The document discusses sedative and hypnotic drugs. Sedatives decrease central nervous system activity and calm anxiety without causing drowsiness, while hypnotics produce drowsiness and force sleep by depressing the CNS. The effects depend on dose, with small doses causing sedation, medium doses causing hypnosis, and larger doses causing anesthesia. Common sedative drugs include barbiturates and benzodiazepines. Barbiturates such as phenobarbital are long-acting and were historically used as anticonvulsants and sedatives, but benzodiazepines like diazepam have largely replaced them due to lower addiction risk. Ultra short-acting barbiturates like th
The document discusses sedatives and hypnotics. It defines sedatives as drugs that decrease activity and excitement and produce calmness and drowsiness. Hypnotics are sedatives that higher doses that produce deep sleep. The document then covers the classification of various sedatives and hypnotics like benzodiazepines, barbiturates, alpha-2 adrenergic agonists, chloral derivatives, and paraldehydes. For each class, it discusses their mechanism of action, examples, pharmacological effects, pharmacokinetics, clinical uses and dosages.
This document discusses sedatives and hypnotics that act in the central nervous system. It defines insomnia, sedatives, and hypnotics. Sedatives and hypnotics are classified as either barbituric acid derivatives or benzodiazepines. Barbiturates act by potentiating the effects of the inhibitory neurotransmitter GABA at GABA receptors. Common barbiturates include phenobarbital and pentobarbital. Benzodiazepines also act by enhancing GABA effects and are safer than barbiturates. Common benzodiazepines include diazepam, chlordiazepoxide, and oxazepam. Both classes are used to treat insomnia
This document discusses sedatives and hypnotics, including their mechanisms of action, classifications, and examples. It focuses on barbiturates and benzodiazepines. Barbiturates act by enhancing GABA activity in the brain, leading to CNS depression. They are classified based on duration of action and therapeutic use. Common side effects include dependence and withdrawal. Benzodiazepines also enhance GABA activity and are used as anxiolytics, for seizures, and to treat sleep disorders. They are classified based on duration of action from long to short acting.
This document summarizes information about sedatives and hypnotics. It defines sedatives as drugs that reduce excitement and motor activity without inducing sleep, while hypnotics induce and maintain sleep resembling natural sleep. Both cause central nervous system depression in a dose-dependent manner, from sedation to hypnosis to general anesthesia. Common hypnotics discussed include barbiturates, benzodiazepines, chloral hydrate, and other drugs. Their mechanisms of action, pharmacokinetics, uses, side effects, and overdose treatment are concisely described.
This document provides information on a presentation about sedatives and hypnotics given by Yogesh Matta. The presentation covered the objectives of learning about drug structure, chemistry, and therapeutic values. It discussed how sedatives calm patients while hypnotics induce sleep, and their sites of action and chemical classifications. Benzodiazepines and barbiturates were highlighted as examples. The presentation also reviewed structure-activity relationships of benzodiazepines and the synthesis of barbital. Finally, the therapeutic uses and example drugs for insomnia, anxiety, anesthesia, epilepsy, and muscle disorders were outlined.
Barbiturates are central nervous system depressants that were historically used as sedatives, hypnotics, and anticonvulsants. They work by enhancing the effects of the neurotransmitter GABA. While largely replaced by safer benzodiazepines, barbiturates are still used for certain medical purposes. Their structure is based on barbituric acid, with activity requiring lipophilic 5,5-disubstitutions for blood-brain barrier crossing. Mechanisms of action, classifications by duration, and metabolism pathways are described.
The document discusses sedative and hypnotic drugs. Sedatives decrease central nervous system activity and calm anxiety without causing drowsiness, while hypnotics produce drowsiness and force sleep by depressing the CNS. The effects depend on dose, with small doses causing sedation, medium doses causing hypnosis, and larger doses causing anesthesia. Common sedative drugs include barbiturates and benzodiazepines. Barbiturates such as phenobarbital are long-acting and were historically used as anticonvulsants and sedatives, but benzodiazepines like diazepam have largely replaced them due to lower addiction risk. Ultra short-acting barbiturates like th
The document discusses sedatives and hypnotics. It defines sedatives as drugs that decrease activity and excitement and produce calmness and drowsiness. Hypnotics are sedatives that higher doses that produce deep sleep. The document then covers the classification of various sedatives and hypnotics like benzodiazepines, barbiturates, alpha-2 adrenergic agonists, chloral derivatives, and paraldehydes. For each class, it discusses their mechanism of action, examples, pharmacological effects, pharmacokinetics, clinical uses and dosages.
This document discusses sedatives and hypnotics that act in the central nervous system. It defines insomnia, sedatives, and hypnotics. Sedatives and hypnotics are classified as either barbituric acid derivatives or benzodiazepines. Barbiturates act by potentiating the effects of the inhibitory neurotransmitter GABA at GABA receptors. Common barbiturates include phenobarbital and pentobarbital. Benzodiazepines also act by enhancing GABA effects and are safer than barbiturates. Common benzodiazepines include diazepam, chlordiazepoxide, and oxazepam. Both classes are used to treat insomnia
This document discusses sedatives and hypnotics, including their mechanisms of action, classifications, and examples. It focuses on barbiturates and benzodiazepines. Barbiturates act by enhancing GABA activity in the brain, leading to CNS depression. They are classified based on duration of action and therapeutic use. Common side effects include dependence and withdrawal. Benzodiazepines also enhance GABA activity and are used as anxiolytics, for seizures, and to treat sleep disorders. They are classified based on duration of action from long to short acting.
This document summarizes information about sedatives and hypnotics. It defines sedatives as drugs that reduce excitement and motor activity without inducing sleep, while hypnotics induce and maintain sleep resembling natural sleep. Both cause central nervous system depression in a dose-dependent manner, from sedation to hypnosis to general anesthesia. Common hypnotics discussed include barbiturates, benzodiazepines, chloral hydrate, and other drugs. Their mechanisms of action, pharmacokinetics, uses, side effects, and overdose treatment are concisely described.
This document provides information on a presentation about sedatives and hypnotics given by Yogesh Matta. The presentation covered the objectives of learning about drug structure, chemistry, and therapeutic values. It discussed how sedatives calm patients while hypnotics induce sleep, and their sites of action and chemical classifications. Benzodiazepines and barbiturates were highlighted as examples. The presentation also reviewed structure-activity relationships of benzodiazepines and the synthesis of barbital. Finally, the therapeutic uses and example drugs for insomnia, anxiety, anesthesia, epilepsy, and muscle disorders were outlined.
