Barbiturate anxiety with

Kava should not be used with alcohol, benzodiazepines, barbiturates or other sedatives because of their additive effects. In one case, coma resulted from mixing alprazolam and kava. Patients have complained that kava, while relaxing the body, may be less effective for mental anxiety with obsessive or racing thoughts than are the benzodiazepines. 

Tolerance and dependence occur with chronic use. Withdrawal symptoms may be severe, especially with short-acting barbiturates anxiety, agitation, hyperreflexia, seizures, and postseizure depression of vital functions. Management involves treatment with long-acting BZs (e.g., diazepam) and dose tapering. 

Although the use of barbiturates and miscellaneous sedatives and hypnotics for sedation has largely been replaced by the antianxiety drugs (see Chap. 30), they occasionally may be used to provide sedation before certain types of procedures such as cardiac catheterization or the administration of a local or general anesthesia Sedative doses usually given during daytime hours, may be used to treat anxiety and apprehension. Fhtients with chronic disease may require sedation, not only to reduce anxiety, but also as an adjunct in the treatment of their disease... 

The ultra-short-acting barbiturates include methohexital sodium (Brevi-tal) and thiopental sodium (Pentothal). These agents are used as anesthetics and are administered intravenously. Barbiturates with short-to-intermediate duration of action are used for their sedative-hypnotic effect in the treatment of anxiety. These medications include amobarbital (Amytal), butabarbital (Butisol), sodium pentobarbital (Nembutal), and secobarbital (Seconal). 

No health hazards are known with the proper use of kava (Gruenwald et al. 1998). Kava has been approved by the German Commission E for treatment of anxiety and insomnia. In clinical studies of kava for anxiety, adverse effects were uncommon and did not differ across placebo and kava groups. There do not appear to be any studies published on the effects of acute overdosage with kava. Given its CNS depressant effects, it should not be taken with other similar drugs, including benzodiazepines, barbiturates. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Meprobamate was proposed before the introduction of benzodiazepines into medical practice. The exact mechanism of action of this drug is not known however, its effects on the CNS are more similar to the effects barbiturates than to benzodiazepines, but with shorter-lasting action. After the introduction of benzodiazepines into practice, the use of this drug became significantly less. Meprobamate is used primarily as a daytime anxiolytic in treating conditions of anxiety associated with everyday, usual, and common stress. Synonyms for this drug are cypron, equanil, stenzol, mepron, miltaun, and others. 

A significant advantage of the benzodiazepines over other central nervous system depressants (e.g., the barbiturates) is that they possess a much greater separation between the dose that produces sleep and the dose that produces death. This increased margin of safety has been one of the major reasons benzodiazepines have largely replaced the barbiturates and other types of sedative-hypnotics in the treatment of anxiety and insomnia. In addition, benzodiazepine aclministration is associated with few side effects. 

Benzodiazepines, barbiturates, and most older sedative-hypnotic drugs exert calming effects with concomitant reduction of anxiety at relatively low doses. In most cases, however, the anxiolytic actions of sedative-hypnotics are accompanied by some depressant effects on psychomotor and cognitive functions. In experimental animal models, benzodiazepines and older sedative-hypnotic drugs are able to disinhibit punishment-suppressed behavior. This disinhibition has been equated with antianxiety effects of sedative-hypnotics, and it is not a characteristic of all drugs that have sedative effects, eg, the... 

Benzodiazepines are a family of compounds that share the same basic chemical structure and pharmacological effects. Although the more famous members of this family are associated with treating anxiety (e.g., diazepam [Valium] see later in this chapter), several benzodiazepines are indicated specifically to promote sleep (Table 6-1). These agents exert hypnotic effects similar to those of nonbenzodiazepines—such as the barbiturates—but benzodiazepines are generally regarded as safer because there is less of a chance for lethal overdose.22 Benzodiazepines, however, are not without their drawbacks, and they can cause resid-... 

In this condition, ephedrine is used primarily as a chronic medication for mild or only moderately acute cases, especially in children. In severe asthma, the response to ephedrine is usually poor. Compared with epinephrine, ephedrine is less reliable, is slower in action and longer in duration, and probably more often produces undesirable side effects. The average dose is 25 to 50 mg, orally, repeated three or four times a day. Resistance often develops it may often be controlled by discontinuing the drug for a few days. In many patients, ephedrine produces anxiety, nervousness, and insomnia, so a barbiturate is often administered at the same time. Capsules containing either 15 mg of amobarbital, 25 mg of pentobarbital sodium, or 30 mg of phenobarbital in addition to 25 mg of ephedrine sulfate have been used in the past. 

The long-acting barbiturates phenobarbital (Luminal) and mephobarbital (Mebaral) are used medically to help a patient sleep. Another use is day-long sedation, a procedure that treats tension and anxiety. Furthermore, long-acting barbiturates are used with other drugs in the treatment of convulsive conditions like epilepsy. 

Kava. This anti-anxiety herb may react synergisti-cally with (enhancing the effect of) drugs that affect the central nervous system, such as alcohol, barbiturates, or prescribed anti-anxiety drugs. One patient was hospitalized from a reaction between Xanax and kava extract. Herbalists often recommend combinations of kava and St. John s wort to treat anxiety, but the safety of this combination has not been established. 

In addition to treating anxiety and insomnia, intravenous BZDs are used as a sedating agent in outpatient surgical procedures. The most commonly used BZD for this indication is the short-acting agent midazolam (Versed). There is a lower potential for respiratory suppression with midazolam than with the barbiturates. 

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