1.
Drugs.com
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Drugs. com is an online pharmaceutical encyclopedia which provides drug information for consumers and healthcare professionals primarily in the USA. The domain Drugs. com was registered by Bonnie Neubeck in 1994. In 1999 at the height of the boom, Eric MacIver purchased an option to buy the domain from Neubeck. com. Venture Frogs sold the drugs. com domain name to an investor in June 2001. The Drugs. com website is owned and operated by the Drugsite Trust, the Drugsite Trust is a privately held Trust administered by two New Zealand pharmacists, Karen Ann and Phillip James Thornton The Drugs. com website was officially launched in September 2001. Stedmans, AHFS, Harvard Health Publications, Mayoclinic, North American Compendiums, in March 2008, Drugs. com announced the release of Mednotes —an online personal medication record application which connected to Google Health. In May 2010, U. S. FDA announced a collaboration with Drugs. com to distribute consumer health updates on the Drugs. com website, Drugs. com is certified by the TRUSTe online privacy certification program and the HONcode Health on the Net Foundation
2.
Gait (human)
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Human gait refers to locomotion achieved through the movement of human limbs. Different gait patterns are characterized by differences in limb movement patterns, overall velocity, forces, kinetic and potential energy cycles, human gaits are the various ways in which a human can move, either naturally or as a result of specialized training. Human gaits are classified in various ways, every gait can be generally categorized as either natural or trained. Examples of the latter include hand walking and specialized gaits used in martial arts, gaits can also be categorized according to whether the person remains in continuous contact with the ground. The so-called natural gaits, in increasing order of speed, are the walk, jog, skip, run, while other intermediate speed gaits may occur naturally to some people, these five basic gaits occur naturally across almost all cultures. All natural gaits are designed to propel a person forward, as natural gaits all have the same purpose, they are mostly distinguished by when the leg muscles are used during the gait cycle. The walk is a gait which keeps at least one foot in contact with the ground at all times, skipping is a gait children display when they are about four- to five-years-old. While a jog is similar to a horses trot, the skip is closer to the equivalent of a horses canter. The results reveal skipping as more efficient and less fatiguing than walking or running, antalgic gait, limping caused by pain that appears or worsens when bearing weight on one limb, due to injury, disease, or other painful conditions Charlie Chaplin gait, occurs in tibial torsion. For example, the nucleus is a nucleus of the brainstem that helps to control the planning. The PPN is connected extensively with other parts of the brain, including the spinal cord, cortex, and basal ganglia, these work together to plan, initiate. Some researchers classify foot strike by the center of pressure. In this classification, a strike has the initial center of pressure in the rear third of the shoe, a midfoot strike is in the middle third. Foot strike varies to some degree between strides, and between individuals and it varies significantly and notably between walking and running, and between wearing shoes and not wearing shoes. Typically, barefoot walking features heel or midfoot strike, while barefoot running features midfoot or forefoot strike, barefoot running rarely features heel strike because the impact can be painful, the human heel pad not absorbing much of the force of impact. The cause of change in gait in shoe running is unknown. In other cases, it is conjectured that the padding of the heel softens the impact and this was the first study that investigated the link between foot strike and injury rates. However, earlier studies have shown that smaller collision forces were generated when running forefoot strike compared to rear-foot strike and this may protect the ankle joints and lower limbs from some of the impact-related injuries experienced by rear-foot strikers
3.
Reflex
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A reflex action is the bodys movement in response to a stimulus. Scientific use of the term refers to a behavior that is mediated via the reflex arc. Eating, bathing, walking, running, and doing all that day to day activities that involves your muscles with brain are all voluntary actions, hiccups, digestion, coughing, sneezing, and breathing can also be considered involuntary. The stretch reflexes provide information on the integrity of the nervous system. Generally, decreased reflexes indicate a problem, and lively or exaggerated reflexes a central one. Newborn babies have a number of other reflexes which are not seen in adults and these automatic reactions to stimuli enable infants to respond to the environment before any learning has taken place. Others of these involve just a couple of synapses to function, processes such as breathing, digestion, and the maintenance of the heartbeat can also be regarded as reflex actions, according to some definitions of the term. In medicine, reflexes are often used to assess the health of the nervous system, doctors will typically grade the activity of a reflex on a scale from 0 to 4. While 2+ is considered normal, some individuals are hypo-reflexive and register all reflexes at 1+, while others are hyper-reflexive. List of reflexes All-or-none law Automatic behavior Conditioned reflex Involuntary action Voluntary action Preflexes
4.