Barbiturates are central nervous system depressants that were historically used as sedatives, hypnotics, and anticonvulsants. They work by enhancing the effects of the neurotransmitter GABA. While largely replaced by safer benzodiazepines, barbiturates are still used for certain medical purposes. Their structure is based on barbituric acid, with activity requiring lipophilic 5,5-disubstitutions for blood-brain barrier crossing. Mechanisms of action, classifications by duration, and metabolism pathways are described.
This document discusses sedatives and hypnotics. It defines them as chemical substances that reduce tension, anxiety and induce calm or sleep. Most drugs have sedative effects at low doses and hypnotic (sleep inducing) effects at higher doses. Barbiturates are one class that act by potentiating GABA receptors in the brain. They have fallen out of favor due to risk of dependence and overdose. Benzodiazepines emerged as safer alternatives that also target GABA receptors. Other classes discussed include non-benzodiazepines, barbiturates, alcohols, and various other substances.
This document discusses sedative, hypnotic, and anxiolytic drugs. It describes barbiturates and benzodiazepines, which are commonly used as sedative-hypnotics. Barbiturates act by potentiating the inhibitory neurotransmitter GABA, while benzodiazepines facilitate GABA effects by binding to GABAA receptors. The document outlines the mechanisms, effects on sleep, and adverse effects of these drug classes. It also discusses newer nonbenzodiazepine hypnotics and the benzodiazepine antagonist flumazenil.
This document discusses sedative, hypnotic, and anxiolytic drugs. It describes barbiturates and benzodiazepines. Barbiturates were popular hypnotics and sedatives until the 1960s but are no longer used due to risks of overdose, dependence, and withdrawal effects. Benzodiazepines replaced barbiturates as they have a higher therapeutic index and are less likely to cause respiratory depression even at high doses. The document outlines the mechanisms, effects on sleep, and pharmacological properties of barbiturates and benzodiazepines.
Sedatives and Hypnotics
Pharmacology
Clinical uses
Sedation
Coping with stress and anxiety
Smoothing effects of stimulants
Potentiation of narcotics
Treatment of serious mental disorders
Pleasurable sensations, including intoxication
Classifications
Benzodiazepines
Diazepam, Clonazepam, Oxazepam, Clobazam, Clordiazepoxide, Midazolam
Barbiturates
Phenobarbitone, Amobarbital, Thiopental-Na
Newer drugs
Zolpidem, Zaleplon, Buspirone
Chloral hydrate
Paraldehyde
Diphenhydramine
Benzodiazepines
Properties
High therapeutic index (high LD50)
Relatively safe in overdose
Develop tolerance slowly
Less addiction liability
Benzodiazepines
Benzodiazepines
Most commonly prescribed Benzodiazepines
All Benzodiazepines are classified as Controlled Drugs in some countries.
Most are CD Schedule 4
Diazepam (Valium,Anxicalm)
Alprazolam (Xanax)
Bromazepam (Lexotan)
Clobazam (Frisium)
Lormetazepam (Noctamid)
Nitrazepam (Mogadon)
Clonazepam
Two are CD Schedule 3
Flurazepam (Rohypnol)
Temazepam (Nortem)
Structure Activity Relationship
In ring A an electron – withdrawing group such as Cl, Br, NO2 or CN at position 7.
A methyl Group is attached to the nitrogen atom in position 1 in ring B. However, substituents at position 1 that are metabolically are still clinically useful e.g. Flurazepam.
Replacement of the carbonyl function with two hydrogens in position 2 gives medazepam, less potent than diazepam.
Replacement of one of the hydrogen with a OH group on position 3 lower the activity on the one hand and aids elimination on the other.
Introduction of a carbonyl function in the 3 position increases the duration of action and also favours formation of water soluble salts.
e) α-pyridyl derivative and cycloalkyl substituent at 5 position give potent compounds.
f) Electronegative substituents such as Cl or F at the ortho and disubstituted in both ortho positions in ring C.
g) Derivatives with additional rings joining the diazepine nucleus at the 1 and 2 positions are generally more active than the corresponding 1-methylbenzodiazepines.
h) Replacement of the benzene ring by heteroaromatic (e.g. pyrazole) resulted in compounds with interesting anxiolytic properties ( e.g. ripazepam).
i) Saturation of the 4,5- double bond reduces potency, as does a shift of the unsaturation into the 3,4-position.
Barbiturates
Barbiturates
Barbiturates
Barbiturate poisoning
Treatment of Barbiturate poisoning
Buspirone
This document discusses sedative-hypnotic drugs. It defines sedatives as drugs that decrease central nervous system activity and anxiety without causing sleep, while hypnotics produce sleep. Sedative-hypnotics include both types of drugs. Key differences are outlined between sedatives and hypnotics in terms of their effects and doses needed. The mechanisms of action of barbiturates and benzodiazepines are described as facilitating the effects of the inhibitory neurotransmitter GABA. Various therapeutic uses are provided for barbiturates, benzodiazepines, and other sedative-hypnotic drugs.
The document discusses various classes of sedative and hypnotic drugs including benzodiazepines, barbiturates, and miscellaneous agents. It covers their structures, mechanisms of action, uses, and metabolism. Some key points discussed include how benzodiazepines act on GABA receptors to inhibit neuronal activity, the classification of barbiturates based on duration of action, and factors affecting the potency of barbiturates like acidity, lipid solubility, and structural properties.
A drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behavior.
Depending on the substance, psychoactive drugs can cause euphoria, increased energy, sleepiness, hallucinations, and more.
Examples of psychoactive substances include alcohol, caffeine, nicotine, marijuana, and certain pain medicines.
Many illegal drugs, such as heroin, LSD, cocaine, and amphetamines are also psychoactive substances. Also called psychotropic substance.
The document discusses various classes of sedative and hypnotic drugs including barbiturates, benzodiazepines, and newer non-benzodiazepine drugs. It describes the mechanism of action of these drugs as potentiating the effects of the inhibitory neurotransmitter GABA in the brain through binding to GABAA receptors or barbiturate sites. This results in increased chloride conductance, membrane hyperpolarization, and central nervous system depression. The document also provides structure-activity relationships and examples of specific drugs from each class like diazepam, zolpidem, and pentobarbital along with their medical uses, side effects, and synthesis when relevant.
