Tranquilizers, minor sedative-hypnotic

Minor tranquilizers and sedative-hypnotics are widely used in general medical practice and psychiatry. Although the benzodiazepines as a class are much safer than earlier medications (there is less risk of dependency and abuse, and withdrawal symptoms are generally much less dangerous than with barbiturates), problems do exist when patients begin to reduce doses, especially if they discontinue rapidly or "cold turkey." Benzodiazepine withdrawal sjmdromes are encoimtered frequently. They cause considerable patient distress, can be dangerous at times, and are almost always avoidable if the clinician follows the discontinuation guidelines carefully. 

Typically, antianxiety medications with short half-lives (see figure 16-A) are more likely to produce withdrawal symptoms (since the medications are more rapidly eliminated from the system). However, clearly, withdrawal can occur with all minor tranquilizers and sedative-hypnotics (with the exception of buspirone and possibly Zolpidem, which are chemical compounds unrelated to the benzodiazepines). 

Sedatives (also called hypnotics, sedative-hypnotics, minor tranquilizers, antianxiety agents) Secobarbital (barbiturate) Glutethimide (nonbarbiturate hypnotic) Diazepam (benzodiazepine antianxiety agent) Chloral hydrate (miscellaneous hypnotic) alcohol ( substance )... 

First use of sedative-hypnotic, or minor tranquilizer, bromide. 

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)... 

The term minor tranquilizer (which has been replaced by the more precise terms sedative-hypnotic or anxiolytic ) refers to drugs used to treat conditions such as insomnia and anxiety. Because they reduce anxiety and produce pleasantly sedating or tranquilizing effects, these drugs are more subject to abuse than the neuroleptics. 

The first sedative-hypnotic, or minor tranquilizer, bromide, originated in the 1860s. Bromides are long-acting sedatives that were rarely used past the turn of the nineteenth century however, bromide can still be found in Bromo Seltzer. The bromides are gastric irritants with a narrow safety margin and may cause a chronic toxicity known as bromism. 

Like the neuroleptics, all of the commonly used minor tranquilizers—with the possible exception of bus-pirone (BuSpar)—are CNS depressants. Unlike the neuroleptics, however, these drugs are called sedative-hypnotics because they produce relaxation (sedation) at lower doses and sleep (hypnosis) and eventually coma at higher ones. The anxiolytic (antianxiety) effect is merely an early stage of CNS depression. 

At high doses, both the major and minor tranquilizers are severely toxic and may cause coma, respiratory arrest, convulsions, acute renal failure, speech impairment, or death. However, at therapeutic doses, the neuroleptics have been associated with more severe, longterm side effects than the sedative-hypnotics. 

Minor tranquilizers. Some of the most commonly reported adverse effects of the sedative- hypnotics, particularly when used long-term, include ... 

Regular use of the sedative-hypnotics may result in tolerance—the need for increasing doses to achieve the same effect. Within two to four weeks, tolerance can develop to the sedative effect of minor tranquilizers taken at night for sleep. Thus, these drugs are not usually used prescribed for more than a few days at a time. 

The pharmaceutical industry has tried hard to convince doctors and patients that these chemicals arc revolutionary drugs that specifically reduce anxiety, making people calm and relaxed. In fact, the minor tranquilizers are just another variation on the theme of alcohol and other sedative-hypnotics, with the same tendency to produce adverse effects and dependence. 

Withdrawal from narcotics is also less hazardous than withdrawal from sedative-hypnotics. Alcohol, downers, and the minor tranquilizers can produce violent withdrawal, marked by convulsions and, sometimes, death. Narcotic withdrawal can be intensely unpleasant, but it is not life-threatening. 

Sedative-hypnotics A class of depressants that induces restfulness m low doses and sleep in higher doses. Alcohol, barbiturates, and the minor tranquilizers make up this class of drugs... 

Synonyms Minor tranquilizers Antianxiety drugs Sedative-hypnotics Benzodiazepines (BZDs)... 

CifiHijClNj. White plates m.p. 125 C. Diazepam is one of several benzodiazepines which are very widely used as minor tranquillizers for allaying anxiety, as hypnotics or, in sufficiently high dosage given intravenously, as pre-anaesthetic sedatives. 

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