Hypnotics antidepressants

Alcohol, antidepressants, hypnotics, sedatives, tranquillizers, fenfluramine, levodopa, vasodilators such as nitrates, nifedipine, verapamil Potentiation. 

Benzodiazepines and 3//-1,5-benzodiazepines are important classes of compounds because of their interesting pharmacological properties. They show anticonvulsant, antianxiety, analgesic, sedative, antidepressive, hypnotic, antiinflammatory activity and also potent inhibitor of HIV-1 reverse transcriptase. Besides their biological relevance, benzodiazepines have also found application as dyes for acrylic fibers [163]. 

SARI (serotonin 2 antagonist/reuptake Inhibitor) antidepressant hypnotic... 

A person shall not supply a sample of a medicinal product that is a controlled drug under Section 2 of the Misuse of Drugs Act 1977, or that is an antidepressant, hypnotic or tranquilliser. 

Many patents have been issued on the use of pyrogaUol derivatives as pharmaceuticals. PyrogaUol has been used extemaUy in the form of an ointment or a solution in the treatment of skin diseases, eg, psoriasis, ringworm, and lupus erythematosus. GaUamine triethiodide (16) is an important muscle relaxant in surgery it also is used in convulsive-shock therapy. Trimethoprim (2,4-diamino-5-(3,4,5-trimethoxybenzyl)pyrimidine) is an antimicrobial and is a component of Bactrin and Septra. Trimetazidine (l(2,3,4-trimethoxybenzyl)piperazine (Vastarel, Yosimilon) is used as a coronary vasodilator. l,2,3,4-Tetrahydro-6-methoxy-l-(3,4,5-trimethoxyphenyl)-9JT-pyrido[3,4- ]indole hydrochloride is useful as a tranquilizer (52) (see Hypnotics, sedatives, ANTICONVULSANTS, AND ANXIOLYTICS). Substituted indanones made from pyrogaUol trimethyl ether depress the central nervous system (CNS) (53). Tyrosine-and glycine(2,3,4-trihydroxybenzyl)hydrazides are characterized by antidepressant and anti-Parkinson activity (54). 

Derivatives of 11 //-dibenz[6,e]azepine (morphanthridines) and 5/2-dibenz[Z>,/]azepine are valuable, commercial pharmaceutical products. The most important derivatives are the antidepressant, Depramine (16),30 the antiepileptic, Carbamazepin (17),62 the hypnotic agents Perlapine (18),63-64 and its 2-fluoro derivative (Fluperlapine),65 and Opipramol (19), an antidepressant and antipsychotic agent.66... 

The sedatives and hypnotics have an additive effect when administered with alcohol, antidepressants, narcotic analgesics, antihistamines, or phenothiazines. 

The antiemetics and antivertigo drug may have additive effects when used with alcohol and other CNS depressants such as sedatives, hypnotics, antianxiety drugp, opiates, and antidepressants. There may be additive anticholinergic effects (see Chap. 25) when administered with drag s that have anticholinergic activity such as the antihistamines, antidepressants, pheno-thiazines, and disopyramide The antacids decrease absorption of the antiemetics. 

The antidiarrheal drugs cause an additive CNS depression when administered with alcohol, antihistamines, narcotics, and sedatives or hypnotics. There are additive cholinergic effects when administered with other drugp having anticholinergic activity, such as antidepressants or antihistamines. Concurrent use of the antidiarrheals witii a monoamine oxidase inhibitor increases the risk of a hypertensive crisis. 

Selective serotonin reuptake inhibitor antidepressant selection and anxiolytic and sedative hypnotic prescribing a multivariate analysis./ Clin Outcomes Manage 4, 16—22. 

A number of medications have been associated with an increased risk of falling, including drugs affecting mental status such as antipsychotics, benzodiazepines, tricyclic antidepressants, sedative-hypnotics, anticholinergics, and corticosteroids. Some cardiovascular and antihypertensive drugs also can contribute to falls, especially those causing orthostatic hypotension.9... 

Metabolism converts a lipophilic molecule into a more hydrophilic (water-loving) metabolite that can be excreted in urine by the kidneys. In the majority of cases the drug is detoxified, or made pharmacologically inactive by this metabolic breakdown. However, a few drugs need to be metabolised to become psychoactive for instance, the sedative-hypnotic chloral hydrate is converted to the active metabolite trichloroethanol. In this case the parent molecule is referred to as a prodrug. With many drugs, both the parent compound and its metabolites are psychoactive. An example of this is the tricyclic antidepressant imipramine which is metabolised to desipramine, with... 

The amino acid precursor for 5-HT, L-tryptophan, increases the biosynthesis 5-HT and, therefore, has been investigated for potential antidepressant properties, but with mixed results (Green and Costain, 1979). It was withdrawn in 1990, following a number of fatal cases of eosinophilia myalgia (a disorder characterised by severe muscle pain and abnormally high levels of one type of white blood cell, the eosinophil) in individuals principally using it as a natural hypnotic. 