Sedatives calm without sleep, hypnotics induce sleep. Benzodiazepines like diazepam are commonly used sedative-hypnotics with high safety indices. They act by enhancing GABA inhibition. Newer drugs like zolpidem act similarly but with less residual effects. Barbiturates were widely used previously but are no longer preferred due to risks of overdose and dependence. The goal of treatment is to reduce anxiety, induce sleep, and have minimal daytime effects.
This document summarizes sedatives and hypnotics, including their mechanisms of action and classifications. It discusses that sedatives calm without inducing sleep while hypnotics induce and maintain sleep. The main classes covered are barbiturates and benzodiazepines. Barbiturates act by potentiating GABA receptors but are no longer commonly used due to side effects like tolerance and dependence. Benzodiazepines also act through GABA receptors with fewer side effects and are still frequently prescribed as hypnotics, anxiolytics, anticonvulsants, and muscle relaxants.
This document discusses sedative-hypnotic drugs. It defines sedatives as drugs that decrease excitement and cause drowsiness without sleep, while hypnotics induce and maintain sleep. Different stages of sleep are described, along with the effects of sedative-hypnotics on sleep architecture. Benzodiazepines and barbiturates are provided as examples of sedative-hypnotic drugs and their mechanisms of action, effects, uses, and adverse effects are summarized. Non-benzodiazepine hypnotics such as zolpidem and zopiclone are also mentioned.
Barbiturates are a class of drugs that act as central nervous system depressants and were one of the first intravenous anesthetic agents used clinically, with thiopental and methohexital being two examples that are ultra short-acting and can be used for anesthetic induction. Barbiturates work by enhancing the effects of the inhibitory neurotransmitter GABA in the brain and have a variety of clinical uses but also potential adverse effects like respiratory depression if overdosed.
This document discusses sedative-hypnotics, including their classification, mechanisms of action, and uses. It covers barbiturates, benzodiazepines, and non-benzodiazepine hypnotics. Barbiturates were formerly used as hypnotics and sedatives but have mostly been replaced by benzodiazepines due to lower toxicity. Both barbiturates and benzodiazepines act by enhancing the effects of the inhibitory neurotransmitter GABA. Non-benzodiazepine hypnotics act through specific benzodiazepine receptors to induce sleep with fewer side effects than benzodiazepines. Hypnotics are used for short-term
Sedative-hypnotics are central nervous system depressants that reduce excitement and induce sleep. Common classes include barbiturates, benzodiazepines, and newer nonbenzodiazepine drugs. Barbiturates such as phenobarbital are no longer primarily used due to risk of dependence and withdrawal symptoms. Benzodiazepines like diazepam are now preferred for treatment of insomnia and anxiety. Sleep involves different stages including REM sleep, which is important for dreaming. Classification, mechanisms of action, uses, and adverse effects of sedative-hypnotics are described.
This document discusses sedatives and hypnotics, including their classification, mechanisms of action, pharmacokinetics, uses, and adverse effects. It covers barbiturates, benzodiazepines, and newer non-benzodiazepine hypnotics. Barbiturates and benzodiazepines act as depressants in the central nervous system by enhancing GABA activity. They are used as hypnotics to induce and maintain sleep, but have risks of tolerance, dependence, and withdrawal symptoms with chronic use. Newer non-benzodiazepine hypnotics like zolpidem, zopiclone, and zaleplon selectively target GABA receptors to
It contains classification, SAR, MOA, metabolism and usd of hypnotics and sedatives. Barbiturates and benzodiazepines were discussed as per PCI syllabus. This helps B.Pharm students to learn with focus
This document discusses sedatives and hypnotics. It defines them as chemical substances that reduce tension, anxiety and induce calm or sleep. Most drugs have sedative effects at low doses and hypnotic (sleep inducing) effects at higher doses. Barbiturates are one class that act by potentiating GABA receptors in the brain. They have fallen out of favor due to risk of dependence and overdose. Benzodiazepines emerged as safer alternatives that also target GABA receptors. Other classes discussed include non-benzodiazepines, barbiturates, alcohols, and various other substances.
This document discusses sedative, hypnotic, and anxiolytic drugs. It describes barbiturates and benzodiazepines, which are commonly used as sedative-hypnotics. Barbiturates act by potentiating the inhibitory neurotransmitter GABA, while benzodiazepines facilitate GABA effects by binding to GABAA receptors. The document outlines the mechanisms, effects on sleep, and adverse effects of these drug classes. It also discusses newer nonbenzodiazepine hypnotics and the benzodiazepine antagonist flumazenil.
This document discusses sedative, hypnotic, and anxiolytic drugs. It describes barbiturates and benzodiazepines. Barbiturates were popular hypnotics and sedatives until the 1960s but are no longer used due to risks of overdose, dependence, and withdrawal effects. Benzodiazepines replaced barbiturates as they have a higher therapeutic index and are less likely to cause respiratory depression even at high doses. The document outlines the mechanisms, effects on sleep, and pharmacological properties of barbiturates and benzodiazepines.
Sedatives and Hypnotics
Pharmacology
Clinical uses
Sedation
Coping with stress and anxiety
Smoothing effects of stimulants
Potentiation of narcotics
Treatment of serious mental disorders
Pleasurable sensations, including intoxication
Classifications
Benzodiazepines
Diazepam, Clonazepam, Oxazepam, Clobazam, Clordiazepoxide, Midazolam
Barbiturates
Phenobarbitone, Amobarbital, Thiopental-Na
Newer drugs
Zolpidem, Zaleplon, Buspirone
Chloral hydrate
Paraldehyde
Diphenhydramine
Benzodiazepines
Properties
High therapeutic index (high LD50)
Relatively safe in overdose
Develop tolerance slowly
Less addiction liability
Benzodiazepines
Benzodiazepines
Most commonly prescribed Benzodiazepines
All Benzodiazepines are classified as Controlled Drugs in some countries.
Most are CD Schedule 4
Diazepam (Valium,Anxicalm)
Alprazolam (Xanax)
Bromazepam (Lexotan)
Clobazam (Frisium)
Lormetazepam (Noctamid)
Nitrazepam (Mogadon)
Clonazepam
Two are CD Schedule 3
Flurazepam (Rohypnol)
Temazepam (Nortem)
Structure Activity Relationship
In ring A an electron – withdrawing group such as Cl, Br, NO2 or CN at position 7.
A methyl Group is attached to the nitrogen atom in position 1 in ring B. However, substituents at position 1 that are metabolically are still clinically useful e.g. Flurazepam.
