdose deaths.

References - Material from this module was Developed from the following sources, which are recommended reading for the LADAC exam:

Basics Of Addiction Counseling: Desk Reference And Study Guide National Association for Addiction Professionalswww.naadac.org

National Institute of Drug Abusehttp://www.nida.nih.gov/

National Institute of Alcohol Abuse and Alcoholismhttp://www.niaaa.nih.gov/