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Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

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Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

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Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
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Sedatives and Hypnotics Drugs: Barbiturates01:20

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Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
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Depressants01:28

Depressants

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Depressant drugs, including alcohol and sedative-hypnotics, diminish central nervous system activity by enhancing the action of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces brain activity and promotes relaxation. These substances can have various therapeutic uses but also pose significant risks, especially when misused or combined.
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Pharmacist-led sedative-hypnotic deprescribing in team-based primary care practice.

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A pharmacist-led program helped nearly two-thirds of patients stop or reduce sedative-hypnotic (SH) medications. Cognitive Behavioral Therapy for Insomnia (CBT-I) showed a trend toward improved outcomes in SH deprescribing.

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Area of Science:

  • Pharmacology
  • Geriatrics
  • Primary Care

Background:

  • Sedative-hypnotic (SH) medications are commonly prescribed for chronic insomnia.
  • Long-term use of SH medications carries potential risks and side effects.
  • Deprescribing these medications is crucial for patient safety.

Purpose of the Study:

  • To evaluate an interprofessional sedative-hypnotic (SH) deprescribing program.
  • To assess the program's effectiveness in a community primary care setting.
  • To explore the role of Cognitive Behavioral Therapy for Insomnia (CBT-I) in SH deprescribing.

Main Methods:

  • Retrospective chart review of patients referred for SH deprescribing.
  • Data collected from February 2016 to June 2019.
  • Analysis included patients who attempted deprescribing, with or without CBT-I.

Main Results:

  • 111 patients attempted SH deprescribing; 32% achieved complete abstinence, 32% reduced dosage by ≥50%.
  • Of those achieving abstinence, 72% remained abstinent at 6 months.
  • While higher with CBT-I, the difference in successful tapering (abstinence or ≥50% reduction) was not statistically significant (77% vs 62%).

Conclusions:

  • Pharmacist-led SH deprescribing programs can be effective, with nearly two-thirds achieving successful tapering.
  • The specific contribution of CBT-I to SH deprescribing requires further investigation.
  • Deprescribing efforts are vital for managing chronic insomnia and mitigating medication risks.