Replacement of the carbonyl function with two hydrogens in position 2 gives medazepam, less potent than diazepam.
Replacement of one of the hydrogen with a OH group on position 3 lower the activity on the one hand and aids elimination on the other.
Introduction of a carbonyl function in the 3 position increases the duration of action and also favours formation of water soluble salts.
e) α-pyridyl derivative and cycloalkyl substituent at 5 position give potent compounds.
f) Electronegative substituents such as Cl or F at the ortho and disubstituted in both ortho positions in ring C.
g) Derivatives with additional rings joining the diazepine nucleus at the 1 and 2 positions are generally more active than the corresponding 1-methylbenzodiazepines.
h) Replacement of the benzene ring by heteroaromatic (e.g. pyrazole) resulted in compounds with interesting anxiolytic properties ( e.g. ripazepam).
i) Saturation of the 4,5- double bond reduces potency, as does a shift of the unsaturation into the 3,4-position.
Barbiturates
Barbiturates
Barbiturates
Barbiturate poisoning
Treatment of Barbiturate poisoning
Buspirone
This document discusses sedative-hypnotic drugs. It defines sedatives as drugs that decrease central nervous system activity and anxiety without causing sleep, while hypnotics produce sleep. Sedative-hypnotics include both types of drugs. Key differences are outlined between sedatives and hypnotics in terms of their effects and doses needed. The mechanisms of action of barbiturates and benzodiazepines are described as facilitating the effects of the inhibitory neurotransmitter GABA. Various therapeutic uses are provided for barbiturates, benzodiazepines, and other sedative-hypnotic drugs.
The document discusses various classes of sedative and hypnotic drugs including benzodiazepines, barbiturates, and miscellaneous agents. It covers their structures, mechanisms of action, uses, and metabolism. Some key points discussed include how benzodiazepines act on GABA receptors to inhibit neuronal activity, the classification of barbiturates based on duration of action, and factors affecting the potency of barbiturates like acidity, lipid solubility, and structural properties.
A drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behavior.
Depending on the substance, psychoactive drugs can cause euphoria, increased energy, sleepiness, hallucinations, and more.
Examples of psychoactive substances include alcohol, caffeine, nicotine, marijuana, and certain pain medicines.
Many illegal drugs, such as heroin, LSD, cocaine, and amphetamines are also psychoactive substances. Also called psychotropic substance.
The document discusses various classes of sedative and hypnotic drugs including barbiturates, benzodiazepines, and newer non-benzodiazepine drugs. It describes the mechanism of action of these drugs as potentiating the effects of the inhibitory neurotransmitter GABA in the brain through binding to GABAA receptors or barbiturate sites. This results in increased chloride conductance, membrane hyperpolarization, and central nervous system depression. The document also provides structure-activity relationships and examples of specific drugs from each class like diazepam, zolpidem, and pentobarbital along with their medical uses, side effects, and synthesis when relevant.
Sedatives calm without sleep, hypnotics induce sleep. Benzodiazepines like diazepam are commonly used sedative-hypnotics with high safety indices. They act by enhancing GABA inhibition. Newer drugs like zolpidem act similarly but with less residual effects. Barbiturates were widely used previously but are no longer preferred due to risks of overdose and dependence. The goal of treatment is to reduce anxiety, induce sleep, and have minimal daytime effects.
This document summarizes sedatives and hypnotics, including their mechanisms of action and classifications. It discusses that sedatives calm without inducing sleep while hypnotics induce and maintain sleep. The main classes covered are barbiturates and benzodiazepines. Barbiturates act by potentiating GABA receptors but are no longer commonly used due to side effects like tolerance and dependence. Benzodiazepines also act through GABA receptors with fewer side effects and are still frequently prescribed as hypnotics, anxiolytics, anticonvulsants, and muscle relaxants.
This document discusses sedative-hypnotic drugs. It defines sedatives as drugs that decrease excitement and cause drowsiness without sleep, while hypnotics induce and maintain sleep. Different stages of sleep are described, along with the effects of sedative-hypnotics on sleep architecture. Benzodiazepines and barbiturates are provided as examples of sedative-hypnotic drugs and their mechanisms of action, effects, uses, and adverse effects are summarized. Non-benzodiazepine hypnotics such as zolpidem and zopiclone are also mentioned.
Barbiturates are a class of drugs that act as central nervous system depressants and were one of the first intravenous anesthetic agents used clinically, with thiopental and methohexital being two examples that are ultra short-acting and can be used for anesthetic induction. Barbiturates work by enhancing the effects of the inhibitory neurotransmitter GABA in the brain and have a variety of clinical uses but also potential adverse effects like respiratory depression if overdosed.
This document discusses sedative-hypnotics, including their classification, mechanisms of action, and uses. It covers barbiturates, benzodiazepines, and non-benzodiazepine hypnotics. Barbiturates were formerly used as hypnotics and sedatives but have mostly been replaced by benzodiazepines due to lower toxicity. Both barbiturates and benzodiazepines act by enhancing the effects of the inhibitory neurotransmitter GABA. Non-benzodiazepine hypnotics act through specific benzodiazepine receptors to induce sleep with fewer side effects than benzodiazepines. Hypnotics are used for short-term
Sedative-hypnotics are central nervous system depressants that reduce excitement and induce sleep. Common classes include barbiturates, benzodiazepines, and newer nonbenzodiazepine drugs. Barbiturates such as phenobarbital are no longer primarily used due to risk of dependence and withdrawal symptoms. Benzodiazepines like diazepam are now preferred for treatment of insomnia and anxiety. Sleep involves different stages including REM sleep, which is important for dreaming. Classification, mechanisms of action, uses, and adverse effects of sedative-hypnotics are described.
