SEDATIVE/HYPNOTIC DRUGS     

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Sedative/ hypnotics are drugs that depress brain function.  They due this by binding to the GABA receptors in the brain and augmenting their function.  GABA receptors are ubiquitous in the nerve tissue of our body.  They inhibit nerve cell firing.  Every nerve has these receptors and they are always active.  In fact, they represents the main control of our nerves.  It is like driving a car.  We can make the car go by easing off the brake.  GABA represents that brake and without it we would lose control of all our brain functions.  Even when the brake is weakened, we suffer serious effects.

There are many drugs that are considered sedatives.  Some are prescribed for anxiety, insomnia, headache, seizures and/or muscle spasms.   They are effective drugs but associated with tolerance and physical dependency.  Many have been abused

The sedative drugs can be divided into three groups:

Barbiturates, which include phenobarbital, Fiorinal and Fioricet, tuinal and seconal;

Benzodiazepines, which include Valium, Xanax, Ativan, Klonopin among others;

Barbiturate-like drugs, which include meprobamate, placidyl, Quaalude.  Club drugs like GHB, GBL and Rohypnol likely fall into this group as well.  Soma, a commonly prescribed muscle relaxer, is metabolized to meprobamate in the body; Soma is addictive.    

While the above groups have similar effects, they bind to the receptor at different sites.  This may account for some clinical differences among the groups.  

Barbiturates are the oldest class.  They can be highly addictive.  In addiction to their effect on GABA, they can also lead to release of dopamine.  The dopamine release makes them more addictive.  They are also easier to overdose on than other sedatives. 

Benzodiazepines are safer to use.  They are less euphoric than some of the barbiturates.   Side effects include sedation, memory impairment and learning impairment.  Elderly people will often become confused and are more susceptible to falls. At higher doses, anyone can develop ataxia (clumsiness) and vertigo.  The combination of these drugs with alcohol can be fatal. 

Barbiturate-like drugs have not been as well characterized 

Several of the barbiturate have beeen used as "date-rape" drugs.  This means that they have an extremely rapid onset of action and victims are sedated quickly.  They do not process memory so they are in a black-out for that period and cannot remeber afterward. 

These drugs are very quickly metabolized.  Patients can go from overdosed to mild withdrawal in a few hours.  It can be very tough for these patients to stabilize; I see these drgs used as often as 6-8 times daily.

People will take sedatives in doses much higher than recommended in order to get high.    Others will gradually increase their dose over long periods.  Still others stay at low dosages but remain on the medications for years.  Physical dependency and withdrawal will occur in all these situations.  

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