Central Nervous System Depressants

1. Central Nervous System Depressants Alcohol Barbiturates Benzodiazepines Prescription Medications

2. CNS Depressants (prescription) • Valium • Librium • Ativan • Serax • Xanax • Tranzene • Klonopin

3. General Symptoms of Users • “Drunken” Behavior (lack of coordination, slurred speech, staggering • Confusion • Faulty Judgment • Emotional Lability • Irritability • Drowsiness • Hostility • Paranoid ideas

4. Route of Administration • Orally – pill (capsule or tablet) • Or mixed with water and injected

5. Physical Dependence Potential for moderate to high dependence

6. Tolerance Low to Moderate

7. Psychological Dependence Moderate to High Potential

8. Withdrawal • Must be monitored closely due to potential fatalities • Risk of seizures and delirium tremens • Prolonged symptoms can last for months, resolve, then reappear. Especially with Benzodiazepines (Valium, Librium, Tranzene, and Zanax).

9. Depressant Withdrawal – Stage I Tremors (shakes) occur in the morning after heavy use the night before Peak intensity is about 24-36 hours after last dose “Jitters”, irritability, nausea, vomiting, easily startled, facial flushing, rapid heart rate Loss of appetite insomnia, inattention, mildly disoriented, poor recent memory, sense of uneasiness.

10. CNS Depressant WithdrawalStage II • Hallucinations (disordered perceptions) vary in intensity • misinterpreted shadows and movements • Objects seeming distorted and unreal • May occur when the rest of the sensorium is clear, and seem intensely real.

11. CNS Depressant Withdrawal Stage III • Seizures (grand mal) • Bursts of 2-6 full body seizures • 90% occur 7-48 hours after the last drink • One third of patients with seizures will go on to develop delirium tremens

12. CNS Depressant Withdrawal Stage IV • Delirium Tremens (Profound Confusion, Delusions, Vivid Hallucinations, Tremor, Agitation, Sleeplessness, Dilated Pupils, Fever, Tachycardia, Profuse Perspiration • Usually occurs 3-5 Days after the last dose • Most cases mild, and end abruptly • Severe cases considered a medical emergency, and carry a 15% fatality rate • Single episode lasts 72 hours or less in 80% of the cases

13. Pharmacological Effects Alcohol (Ethanol):

14. Alcohol as a drug • Alcohol is a psychoactive drug that is a CNS depressant • Alcohol is the second most widely used and abuse of all psychoactive drugs Q. What drug is the most widely used and abused drug? A. Caffeine

15. Methyl alcohol poisonous Isopropyl alcohol poisonous Four types of alcohol Ethylene glycol poisonous Ethanol drinking alcohol

16. Physical effects of alcohol • The body is affected by alcohol in two ways: • Direct contact with mouth, esophagus, stomach, and intestine • Influence on almost every organ system in the body after entering the bloodstream

17. Physical Effects of Alcohol • Absorption is the process in which the drug molecules reach the bloodstream • The effects of alcohol on the human body depend on the amount of alcohol in the blood (BAC)

18. Physical effects of alcohol • BAC produced depends on the: 1. Presence of food in the stomach 2. Rate of alcohol consumption 3. Concentration of alcohol 4. Drinker’s body composition • Alcohol beverages have almost no vitamins, mineral, protein, or fat - just large amount of carbohydrates

19. Physical effects of alcohol • Alcohol can cause severe physical and psychological dependence 1. Cross-tolerance 2. Behavioral tolerance - compensation of motor impairments by chronic alcohol users through behavioral pattern modification

20. Blood alcohol level • Almost 95% of the consumed alcohol is inactivated by liver metabolism. • The liver metabolizes alcohol at a slow and constant rate and is unaffected by the amount ingested. • Thus, if on can of beer is consumed each hour, the blood alcohol level (BAL) will remain constant.

21. Blood alcohol level • Blood alcohol level (BAL) is the concentration of alcohol expressed as a percentage.

22. How alcohol is absorbed in the body

23. Short-term effects of alcohol • Low to moderate doses • Disinhibition • Social setting and mental state • Euphoric, friendly, talkative • Aggressive and hostile • Interfere with motor activity, reflexes, and coordination

24. Short-term effects of alcohol • Moderate quantities • Slightly increases in heart rate • Slightly dilates blood vessels in arms, legs, skin • Moderately lowers blood pressure • Stimulate appetite • Increases production of gastric secretions • Increases urine output