This document discusses sedatives and hypnotics, including their classification, mechanisms of action, pharmacokinetics, uses, and adverse effects. It covers barbiturates, benzodiazepines, and newer non-benzodiazepine hypnotics. Barbiturates and benzodiazepines act as depressants in the central nervous system by enhancing GABA activity. They are used as hypnotics to induce and maintain sleep, but have risks of tolerance, dependence, and withdrawal symptoms with chronic use. Newer non-benzodiazepine hypnotics like zolpidem, zopiclone, and zaleplon selectively target GABA receptors to
It contains classification, SAR, MOA, metabolism and usd of hypnotics and sedatives. Barbiturates and benzodiazepines were discussed as per PCI syllabus. This helps B.Pharm students to learn with focus
Similar to Medicinal chemistry I- Unit 4A. sedative and hypnotics.pptx (20)
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4) Hydration of alkynes
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إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
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تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
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كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
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2. Defination
• A sedative drug decreases activity and
excitement of the patient and clams anxiety
by producing mild depression of CNS without
causing drowsiness or sleep
• A hypnotic drug produces drowsiness, forcing
the patient to sleep by depressing the CNS,
particularly the reticular activity which
influences wakefulness
Mr. Mote G.D, ADCBP, Ashta
3. Dose dependent activity
• All sedative, hypnotic and GA depress the CNS
• The observed effect depends on the dose
given to patient
• Small dose cause sedation (calmness)
• Medium dose cause hypnosis (sleepy)
• Largerdose causes surgical anesthesia
Mr. Mote G.D, ADCBP, Ashta
4. Utility
Sedatives counter various types of anxiety such as
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Specific phobias
Hypnotics is for insomnia. Insomnia is a condition
where person is not able to fall sleep
Mr. Mote G.D, ADCBP, Ashta
5. Ideal properties of hypnotics
1. Cause a temporary decrease in the level of
consciousness for the purpose of falling
asleep without any alteration to sleep cycle
2. Must not decrease or arrest respiration, even
at high doses
3. Cause no addiction, tolerance or dependence
Mr. Mote G.D, ADCBP, Ashta
7. Stage 1
Stage one begins when a person shifts from wakefulness to sleep. It is a
period of light non-REM sleep that slows down a person’s heart rate,
breathing, eye movements, and brain waves. The muscles also relax,
although they may twitch occasionally.
This stage is short and lasts for around 1–5 minutes.
Sleep Cycle
Mr. Mote G.D, ADCBP, Ashta
8. Stage 2
This is a period of deeper non-REM sleep, where the muscles relax further, eye
movements stop, and body temperature drops.
During the first sleep cycle of the night, this stage lasts for around 25 minutes,
lengthening with each new sleep cycle. Overall, it accounts for more than 50% of
sleep in adults.
Sleep Cycle
Mr. Mote G.D, ADCBP, Ashta
9. Stage 3
Stage 3 non-REM sleep is the deepest stage of sleep and the hardest to
awaken from. During this stage, heart rate, breathing, and brain waves
become regular.
A person will experience the most deep sleep during the first half of the
night. With each sleep cycle, the amount of deep sleep decreases.
This is the stage people typically find most difficult to wake from. If a person
wakes during deep sleep, they may feel mentally foggy for around 30–60
minutes. The overall percentage of deep sleep tends to decrease with age
Sleep Cycle
Mr. Mote G.D, ADCBP, Ashta
10. Stage 4
The last stage of the sleep cycle is REM sleep. The term “REM” refers to a
person’s eye movements. During this stage, the eyes move quickly and rapidly
from side to side.
During REM sleep, breathing quickens and becomes more erratic. Other vital
signs, such as blood pressure and heart rate, become less regular.
REM is the sleep stage most associated with dreaming,
Sleep Cycle
Mr. Mote G.D, ADCBP, Ashta
11. • sleep cycle : Sleep proceeds in cycles of light
sleep and deep sleep
• Light sleep – NREM sleep, lasts for about 90
mins
• Easy to wake in this period
• Deep sleep – REM sleep, last 5 to 10 mins
• Difficult to wake in this time
Mr. Mote G.D, ADCBP, Ashta
18. Barbiturates
• All derivatives of Barbituric acid
• They are CNS depressants. They are effective
as anxiolytics, hypnotics, anticonvulsants and
analgesics.
• They have addiction potential, both physical
and psychological.
• Thus Benzodiazipines have largely replaced
them in term of sedative-hypnotic
Mr. Mote G.D, ADCBP, Ashta
20. Factors effecting Duration of action as by the SAR
Phenobarbital Thiopental Sodium
Branched R group
Short ethyl chain
Total carbon = 2 (not counting
aromatic)
Long chain of R group
Total C = 7
Additional improvements to
Thiopental Sodium tofurther
decrease duration of action
•N methylation (potency also inc)
•Unsaturated R group
Mr. Mote G.D, ADCBP, Ashta
21. • Mode of action of barbiturates
1. They have positive allosteric effect at GABA
receptor. They bind at a different site than GABA
or Benzodiazepines and stimulate the
pharmacologic action of GABA which is the
principal inhibitory neurotransmitter in the CNS
2. They inhibit AMPA receptor, which binds
glutamate which is principal excitatory
neurotransmitter in the CNS
3. At higher does they inhibit Ca2+ dependent
release of neurotransmitters
Mr. Mote G.D, ADCBP, Ashta
23. • Allosteric drugs bind the receptor at different site. They can both
stimulate or inhibit the receptor function.
• Agonist can only stimulate the receptor function
• Antagonist can only inhibit the receptor function
Mr. Mote G.D, ADCBP, Ashta
24. Structure-Activity Relationship
• Barbituric acid itself does not possess any hypnotic
properties.
•Activity requires a balance of acidic and lipophilic properties.
To make the drug sufficiently acidic, both or at least one of
the two nitrogen must be unsubstituted
To make drug sufficiently lipophilic, the two hydrogen
atoms at position 5 : 5 must have the appropriate substituent
(e.g., alkyl or aryl groups)
The type of substituent's control 2 aspects of the drug
Potency
Duration of Action.
Mr. Mote G.D, ADCBP, Ashta
25. N NH
O
O O
HN NH
O
O O
HN NH
O
O O
HN NH
O
O O
Inactive inactive coz not lipophilic enough
R R R
R R
R
N N
O
O O
R
R
R R
Inactive coz not acidic enough
active
active
inactive
coz not lipophilic enough
Barbituric acid
Mr. Mote G.D, ADCBP, Ashta
26. the total number of carbon atoms present in the two groups
at carbon 5 must not be less than 4 and more than 10 and
influences onset of action and duration
Total carbon Duration of action
7-9 Rapid onset n shorter
duration
5-7 Intermediate duration
of action
4 Slowest onset and
longest duration of
action
Mr. Mote G.D, ADCBP, Ashta
27. Only one of the substituent groups at position 5 may be a
cyclic group.
C
N C
C
C
HN
C2H5
O
O
O
CH3
Methylepentobarbital
Mr. Mote G.D, ADCBP, Ashta
28. The branched chain isomer exhibits greater activity but
shorter duration. The greater the branching, the more potent
is the drug (e.g., pentobarbital > amobarbital).
