Barbiturates addiction

GNS depressants are drugs that decrease brain activity, resulting in both behavioral and physiological changes. The effects of alcohol on coordination, speech, and cognitive functions are familiar to most people. The effects of barbiturates are similar to alcohol. In low doses, barbiturates act as sedatives increased doses have a hypnotic or sleep-inducing effect and stiU larger doses have anticonvulsant and anesthetic activity, and can lead to respiratory depression, coma, and death. Barbiturate addicts... 

Other types of medications may be used to treat people going through drug abuse treatment for anxiety that may develop or for any sort of psychological problems the patient may have. So while no drugs are available to directly treat barbiturate addiction, a patient suffering from barbiturate abuse... 

Like the barbiturates, the miscellaneous drugp sedative or hypnotic effects diminish after approximately 2 weeks. Ffersons taking these dragp for periods longer than 2 weeks may have a tendency to increase the dose to produce the desired effects (eg, sleep, sedation). Physical and psychological dependence may occur, especially after prolonged use of high doses. However, their addictive potential appears to be less than that of the... 

Ibrahim RB, Wilson JG, Thorsby ME, et al Effect of buprenorphine on CYP3Aactivity in rat and human liver microsomes. Life Sci 66 1293—1298, 2000 Iguchi MY, Handelsman L, Bickel WK, et al Benzodiazepine and sedative use/abuse by methadone maintenance clients. Drug Alcohol Depend 32 257—266, 1993 Isbell H Manifestations and treatment of addiction to narcotic drugs and barbiturates. Med Clin North Am 34 423 38, 1950... 

The importance of producing pharmaceuticals in enantiomerically pure forms was brought to the public s attention with the thalidomide (Formula 4.2) tragedy in the early 1960s. Thalidomide, as a racemic mixture, was originally produced in 1953 as a sedative and a non-addictive alternative to barbiturates. It was later found that it alleviated many of the unpleasant symptoms of early pregnancy but by 1961 its use had been linked with an increase in the number of severe birth deformities and it was withdrawn. It... 

Secobarbital exhibits the same pharmacologic properties as other members of the barbiturate class. Most nonmedical use is with short-acting barbiturates, such as secobarbital. Although there may be considerable tolerance to the sedative and intoxicating effects of the drug, the lethal dose is not much greater in addicted than in normal persons. Tolerance does not develop to the respiratory effect. The combination of alcohol and barbiturates may lead to fatalities because of their combined respiratory depressive effects. Similar outcomes may occur with the benzodiazepines. Severe withdrawal symptoms in epileptic patients may include grand mal seizures and delirium. 

Monoamine Oxidase inhibitors (MAOis). Developed in the 1950s, the MAOIs were the first class of antidepressants. Subsequently, in the 1960s, the MAOis were also found to be effective anxiolytics. Unlike benzodiazepines and barbiturates, the MAOis are not addictive however, their onset of action is delayed not by minutes or hours but by 3 weeks or more. 

Due to their narrower margin of safety (risk of misuse for suicide) and their potential to produce physical dependence, barbiturates are no longer or only rarely used as hypnotics. Dependence on them has all the characteristics of an addiction (p. 210). 

Thalidomide was a sedative and a h)rpnotic that first went on sale in 1956 in West Germany. Between 1958 and 1960, it was introduced in 46 countries under 51 different trade names. It was first introduced in the UK market in April 1958 under the name Distaval. It enjoyed good sales because of its prompt action, lack of hangover and addiction observed with barbiturates, and apparent safety. 

Barbiturate sensitivity manifest or latent porphyria marked impairment of liver function severe respiratory disease when dyspnea or obstruction is evident nephritic patients patients with respiratory disease where dyspnea or obstruction is present intra-arterial administration subcutaneous administration previous addiction to the sedative/hypnotic group. 

Monitoring Perform baseline and follow-up LFTs (10 to 14 days) to detect hepatic dysfunction resulting from therapy. Perform a CBC and serum chemistries. Dependence and addiction Alcoholism may accompany or be followed by dependence on narcotics or sedatives. Barbiturates have been coadministered with disulfiram without untoward effects, but consider the possibility of initiating a new abuse. 

