• SEDATIVE is a drug that reduces excitement and
calms the person without inducing sleep.
• HYPNOTIC is a drug that produces sleep
resembling normal sleep.
• ANXIETY is characterized by
1.Psychological symptoms: tension, fear, lack of
2.Sympathetic and somatic symptoms: tachycardia,
tremors, sweating, GI distress.
• PHASES OF SLEEP:TWO Phases
1. Rapid eye movement REM sleep where
sympathetic system is activated.
2. Non REM sleep where parasympathetic is
• SLEEP DISORDERS
4.Sleep talking. All are treated with BDZ.
5.Insomnia (lack of sleep) sed.-hypnotics
6.Hypersomnia (excess sleep or narcolepsy)treated
7.Nocturnal enuresis treated with antidepressants
• Binds to specific site on GABA-A-BDZ
Receptor chloride channel complex.
• Potentiates inhibitory effect of GABA.
• Increase in frequency of opening of
• Increase in chloride conductance.
• Membrane hyperpolarization causing
• Usually given by oral route or I.V & occasionally by
rectal route in children.
• IM absorption is irregular& erratic.
• PPB is variable and they are widely distributed .
• They are metabolised in liver and some produce
• Metabolites are excreted in urine.
• DIAZEPAM: is used to
1. Control convulsions in status epilepticus (diazepam-drug
of first choice) but not to treat epilepsy as there is rapid
development of tolerance.
2. Treat Anxiety disorder
3. Treat Insomnia.
4. Skeletal muscle relaxant in spastic disorders
5. Treat Withdrawal effects of alcohol
6. As pre-anesthetic medication (diazepam)
USES OF OTHER BDZ
1. Induction and short term anesthesia ( midazolam )
2. As antidepressant ( Alprazolam)
• ALPRAZOLAM: In addition to antianxiety action it
also has antidepressant action. It is Short Acting
• MIDAZOLAM: Is also SA with potent amnesic
effect. Used as short term anesthetic and for induction
• BZD have wide margin of safety & well tolerated.
• Common side effects : Drowsiness, Confusion,
Blurred vision, Amnesia, disorientation, drug
tolerance and drug dependance.
• Withdrawal effects : Tremors, Insomnia, Restlessness,
Nervousness & loss of appetite.
• Teratogenic effect: (floppy baby syndrome) baby
may have respiratory depression and hypotonia.
• SEDATION &HYPNOSIS:
At present BDZ are preferred drugs for short term
1.have wide therapeutic index.
2.cause near normal sleep.
3.produce minimal hangover effect
• It competitively reverses the effects of BZD agonists
& also inverse agonists. ( Beta carbolines)
• It is given IV route and has rapid onset of action.
• It is used to reverse the BZD sedative effect during
anesthesia and also in BZD over dose as antidote.
• ADR: Nausea, Confusion, Dizziness & may
precipitate withdrawal symptoms (anxiety
• It is not used as sedative –hypnotic as they posses:
1.low therapeutic index.
2.marked respiratory depression.
4.high degree of tolerance and drug dependence.
5.there is no antidote available
• Thiopentone is used for induction anesthesia &
diagnostic aid in Psychiatry & Narcoanalysis.
• Phenobarbitone used as antiepileptic.
1. Airway ,Breathing and Circulation.
2. Electrolyte balance.
3. Gastric Lavage.
4. Alkaline diuresis giving IV sodium bicarbonate.
5. Haemodialysis in severe cases.
Note: No antidote available for barbiturates
NON BZD HYPNOTICS
• ZOLPIDEM: act on BDZ receptors &produce
hypnotic effect with minimal anticonvulsant and
• USED for short term insomnia as it is short acting.
• Well tolerated with minimal ADR like nausea,
vomiting, confusion, headache.
• Flumazenil antagonizes its action.
• ZOPICLONE: SAME AS ABOVE .Both are given
• MELATONIN: is used for jet lag given orally in the