This Branched, cyclic or unsaturated alkyl groups reduce
duration of action due to increased ease of metabolic
inactivation
Pentobarbital Amobarbital
Mr. Mote G.D, ADCBP, Ashta
29. (iv) Double bonds in the alkyl substituent groups produce
compounds more readily vulnerable to tissue oxidation ;
hence, they are short-acting.
Pentobarbital Sodium
Mr. Mote G.D, ADCBP, Ashta
30. Aromatic and alicyclic moieties exert greater potency than
the corresponding aliphatic moiety having the same number
of carbon atoms.
C
HN C
C
C
HN
C2H5
O
O
O
C
N
H
C
C
C
HN C2H5
O
O
O
1 2
3
4
5
6
1
2
3
4
5
6
more potent than
Mr. Mote G.D, ADCBP, Ashta
31. Short chains at carbon 5 resist oxidation and hence are
long-acting. Long chains are readily oxidized and thus produce
short-acting barbiturates.
Pentobarbital Sodium
Barbital
Mr. Mote G.D, ADCBP, Ashta
32. Inclusion of a halogen atom in the 5-alkyl moiety enhances
activity.
Inclusion of polar groups (e.g., OH, CO, COOH, NH2, RNH, and
SO3H) in the 5-alkyl moiety reduces potency considerably.
Methylation of one of the imide hydrogens enhances onset and
reduces duration of action
Methylepentobarbital
Mr. Mote G.D, ADCBP, Ashta
33. The replacement of O-atom with an S-atom, at C- 2 position
of the barbiturates significantly enhances the lipid solubility.
The resulting modified versions of the barbiturates thus
obtained exert a rapid onset of activity by virtue of the fact
that they attain maximal thiobarbiturate-brain levels.
Therefore, such drugs as ‘thiopental sodium’ find their profuse
and abundant application as ‘intravenous anaesthetics’.
Thiopental sodium
HC
HN C
C
C
HN
SNa
O
O
C2H5
CH
(CH2)2CH3
CH3
Mr. Mote G.D, ADCBP, Ashta
34. Inclusion of more sulphur atoms (at C-2 and C-6) decreases
activity. Likewise replacement of Oxygen with Nitrogen
abolishes activity
N N
NH
O O
R
R
R R
Inactive
Mr. Mote G.D, ADCBP, Ashta
35. Phenobarbital
• Phenobarbital or phenobarbitone is
a barbiturate which is most widely
used anticonvulsant worldwide and
the oldest still commonly used.
Phenobarbital
C
C
N
H
C
NH
C
O
O O
C2H5
Mr. Mote G.D, ADCBP, Ashta
36. • It also has sedative and hypnotic
properties but, as with other
barbiturates, has been outdated by the
benzodiazepines for these indications.
• first-line for partial and generalized tonic-
clonic seizures
• first line choice for the treatment of
neonatal seizures
Mr. Mote G.D, ADCBP, Ashta
37. • Sedation and hypnosis are the principal
side effects of phenobarbital. Also
dizziness, nystagmus and ataxia are
common.
• In elderly patients, it may cause
excitement and confusion while in
children, it may result in paradoxical
hyperactivity.
• Overdose may also lead to pulmonary
edema and acute renal failure
Mr. Mote G.D, ADCBP, Ashta
38. • It is one of the longest-acting
barbiturates available – it remains
in the body for a very long time
(half-life of 2 to 7 days) and has
very low protein binding
• Phenobarbital is metabolized by
the liver, mainly through
hydroxylation and glucuronidation
• It is excreted primarily by the
kidneys
Mr. Mote G.D, ADCBP, Ashta
39. Synthesis of
Phenobarbi
tone
Benzyl cyanide
i)Acid hydrolysid
ii) EtOH
C C
O
CH2
CH2 C
O
OC2H5
Ethyl phenyl acetate
EtOH
and Na
(-OC2H5)
Diethyl
oxalate
CH C OC2H5
O
C C OC2H5
O O
Distilled at 180O
C
(-CO)
H
C
C OC2H5
O
C OC2H5
O
CN
Phenyl malonic ester Diethyl phenyl-oxyalo-
acetate
C2H5-Br(ethyl bromide)
C2H5-ONa (sodium ethoxide)
C
C OC2H5
O
C OC2H5
O
C2H5
H2N
C
O
NH2
urea
-2 EtOH
Ethylphenyl malonic
ester
Phenobarbital
OC2H5
O
C2H5O
C
C
N
H
C
NH
C
O
O O
C2H5
-HBr
Mr. Mote G.D, ADCBP, Ashta
40. Thiopental sodium
•Ultra short acting barbiturate (5-10 mins)
•Rapid action (10 -15 sec) and rapid
recovery
•Used mainly as inducing anesthetic
• has no analgesic properties
• anesthetic state maintained by inhalation
anesthetic eg N20
•it is a poor muscle relaxant
HC
HN C
C
C
HN
NaS
O
O
C2H5
CH
(CH2)2CH3
CH3
Mr. Mote G.D, ADCBP, Ashta
41. • it possesses potent anticonvulsant activity it may
be given to treat epileptic seizures that do not
respond to other therapy.
• It is stored as a solid white salt and needs to be
prepared in sterile water to inject the patient
• Rapid recovery not due to rapid metabolism
• It is due to lowered concentration caused by
redistribution of drug from brain to blood. This is
made possible becoz of the salt form of drug
Mr. Mote G.D, ADCBP, Ashta
42. • Dose: 3 to 7 mg/kg.