TDM has improved the performance of anticancer, antidementia, antidepressant, antiepileptic, anticonvulsant, antifungal, antimicrobial, antipsychotic, antiretroviral, anxiolytic, hypnotic, cardiac, addiction treatment, immunosuppressant, and mood stabilizer drags for more than 30 years.2-9 Many analytical procedures evolved as analytical techniques and instrumentation have advanced. This chapter briefly reviews the different types of analytical methods the applications of high-throughput techniques in TDM are discussed in detail. 

BickeboeUer-Friedrich J, Maurer H. 2001. Screening for the detection of new antidepressants, neuroleptics, hypnotics... 

Antihistamines. After alcohol, antihistamines are the most commonly self-administered sleep medications. Foremost among these is diphenhydramine (Benadryl), which is also available as a component in a variety of over-the-counter nighttime medications including Tylenol PM and Excedrin PM. Prescription antihistamines like hydroxyzine (Vistaril, Atarax) are also occasionally used to treat insomnia. Finally, it is the antihistamine effect of some antidepressants and anti-psychotics that contribute to their utility as sedative-hypnotics. 

Drugs that may be affected by dronabinol include amphetamines, cocaine, sympathomimetics, anticholinergics, antihistamines, tricyclic antidepressants, alcohol, sedatives, hypnotics, psychomimetics, disulfiram, fluoxetine, and theophylline. 

Forced diuresis is occasionally useful. It may cause volume overload or electrolyte disturbances. Forced diuresis is useful for phenobarbital, bromides, lithium, salicylate, or amphetamines overdoses. Do not use for tricyclic antidepressants, sedative-hypnotics, or highly protein-bound medications. The most common agents employed are furosemide and osmotic diuretics with mannitol. 

The kidney brush border also possesses a carnosine transport system and there is evidence that kidney also contains an active carnosinase (Sauerhoefer et al., 2005). There is also evidence that carnosine can influence sympathetic nervous activity in kidney (Tanida et al., 2005) as well as brown (Tanida et al., 2007) and white adipose tissue (Shen et al., 2008). Other studies have shown that carnosine has antidepressant activity in rats (Tomonaga et al., 2008). In chicks, carnosine induces hyperactivity (Tsuneyoshi et al., 2007) whereas its reverse structure (L-histidinyl-13-alanine) has sedative and hypnotic effects (Tsuneyoshi et al., 2008). The mechanisms involved in remain obscure however. 

Flurazepam (Dalmane) [C-IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose Adults Beds >15 y. 15-30 mg PO qhs PRN X in elderly Caution [X, /-] Elderly, low albumin, hepatic impair Contra NAG PRG Disp Caps SE Hangover d/t accumulation of metabolites, apnea, anaphylaxis, angioedema, amnesia Interactions T CNS depression W/ antidepressants, antihistamines, opioids, EtOH T effects OF digoxin, phenytoin T effects W/ cimetidine, disulfiram, fluoxetine, iso-niazid, ketoconazole, metoprolol, OCPs, propranolol, SSRIs, valproic acid. 

Adults. 3 g PO q6h x 4 PRN Supl 1-2 g IM or IV repeat PRN Preeclampsia/pre-mature labor 4 g load then g/h IV inf Cardiac arrest 1-2 g IV push (2-4 mL 50% soln) in 10 mL DjW AMI Load 1-2 g in 50-100 mL D5W, over 5-60 min IV then 0.5-1.0 g/h IV up to 24 h (ECC 2005) Feds. 25-50 mg/kg/dose IM or IV q4-6h for 3-4 doses repeat PRN dose w/ low urine output or renal insuff Caution [B, +] Contra Heart block, renal failure Disp Inj 10, 20, 40, 80, 125, 500 mg/mL bulk powder SE CNS depression, D, flushing, heart block Interactions T CNS depression W/ antidepressants, antipsychotics, anxiolytics, barbiturates, hypnotics, narcotics EtOH T neuromuscular blockade Wf aminoglycosides, atracurium, gallamine, pancuronium, tubocurarine, vecuronium EMS Check for absent patellar reflexes this may indicate tox may cause hypokalemia (flattened T waves) and hypocalcemia OD May cause hypotension, resp arrest, T PR, QRS, and QT interval, AV block, and cardiac arrest calcium salts can be given to reverse resp depression... 

As it inhibits microsomal cytochrome P450 cimetidine has a high potential for drug interactions not shared by the other H2 receptor antagonists. The oxidative metabolism of agents such as anticoagulants, most antiepileptics, some beta-blockers, warfarin, theophylline and many hypnotics, neuroleptics and antidepressants may be reduced, leading to increased effects. 

Guidance on the clinical indications for benzodiazepine therapy is available from various sources (Task Force Report of the American Psychiatric Association 1990 Ballenger et al. 1998a Bandelow et al. 2002). Long-term therapy is most likely to present problems with discontinuation and is usually reserved for cases that have proved resistant to treatment with antidepressants alone. Patients may benefit from a 2-4 week course of a benzodiazepine whilst antidepressant therapy is initiated, as this counteracts the increased anxiety caused by some drugs (Goddard et al. 2001). A benzodiazepine maybe useful as a hypnotic in some cases of anxiety disorder, and can be used by phobic patients on an occasional basis before exposure to a feared situation. 

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