On the rapid and non-destructive approach for barbiturates, benzodiazepines, and phenothiazines determination and differentiation using spectral combination analysis and chemometric methods
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Sedative/hypnotic
Objective To determine the frequency of sleep-related complaints among institutionalized elderly subjects and to assess the relationship between perceived sleep quality and the use of sedative-hypnotic agents and other psychoactive medications. Methods In 12 nursing homes in Massachusetts, we conducted observational, cross-sectional, and longitudinal studies of 145 institutionalized elderly subjects (average age, 83.0 years; age range, 65 to 105 years). We recorded the patients' demographic characteristics and all medication use (both scheduled and as needed) during a 1-month baseline period. A research assistant who was blinded to diagnoses and medication use performed detailed neuropsychologic testing and administered a series of standardized questions concerning difficulty sleeping, early morning awakening, and time spent awake in bed. Medication use and patient assessments were repeated after a 6-month interval. Results One or more sleep-related complaints were present at baseline in 94 (65%) of the residents studied. Using logistic regression to adjust for potential confounding, we found no relationship in the baseline month between use of sedative-hypnotic agents and the presence or absence of sleep complaints. After 6 months of follow-up, 27 (19%) of the residents had decreased their use of sedative-hypnotic agents and 23 (16%) had increased their use. However, there was no relationship between decreased use of sedative-hypnotic agents and worsened sleep (p > 0.20) or between their increased use and improved sleep reports (p > 0.10). Improvement in functional status was significantly associated with improved sleep at follow-up (p < 0.005). Conclusions Sleep complaints occur in the majority of institutionalized elderly persons. Neither cross-sectional nor longitudinal analyses showed a relationship between patterns of sedative-hypnotic use and the presence, absence, or change in sleep complaints. Clinical Pharmacology & Therapeutics (1996) 59, 83–92; doi:
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Sedative-hypnotic medications are frequently prescribed for hospitalized patients with insomnia, but they can result in preventable harm such as delirium, falls, hip fractures, and increased morbidity. Furthermore, sedative-hypnotic initiation while in the hospital carries a risk of chronic use after discharge. Disrupted sleep is a major contributor to sedative-hypnotic use among patients in the hospital and other institutional settings. Numerous multicomponent studies on improving sleep quality in these settings have been described, some demonstrating an associated reduction of sedative-hypnotic prescriptions. This selected review summarizes effective interventions aimed at promoting sleep and reducing inappropriate sedative-hypnotic initiation and proposes an implementation strategy to guide quality improvement teams.
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In the human central nervous system, the gamma-aminobutyric acid (GABA) type A receptor complex undergoes changes with both acute and chronic exposure to sedative–hypnotic drugs. These changes contribute to both the acute effects of these drugs as well as the chronic effects of sedative–hypnotic dependence, withdrawal, and drug craving. Clinically these chronic effects are difficult to treat in patients dependent on ethanol or benzodiazepines. Valproate may return the GABA type A receptor function to a state more closely resembling its normal function. By this mechanism, it is possible to reduce the symptoms of sedative–hypnotic withdrawal and relapse.
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Objective:To investigate the sedative and hypnotic effects of Tianwang Buxin Wan(TWBXW)on mice model.Method: ICR rats were divided into five groups randomly,three dose groups of TWBXW(3.24,1.62,0.81 g·kg-1),control group and Annao Jianshen group.Spontancous locomotor activities of mice in five minutes,precentage of sleep,sleep latency,maintaining sleep were evaluated.The effects of TWBXW on spontaneous locomotor activities in normal mice group and yin deficiency mice group were observed.Hypnotic effects were assayed by cooperated with pentobarbital sodium.Result: There was no direct influence of TWBXW on the spontaneous locomotor activity in normal mice.But it could significantly decrease the spontaneous locomotor activity of mice with yin deficiency syndrome.TWBXW could reduce sleep latency and extend sleep time induced by pentobarbital sodium.Conclusion:TWBXW showed certain sedative and hypnotic effects.
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Although the metabolism and pharmacokinetics of chloral hydrate (CH) have been reported, there have been no attempts to correlate CH or its metabolite, trichloroethanol (TCE) with the sedative or hypnotic effects. In order to determine whether plasma concentrations of CH or TCE reflect the sedative/hypnotic effects, a sedation/agitation scale was developed. Based on the results of the present study, the sedative/hypnotic effects of TCE cannot be ruled out completely. However, in the neonate, the parent drug CH seems to have a more important role than has been previously suggested from human research.
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A retrospective analysis of sedative-hypnotic overdoses reported to the New York City Poison Control Center (NYCPCC) for the years 1988 and 1989 was performed to evaluate the effects of the triplicate benzodiazepine (BZ) prescription program on the incidence and severity of sedative hypnotic overdoses. Although total BZ overdoses fell slightly, from 1,294 in 1988 to 1,265 in 1989, a statistically significant increase in non-benzodiazepine (NBZ) sedative-hypnotic overdoses, from 111 in 1988 to 144 in 1989, was noted. No difference in clinical outcomes between the two years could be demonstrated. These results suggest that the restriction of BZ failed to reduce the incidence or severity of sedative-hypnotic overdose, largely because of the substitution of similar nonrestricted agents.
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Objective:To study the effect of sedative and hypnotic of Spina Date Seed extract on mice.Methods:Through direct sleep experiment,experiment and to extend the disappointment behavior observation of pentobarbital sodium mice sleep time experimental investigation Spina Date Seed extract on mice sedative and hypnotic effects.Results: Spina Date Seed extract on mice directly sleep function is weak,Date Seed extract enable mice activity decreases,extend sodium pentobarbital mice sleep time.Conclusions: Spina Date Seed extract have the effects of sedative and hypnotic.
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Dormison is a drug of a new type that, when used as a hypnotic, is highly efficient and relatively nontoxic and noncumulative. It is the hypnotic of choice in elderly, senile, and arteriosclerotic patients and it has definite advantages over other hypnotics in other types of patients. The hypnotic effect is highly specific, and Dormison is of little value as a sedative since toxic or near-toxic doses are required to produce an adequate sedative effect in disturbed patients. We have observed cumulative effects only when large doses were given as a sedative. The danger of addiction may be less than with other hypnotic-sedative drugs, as Dormison is ultra-short-acting and tends to lack their stupefying and euphorigenic action. Nevertheless, Dormison should not be given as a sedative to patients who have previously been addicted to other drugs, and it should be used as a hypnotic in these cases only under hospital conditions. In view of previous reports, and our findings on cumulation and addiction, barbiturates should not be given to patients receiving Dormison until such time as extensive data are available on the potentiating effect of Dormison on barbiturates in man.
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