Deaths, cardiac and resp have been reported during initiation and conversion of pain pts to methadone Tx from Tx w/ other opioids Uses Severe pain detox w/ maint of narcotic addiction Action Narcotic analgesic Dose Adults. 2.5-10 mg IM q3-8h or 5-15 mg PO q8h titrate as needed Feds. 0.7 mg/kg/24 h PO or IM -s- q8h T slowly to avoid resp depression X in renal impair Caution [B/D (prolonged use/high doses at term), + (w/ doses =/> 20 mg/24 h)], severe liver Dz Disp Tabs, inj SE Resp depression, sedation, constipation, urinary retention, T QT interval, arrhythmias Interactions T Effects W/ cimetidine, CNS depressants, protease inhibitors EtOH T effects OF anticoagulants, antihistamines, barbiturates, glutethimide, methocarbamol ... 

The combination of pentazocine with the antihistamine tripelennamine results in a combination known to drug abusers as T s and blues. This combination produces heroinlike subjective effects, and heroin addicts use it in the absence of heroin. In addition, the use of pentazocine in combination with alcohol or barbiturates greatly enhances its sedative and respiratory depressant effects. 

The CNS depressants include barbiturates, nonbarbiturate sedatives, and the benzodiazepines. As the medical use of barbiturates decreased, primarily because of their high addiction liability and the danger of acute lethality, the use of the benzodiazepine anxiolytics increased. The most commonly abused barbiturates are secobarbital, pentobarbital, and amobarbital. Pheno-barbital is not generally abused, because of its slow onset of action. The most commonly abused anxiolytics include diazepam, chlordiazepoxide, midazolam, lo-razepam, and flurazepam. These drugs are readily attainable from illicit sources. 

All barbiturates (except phenobarbital) except when used to control seizures Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly patients. High... 

Historically, alcohol has been used as an anxiety-reducing agent, both casually and in professional medical settings. In 1903, barbital was introduced as the first barbiturate to treat anxiety, and phenobarbital followed a few years later. Barbiturates have many side effects and addictive properties, and overdose can lead to coma and death. For these reasons, they are rarely used today, except to treat some forms of epilepsy. This class of drugs was eventually replaced by the benzodiazepines (see Chapter 4). 

The principal disadvantages of barbiturates as hypnotics include the development of physical dependence, a relatively low therapeutic index (and the potential of poisoning, as in suicide), suppression of REM sleep, and possible hangover effects. As mentioned above, benzodiazepines (e.g., flurazepam or brotizolam) are hypnotics as effective as barbiturates and are much safer in terms of their therapeutic index, addiction potential, and REM sleep-deprivation effects. Thus benzodiazepines have displaced barbiturates as sedative hypnotics. 

The antipsychotics do not produce a ciassic withdrawai syndrome of the type seen with barbiturates or opioids nor do they produce psychological dependency, as seen with psychostimuiants (e.g., cocaine, amphetamine). Addicts and patients both dislike these drugs and do not spontaneously increase their dose. Indeed, they are more likely to discontinue them without medical advice. 

The variety of drugs found in the urine of fifty consecutive heroin addicts attending the clinic in East Dorset in 1986 is displayed in Table 6.1. Amphetamines and barbiturates were found to be the drugs which were most often taken inadvertently. Polydrug abuse remains a problem, as shown in Table 6.2. This lists all of the drugs identified in the urine of fifty-two patients on their first attendance at the clinic in East Dorset. Only in 54 per cent of cases was just one drug present the rest had two or more. 

Barbiturates, which preceded benzodiazepines as the most commonly abused sedative hypnotics (after ethanol), are now rarely prescribed to outpatients and therefore constitute a less common prescription drug problem than they did in the past. Street sales of barbiturates, however, continue. Management of barbiturate withdrawal and addiction is similar to that of benzodiazepines. 

Despite their beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed. 

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