• It does not have any direct toxic effects on
the liver or kidney
• Although it crosses the placenta it is a safe
agent for induction in pregnancy
Mr. Mote G.D, ADCBP, Ashta
43. Synthesis of Thiopental sodium
i) Preparation of Diethyl ester of ethyl-(1-methyl butyl)
malonic acid
C2H5 O C
C
O
O
O
C2H5
Na
C2H5 O C
C
O
O
O
C2H5
C2H5-Br
Ethyl Bromide
- NaBr
C2H5 O C
C
O
O
O
C2H5
C2H5
C-CH2-CH2-CH3
2-Bromopentane
- HBr
CH3
C2H5 O C
C
O
O
O
C2H5
C2H5
H
Sodium Metal
Diethyl
malonate
Diethyl ester of
ethyl malonic acid
C-CH2-CH2-CH3
CH3
Br
Diethyl ester of ethyl-
(1-methyl butyl)
malonic acid
H
H
Na
H
-H
Mr. Mote G.D, ADCBP, Ashta
44. ii) Preparation of Thiopental sodium
C2H5 O C
C
C
O
O
O
C2H5
C2H5
C-CH2-CH2-CH3
CH3
Diethyl ester of ethyl-
(1-methyl butyl)
malonic acid
C
NH2
NH2
S
HN
C
HN C
C
C
S
O
O
C2H5
- 2 EtOH
NaOH
N
C
HN C
C
C
HS
O
O
C2H5
C-CH2-CH2-CH3
CH3
C-CH2-CH2-CH3
CH3
Thiourea
Keto form
Enol form
HN
CH
HN C
C
C
NaS
O
O
C2H5
C-CH2-CH2-CH3
CH3
Thiopental sodium
Mr. Mote G.D, ADCBP, Ashta
45. Thiamylal
• Ultra short acting barbiturate
• Rapid action but not rapid recovery due to high
lipophilicity and subsequent drug accumulation in
the fatty tissues
• Used mainly as inducing anesthetic in lab animals
• anesthetic state maintained by inhalation
anesthetic eg N20
• Use limited to Veterinary field. Only its sodium
salt is used in humans
Mr. Mote G.D, ADCBP, Ashta
46. Benzodiazepines
• Chemically they are a fusion of a benzene
ring and a diazepine ring
• Benzodiazepines enhance the effect of the
GABA at the GABAA receptor, resulting in
sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety)
anticonvulsant, and muscle relaxant properties
•useful in treating anxiety, insomnia, seizures,
muscle spasms, alcohol withdrawal and preanesthetic
• are safer than barbiturate and not additive
Mr. Mote G.D, ADCBP, Ashta
47. MOA of benzodiazepines
1. They have positive allosteric effect at GABA receptor. They
bind at a different site than GABA or Benzodiazepines and
stimulate the pharmacologic action of GABA which is the
principal inhibitory neurotransmitter in the CNS
2. They block reuptake of Adenosine which is sedating
neurotransmitter, thus promoting its sedative action.
Attach to and directly block the Acetylcholine (ACh) receptors
in the hippocampus thus causing amnesia. (Hippocampus is
where memory is stored and processed. This is how date rape
drug Flunitrazepam works)
Mr. Mote G.D, ADCBP, Ashta
57. Types of benzodiazepines
Half life example
Long acting > 24 hrs Diazepam,Nitrazepam
chlordiazepoxide, flurazepam
Intermediate acting 12-24 hrs alprazolam, lorazepam
clonazepam, flunitrazepam,
Short acting < 1-12 hrs midazolam and triazolam.
Based on drug elimination (metabolism + kidney filtration),
3 category of benzodiazepines exist
longer-acting benzodiazepines are recommended for the
treatment of anxiety
Short- and intermediate-acting are preferred for the
treatment of insomnia;
Mr. Mote G.D, ADCBP, Ashta
58. Midazolam
• Midazolam has a rapid onset of action, high
effectiveness and low toxicity level and fast recovery
time
• Properties: It has potent anxiolytic, amnestic, hypnotic,
anticonvulsant, skeletal muscle relaxant, and sedative
properties
• Uses: Used for treatment of acute seizures, moderate
to severe insomnia and for inducing sedation and
amnesia before medical procedures
• used mostly as a premedication for sedation and less
commonly for induction or maintenance of anesthesia.
• MOA- alloteric GABAA enhancer
Mr. Mote G.D, ADCBP, Ashta
59. Diazepam
• Long acting benzodiazepine (>20 hrs)
• due to high blood protein binding of 98.5% which reduces rate of
elimination and it’s metabolic product is also active
• Properties: It has anxiolytic, anticonvulsant, hypnotic -
sedative, skeletal muscle relaxant, and amnestic properties
• Uses :anxiety, panic attacks, insomnia, seizures , muscle
spasms (such as in tetanus cases), restless legs syndrome, alcohol
withdrawal, opiate withdrawal syndrome
• Not used for long term epilepsy due to development of tolerance
• Avoid during pregnancy
• MOA – Allosteric GABAA enhancer
Mr. Mote G.D, ADCBP, Ashta
60. Lorazepam
• high-potency, intermediate acting
duration benzodiazepine drug
Properties: anxiolysis, short term
amnesia, sedation/hypnosis, anticonvulsion, muscle
relaxation
Uses:
• short-term treatment of anxiety, insomnia, acute
seizures, sedation of aggressive patients
• to decrease the likelihood of agitation and seizures in
patients who have overdosed on stimulant drugs
• lorazepam has advantage over diazepam, as in
– Better at ending seizures and
– more prolonged anticonvulsant effect
Mr. Mote G.D, ADCBP, Ashta
61. Lorazepam
• lorazepam is removed from the blood more
rapidly than many other benzodiazepines,
there is less chance that lorazepam
concentrations in blood will reach high levels
and become toxic
• MOA- alloteric GABAA enhancer
Mr. Mote G.D, ADCBP, Ashta
62. Alprazolam
• It belongs to intermediate acting benzodiazepine
• Properties: It has potent anxiolytic, amnestic, hypnotic,
anticonvulsant, skeletal muscle relaxant, and sedative
properties
• Main uses: Alprazolam is used for the treatment of
anxiety disorders and panic attacks
• can cause fetal abnormalities and should not be used
in pregnancy
• It is excreted in breast milk and should not be used by
women who are nursing
• MOA- alloteric GABAA enhancer
Mr. Mote G.D, ADCBP, Ashta
63. Nitrazepam
• A long acting benzodiazepine
• Properties: It has anxiolytic, anticonvulsant, hypnotic -
sedative, skeletal muscle relaxant,
and amnestic properties
• Uses: Nitrazepam is used to treat short-term sleeping
problems (insomnia) and short term management of
epilepsies
• Nitrazepam is not suitable for use in the elderly,
children, pregnant women, or those with chronic
obstructive pulmonary disease
• MOA- alloteric GABAA enhancer
Mr. Mote G.D, ADCBP, Ashta
64. Barbiturates vs Benzodiazepines
Barbiturates Benzodiazepines
They cause high physiological and
psychological dependence
They cause very less physiological and
psychological dependence
Long term use avoided due to toxicity Long term use is relatively safe
Sleep induced by it causes hangover
effect after waking up
Sleep induced by it is just like natural
sleep and is refreshing to wake up
Increase duration of GABA Cl channel
opening
Increase frequency of GABA Cl channel
opening
High Respiratory depression Manageable Respiratory depression
Mr. Mote G.D, ADCBP, Ashta
66. Different alpha units of GABAA have different effects
GABA A receptors containing
alpha 1 subunits are involved in
sleep.
