Sedatives/hypnotics anxiolytics

Sedative/Hypnotic/Anxiolytic Abuse, Sedative/Hypnotic/Anxiolytic Dependence Polysubstance Dependence... 

Fixed dose combination of sedatives/hypnotics/ anxiolytics with analgesics-antipyretics. 

Available evidence indicates that systematic desensitization and in vivo exposure are the most effective treatment methods available. Pharmacological treatment has not been well investigated, but studies involving antidepressants suggest that TCAs and MAOIs are ineffective ( 85, 86 and 87). In addition, three studies suggest that sedative-hypnotic anxiolytics may undermine the behavioral treatment of specific phobias (88, 89 and 90). In another study, volunteers with animal phobias were exposed to their phobic object 1.5 hours after administration of either tolamolol, diazepam, or placebo in a double-blind crossover design. Tolamolol abolished the stress-induced tachycardia but had no beneficial behavioral or subjective effects ( 91). 

STREET NAMES Minor tranquilizers (benzodiazepines BZDs, tranks, downers, benzos, goofballs, happy pills, sedative-hypnotics, anxiolytics) (barbiturates Amys, barbs, blues, downers, yellow jackets, rainbows, red devils) (nonbarbiturate sedative-hypnotics ludes, Sopors)... 

Chlorazepate. See the detailed discussion of chloraze-pate (Tranxene) in the sedative-hypnotic-anxiolytic section. Its principal anticonvulsant use is adjunctively in complex partial seizures. 

Benzodiazepines. After the first phase of the launch of heterocyclic sedative-hypnotics, as exemplified by glutethimide and methyprylone, most significant milestones were reached by Roche. In 1960, Roche launched Librium (chlordiazepoxide)and in 1963, Valium (diazepam). These two compounds were the first two 1,4-benzodiazepine class compounds launched in the world. Subsequently a number of companies launched several other 1,4-benzodiazepines for a number of indications (sedative-hypnotic, anxiolytic, anticonvulsant, and muscle relaxant). 

Substance-induced persisting dementia (e.g., alcohol, inhalant, sedative, hypnotic, anxiolytic, or other substance)... 

Class selective a -adrenergic agonist with sedative, hypnotic, anxiolytic, analgesic and sympatholytic effects... 

Precedex , dexmedetomidine hydrochloride, is a selective a -adrenergic agonist with sedative, hypnotic, anxiolytic, and analgesic properties as well as marked sympatholytic effects with little or no respiratory depression. It is an imidazole derivative and the refined active d-isomer of medetomidine, an agent used in veterinary medicine as an anesthetic. 

Anticonvulsants or antiepileptics are agents that prevent epileptic seizures or modulate the convulsant episodes eflcited by seizure activity. Certain of these agents, eg, the BZs, are also hypnotics, anxiolytics, and sedatives, reinforcing the possibiUty of a common focus of action at the molecular level (1). 

Anxiolytics are compounds that act primarily to refleve the symptoms of anxiety although such agents can also be used as anticonvulsants, sedatives, hypnotics, and anesthetic agents (see Anesthetics). The principal class of anxiolytics, the BZs, shows dependence HabiUty (5) whereas newer agents such as buspkone [36505-84-7] and ritanserine [8705-43-2] produce antianxiety effects via central serotoninergic systems (6). 

Pharmacological Profiles of Anxiolytics and Sedative—Hypnotics. Historically, chemotherapy of anxiety and sleep disorders rehed on a wide variety of natural products such as opiates, alcohol, cannabis, and kawa pyrones. Use of various bromides and chloral derivatives ia these medical iadications enjoyed considerable popularity early ia the twentieth century. Upon the discovery of barbiturates, numerous synthetic compounds rapidly became available for the treatment of anxiety and insomnia. As of this writing barbiturates are ia use primarily as iajectable general anesthetics (qv) and as antiepileptics. These agents have been largely replaced as treatment for anxiety and sleep disorders. 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Benzodiazepiaes have largely replaced barbiturates and barbiturate-like agents for use as anxiolytics and sedative—hypnotics. Because benzodiazepiaes rarely produce levels of CNS depression that require therapeutic iatervention, the need for analeptics has decreased considerably. 

Benzodiazepines have found wide therapeutic applications as anxiolytics, sedatives, hypnotics, anticonvulsants, and central muscle relaxants. 

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

There are now indications for the interaction of progesterone metabolites with the Cl channel of the GABAa receptor (Fig. 52-7). The A-ring-reduced steroids, especially those with the 5a,3a configuration, are particularly active on the GABAa receptor [ 12]. By facilitating chloride-channel opening, these steroids produce anesthetic, anxiolytic and sedative-hypnotic effects (see Ch. 16). 

While the individual drugs in the benzodiazepine group differ in potency, all benzodiazepines in common use have anxiolytic, sedative-hypnotic, anticonvulsant and muscle-relaxant activity in ascending order of dose. The main clinical difference between the individual drugs lies in the time of onset of their therapeutic effect, and the intensity and duration of their clinical activity. 

---