25. Short-term effects of alcohol • At higher doses • Difficulty in walking, talking, and thinking • Induces drowsiness and cause sleep • In large amounts - severe depression of the brain systems and motor control area of the brain

26. Large Doses of Alcohol • Uncoordination, confusion, & disorientation • Stupor, anesthesia, coma, and even death • Lethal level of alcohol is between 0.4 and 0.6% by volume in the blood

27. ? True of False ? • Drinking black coffee, taking a cold shower, or breathing pure oxygen will hasten the sobering up process • The type of alcohol beverage you drink can influence the hangover that results • Taking an aspirin-caffeine combination before drinking helps the sobering up process and the chances of having a hangover

28. Long-term effects of alcohol • Light or moderate drinking does little permanent harm (exception - FAS) • Heavy drinking • Seriously damages the heart • Kidney and liver damage • Mental disorders, irreversible damage to the brain and peripheral nervous system • Lowers resistance to pneumonia and other infectious diseases • Irritates the gastrointestinal tract

29. Principal control centers of the brain affected by alcohol

30. Alcohol and pregnancy • Women who are alcoholics or who drink heavily during pregnancy have a higher rate of spontaneous abortion. • Infants born to drinking mothers have a high probability of being afflicted with fetal alcohol syndrome.

31. Effects of alcohol on organ systems and bodily functions • Brain and nervous system • Liver • hepatotoxic effect • alcoholic hepatitis • cirrhosis • Digestive system

32. Effects of alcohol on organ systems and bodily functions • Blood • Cardiovascular system • alcoholic cardiomyopathy • Sexual organs • Endocrine system

33. Effects of alcohol on organ systems and bodily functions • Kidneys • Mental disorder and damage to the brain • Wernicke-korsakorr’s syndrome • The fetus (FAS) • Malnutrition

34. Barbiturates • Derivatives of barbituric acid • First synthesized in 1868 • Used as anticonvulsants and sedative hypnotics • High abuse liability • High lethal dose rate

35. Barbiturates • Used with other analgesic combinations (aspirin, codeine) for treatment of tension and migraine headaches • Phenobarbital and belladonna alkaloid combinations used to treat peptic ulcers and irritable bowel syndrome

36. Barbiturates - Medical Uses • Used as an anticonvulsant • Sedative Hypnotic • Detoxification medication for alcohol withdrawal syndrome

38. Route of Administration • Oral (pill form) • Intravenous • Intramuscular (shot)

39. Barbiturates - Short Term Effects • Relieve anxiety and restlessness, relax muscles, induce sleep • Reduce lung function (breathing), heart action, speech, and movement

40. Long-Term Effects • Cardiovascular – bradycardia, hypertension • Digestive System – nausea, vomiting, constipation • Nervous System – agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucination, insomnia, anxiety, dizziness, thinking abnormalities

41. Barbiturate – Long Term Effects • Reproductive System – cross the placental barrier and cause fetal abnormalities • Newborn withdrawal symptoms • Respiratory System – hypoventilation, apnea • Other Reactions - headache, injection site reactions, fever, liver damage, megablastic anemia (with long term use)

42. Tolerance • Develops quickly • Psychological tolerance develops more quickly than physical • Increased amounts approach lethal dosage • Metabolize faster in the liver as dosage increases

43. Half Life • Psychoactive chemicals have age dependent metabolism • Younger people tolerate a higher dose than older (over 50). • Half life = length of time in hours required for one half of the dose taken to be excreted from the body.

44. Toxicity/Overdose • Cold, clammy skin • Weak, rapid, shallow breathing • Combined with ETOH –suppression of respiratory center of brain • Dependence defined by amounts taken 8-10 times normal taken daily for 30 days • Death will occur if drowsiness, loss of consciousness, depressed breathing, and coma are left untreated.

45. Psychological Effects • Early - calming, tension reduction, • Middle – Euphoria, hypnotizing, impaired judgment, sense of “no worry” • Later – mood swings, depression, irritability, obnoxious behavior, manipulation, drug seeking

46. Withdrawal from Sedative Hypnotics • Within 6-8 hours of last dose • Can be life threatening if breathing and blood pressure problems untreated • Nausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremors • Withdrawal deaths more frequent than overdose deaths.

47. References - Material from this module was Developed from the following sources, which are recommended reading for the LADAC exam: • Basics Of Addiction Counseling: Desk Reference And Study Guide National Association for Addiction Professionalswww.naadac.org • National Institute of Drug Abusehttp://www.nida.nih.gov/ • National Institute of Alcohol Abuse and Alcoholismhttp://www.niaaa.nih.gov/