GABA A receptors containing
alpha 2 or alpha 3 subunits are
involved in anxiety.
Mr. Mote G.D, ADCBP, Ashta
67. GABAA Alpha 1 Selective Hypnotics –
MOA of Zaleplon and Zolpidem
• The GABAA receptor contain 6 different alpha subunits
• Benzodiazepines bind to four of GABAA alpha
subunits: alpha 1, alpha 2, alpha 3 and alpha 5.
• Each of these subunits is associated with different
effects, and thus benzodiazepines not only cause
sedation but are also anxiolytic, cause muscle
relaxation, and have alcohol potentiating actions.
• The hypnotics zaleplon and zolpidem bind selectively
to GABA-A receptors that contain the alpha 1 subunit
(sleep).
Mr. Mote G.D, ADCBP, Ashta
68. Advantages over benzodiazepines
• A relatively short half life so one does not wake up
with a "hangover" the following day
• Having little effect on sleep staging, allowing the
individual to obtain approximately the same amount
of time in each stage of sleep as one would without
the medications
• Less likely to cause addiction, withdrawal, or
tolerance relative to older sleeping medications.
Mr. Mote G.D, ADCBP, Ashta
69. • These drugs are very lipophillic which
increases absorption into brain
• They are metabolized by liver into water
soluble metabolites which is rapidly cleared
out in urine and thus avoid accumulation
Zolpidem Zalephon
Mr. Mote G.D, ADCBP, Ashta
70. • Zalephon : hypnotic dose 6-10 mg
Used as hypnotic drug
Good at inducing sleep but not good at maintaining
it since it has short elimination half life
• Zolpidem : hypnotic dose 5-10 mg
Used as hypnotic drug
Slower acting but maintains effect overnight period
due to long elimination half life
Mr. Mote G.D, ADCBP, Ashta
71. Paraldehyde
• Paraldehyde is the cyclic trimer of acetaldehyde
molecules. It is a colorless liquid and sparingly
soluble in water and highly soluble in alcohol.
• Properties: It has an effective anticonvulsant,
hypnotic and sedative
• MOA:
Paraldehyde increases the effects of GABA, a
inhibitory neurotransmitter that depresses CNS, at
the GABAa receptor and decreases levels of
glutamate, which is stimulatory neurotransmitter
that excites CNS
Mr. Mote G.D, ADCBP, Ashta
72. Uses:
•to induce sleep, and is also used to calm psychiatric patients
•it is used to prevent hallucinations and tremors caused due to
alcohol withdrawal
•used to control seizures in infantsm not responding to
phenobarbitone and phenytoin,
• Unlike diazepam and other benzodiazepines, it does not
suppress breathing at therapeutic doses and so is safer when
the patient's breathing is already compromised.
•It is very addictive and Paraldehyde also can stress the
gastrointestinal tract so that a patient can develop ulcers
•Synthesis
•
H3C CH3
O
O O
O CH3
H3C
CH3
H2SO4
ACETALDEHYDE
PARALDEHYDE
Mr. Mote G.D, ADCBP, Ashta
73. Glutethimide
• Properties: sedative, hypnotic
• Use: was used for insomnia but rarely prescribed
today just as likely to cause addiction and caused
severe withdrawal symptoms as barbiturates.
• When taken with codeine, it stimulates metabolic
conversion of codeine into morphine, which is used
for its hallucinogenic effect
• MOA: It binds at the GABAa receptor which
increases the effects of GABA which is a inhibitory
neurotransmitter that depresses CNS
Mr. Mote G.D, ADCBP, Ashta
74. Synthesis of Glutethimide
• Glutethimide (2-ethyl-2-phenylgutarimide) is synthesized by addition of 2-phenylbutyronitrile
to the methylacrylate (Michael reaction), and the subsequent alkaline hydrolysis of the nitrile
group in the obtained compound into an amide group, and the subsequent acidic cyclization
of the product into the desired glutethimide
Mr. Mote G.D, ADCBP, Ashta
75. Chloral Hydrate
• Synthesis
4 Cl2 + C2H5OH + H2O → Cl3CCH(OH)2 + 5 HCl
Chloral hydrate is metabolized to trichloroethanol, which is
responsible for its physiological and psychological effects.
Higher doses can depress respiration and blood pressure.
Properties: seadtive, hypnotic
Use:
It has a very narrow therapeutic window making this drug difficult
to use. Instead benzodiazepines are preferred.
• short time (no more than 2 weeks) treatment of insomnia
• Used in organic synthesis as a reagent
MOA: It binds at the GABAa receptor which increases the effects
of GABA which is a inhibitory neurotransmitter that depresses
CNS
Cl C
Cl
Cl
CH
OH
OH
metabolized
Cl C
Cl
Cl
CH2
OH
Trichloroethanol
(Active compound)
Chloral Hydrate
Mr. Mote G.D, ADCBP, Ashta
76. Synthesis of Barbital
C
O
NH
HN
C
C
C
O
O
O O
H3C
CH3
H2C CH2
CH3 CH3
HN NH
O
H2C
CH2
CH3
CH3
O
O
+ CH3 CH2 OH
2
Sodium Ethoxide
H
H
Urea
2-,2 Diethyl malonate
Barbital
Mr. Mote G.D, ADCBP, Ashta
78. Existing Benzodiazepines are Non-selective
• Benzodiazepines bind to GABA-A alpha subunits: alpha 1, alpha 2, alpha 3 and
alpha 5.
• Each of these subunits is associated with different effects, and thus
benzodiazepines not only cause sedation but are also anxiolytic, cause muscle
relaxation, and have alcohol potentiating actions.
Mr. Mote G.D, ADCBP, Ashta
79. Location of RAS in brain
(no. 7)
RAS is brain centre for arousal and sleep cycle
Mr. Mote G.D, ADCBP, Ashta
Editor's Notes
Nystagmus /nɪˈstæɡməs/ is a condition of involuntary eye movement, Ataxia is neurological sign consisting of lack of voluntary coordination of muscle movements
Only lorazepam and midazolam show this effect
The main symptoms of delirium tremens are nightmares, agitation, global confusion, disorientation, visual and auditory hallucinations, fever, hypertension, diaphoresis, and other signs of autonomic hyperactivity (tachycardia and hypertension)