Hypnotics Health Dictionary

A large family of drugs used as HYPNOTICS, ANXIOLYTICS, TRANQUILLISERS, ANTICONVULSANTS, premedicants, and for intravenous sedation. Short-acting varieties are used as hypnotics; longer-acting ones as hypnotics and tranquillisers. Those with high lipid solubility act rapidly if given intravenously.

Benzodiazepines act at a speci?c centralnervous-system receptor or by potentiating the action of inhibitory neuro-transmitters. They have advantages over other sedatives by having some selectivity for anxiety rather than general sedation. They are safer in overdose. Unfortunately they may cause aggression, amnesia, excessive sedation, or confusion in the elderly. Those with long half-lives or with metabolites having long half-lives may produce a hangover e?ect, and DEPENDENCE on these is now well recognised, so they should not be prescribed for more than a few weeks. Commonly used benzodiazepines include nitrazepam, ?unitrazepam (a controlled drug), loprazolam, temazepam (a controlled drug) and chlormethiazole, normally con?ned to the elderly. All benzodiazepines should be used sparingly because of the risk of dependence.... benzodiazepines

Drugs for the relief of anxiety. They will induce sleep when given in large doses at night, and so are HYPNOTICS as well. Conversely, most hypnotics will sedate when given in divided doses during the day. Prescription of these drugs is widespread but physical and psychological DEPENDENCE occurs as well as TOLERANCE to their effects, especially among those with personality disorders or who abuse drugs and alcohol. This is particularly true of the BARBITURATES which are now limited in their use, but also applies to the BENZODIAZEPINES, the most commonly used anxiolytics and hypnotics. Withdrawal syndromes may occur if drug treatment is stopped too abruptly; hypnotic sedatives and anxiolytics should therefore not be prescribed indiscriminately, but reserved for short courses. Among the anxiolytics are the widely used benzodiazepines, the rarely used barbiturates, and the occasionally prescribed drugs such as BUSPIRONE and beta blockers like OXPRENOLOL (see BETA-ADRENOCEPTORBLOCKING DRUGS).... anxiolytics

A group of drugs which depress the CENTRAL NERVOUS SYSTEM by inhibiting the transmission of impulses between certain neurons. Thus they cause drowsiness or unconsciousness (depending on dose), reduce the cerebral metabolic rate for oxygen, and depress respiration. Their use as sedatives and hypnotics has largely been superseded by more modern drugs which are safer and more e?ective. Some members of this group of drugs – for instance, phenobarbitone – have selective anticonvulsant properties and are used in the treatment of GRAND MAL convulsions and status epilepticus (see EPILEPSY). The short-acting drugs thiopentone and methohexitone are widely used to induce general ANAESTHESIA. (See also DEPENDENCE.)... barbiturates

A drug with the trade name Rohypnol®, ?unitrazepam is one of the BENZODIAZEPINES with a prolonged action prescribed as a hypnotic (see HYPNOTICS). The British National Formulary warns that the drug may be particularly subject to abuse (see DRUG-ASSISTED RAPE).... flunitrazepam

See SLEEP, DISORDERS OF; HYPNOTICS.... insomnia

Substances that induce stupor and eventually UNCONSCIOUSNESS. Used in the relief of severe pain, people can become ?rst tolerant of them – so requiring larger doses – and then dependent (see also ANALGESICS; HYPNOTICS; TOLERANCE; DEPENDENCE).... narcotics

A tranquilliser introduced as a hypnotic. It is long-acting and may produce drowsiness next day. Addiction can occur. (See TRANQUILLISERS; HYPNOTICS; BENZODIAZEPINES.)... nitrazepam

A clear, colourless liquid with a penetrating ethereal (see ETHER) odour, paraldehyde may be given by mouth, rectally, or occasionally in intramuscular injection. The drug’s prime use is as a hypnotic (see HYPNOTICS) in mentally unstable patients. It is also indicated as an anticonvulsant in STATUS EPILEPTICUS (after initial intravenous DIAZEPAM) and in TETANUS. Its unpleasant taste restricts its use, but this has the advantage that it usually prevents the patient from becoming an addict.

Caution is needed when treating patients with bronchopulmonary disease or liver impairment; and intramuscular injection near the sciatic nerve should be avoided, as it may cause severe CAUSALGIA. Adverse effects include rashes; pain and sterile ABSCESS after intramuscular injection; rectal irritation after ENEMA.... paraldehyde

A?ecting the mind. Psychotropic drugs include HALLUCINOGENS, HYPNOTICS or sleeping drugs, sedatives, TRANQUILLISERS and NEUROLEPTICS (antipsychotic drugs).... psychotropic

Drugs and other measures which have a calming e?ect, reducing tension and anxiety. They include ANXIOLYTICS and HYPNOTICS (usually given in smaller doses than is needed to induce sleep).... sedatives

Sopori?cs are measures which induce SLEEP. (See also HYPNOTICS.)... soporifics

A benzodiazepine anxiolytic (see BENZODIAZEPINES; ANXIOLYTICS) derived from diazepam. To be used with care for short-term treatment of insomnia, generally associated with di?culty in falling asleep, frequent nocturnal awakening or early-morning awakening. Temazepam is a relatively quick-acting hypnotic of short duration, so – although there is little hangover the next morning compared with other hypnotics – there may still be some drowsiness and e?ect on skilled tasks such as driving. It should be avoided in elderly people who are at risk of becoming ataxic and so liable to falling and injuring themselves. Temazepam is often abused by drug addicts.... temazepam

(soporific) n. a drug that produces sleep by depressing brain function. Hypnotics include benzodiazepines (such as *loprazolam, *nitrazepam, and *temazepam) and drugs that act at benzodiazepine receptor sites, such as zaleplon, zolpidem, and zopiclone. Hypnotics are used for the short-term treatment of insomnia and sleep disturbances. Some of them (e.g. nitrazepam, *flurazepam) may cause hangover effects in the morning.... hypnotic

In?ammation of the LIVER which damages liver cells and may ultimately kill them. Acute injury of the liver is usually followed by complete recovery, but prolonged in?ammation after injury may result in FIBROSIS and CIRRHOSIS. Excluding trauma, hepatitis has several causes:

Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.

Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.

WILSON’S DISEASE.

Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).

Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.

Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.

Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.

Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.

•Hepatitis A virus (HAV) is an ENTEROVIRUS

which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.

Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.

Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.

Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.

Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic

viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.

As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.

Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around

0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).

Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:

Parenteral drug abusers.

Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.

Men who have sex with men.

Patients undergoing regular haemodialysis.

Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis

n. any of a group of drugs, derived from barbituric acid, that depress activity of the central nervous system and were formerly widely used as sedatives and hypnotics. They are classified into three groups according to their duration of action – short, intermediate, and long. Because they produce *tolerance and psychological and physical *dependence, have serious toxic side-effects (see barbiturism), and can be fatal following large overdosage, barbiturates have been largely replaced in clinical use by safer drugs. The main exception is the very short-acting drug *thiopental, which is used to induce anaesthesia. See also amobarbital; butobarbital; phenobarbital.... barbiturate

n. a drug that induces stupor and insensibility and relieves pain. Now largely obsolete in medical contexts, the term was used particularly for morphine and other derivatives of opium (see opiate) but also referred to other drugs that depress brain function (e.g. general anaesthetics and hypnotics). In legal terms a narcotic is any addictive drug subject to illegal use.... narcotic