Benzodiazepine
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Benzodiazepines, sometimes called benzos, are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. In 1977 benzodiazepines were globally the most prescribed medications, Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid at the GABAA receptor, resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. High doses of many shorter-acting benzodiazepines may also cause anterograde amnesia and these properties make benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures. Benzodiazepines are categorized as either short-, intermediate-, or long-acting, short- and intermediate-acting benzodiazepines are preferred for the treatment of insomnia, longer-acting benzodiazepines are recommended for the treatment of anxiety. Benzodiazepines are generally viewed as safe and effective for use, although cognitive impairment. A minority of people can have paradoxical reactions such as worsened agitation or panic, long-term use is controversial because of concerns about adverse psychological and physical effects, decreasing effectiveness, and physical dependence and withdrawal. As a result of adverse effects associated with the use of benzodiazepines, withdrawal from benzodiazepines, in general. There is controversy concerning the safety of benzodiazepines in pregnancy, Benzodiazepines can be taken in overdoses and can cause dangerous deep unconsciousness. However, they are less toxic than their predecessors, the barbiturates, when combined with other central nervous system depressants such as ethanol and opioids, the potential for toxicity and fatal overdose increases. Benzodiazepines are commonly misused and taken in combination with other drugs of abuse, most are administered orally, however, they can also be given intravenously, intramuscularly, or rectally. In general, benzodiazepines are well-tolerated and are safe and effective drugs in the term for a wide range of conditions. Tolerance can develop to their effects and there is also a risk of dependence and these factors, combined with other possible secondary effects after prolonged use such as psychomotor, cognitive, or memory impairments, limit their long-term applicability. The effects of use or misuse include the tendency to cause or worsen cognitive deficits, depression. The College of Physicians and Surgeons of British Columbia recommends discontinuing the usage of benzodiazepines in those on opioids, because of their effectiveness, tolerability, and rapid onset of anxiolytic action, benzodiazepines are frequently used for the treatment of anxiety associated with panic disorder. However, there is disagreement among expert bodies regarding the use of benzodiazepines for panic disorder. APA states that there is insufficient evidence to recommend any of the established panic disorder treatments over another, one advantage of benzodiazepines is that they alleviate the anxiety symptoms much faster than antidepressants, and therefore may be preferred in patients for whom rapid symptom control is critical. However, this advantage is offset by the possibility of developing benzodiazepine dependence, APA does not recommend benzodiazepines for persons with depressive symptoms or a recent history of substance abuse. Although major concerns about benzodiazepine tolerance and withdrawal have been raised, for many such patients stable doses of benzodiazepines retain their efficacy over several years
5.
Hypnotic
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This group is related to sedatives. Whereas the term sedative describes drugs that serve to calm or relieve anxiety, because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects they are often referred to collectively as sedative-hypnotic drugs. Hypnotic drugs are prescribed for insomnia and other sleep disorders. When prescribed, hypnotic medication should be used for the shortest period of time necessary, most hypnotics prescribed today are either benzodiazepines or nonbenzodiazepines. Among individuals with sleep disorders,13. 7% are taking or prescribed nonbenzodiazepines, while 10. 8% are taking benzodiazepines, early classes of drugs, such as barbiturates, have fallen out of use in most practices but are still prescribed for some patients. In children, prescribing hypnotics is not yet acceptable unless used to treat night terrors or somnambulism, falling outside of the above-mentioned categories, the neuro-hormone melatonin has a hypnotic function. Research about using medications to treat insomnia evolved throughout the last half of the 20th century, treatment for insomnia in psychiatry dates back to 1869 when chloral hydrate was first used as a soporific. Barbiturates emerged as the first class of drugs that emerged in the early 1900s, although the best drug family at the time they were dangerous in overdose. During the 1970s, quinazolinones and benzodiazepines were introduced as alternatives to replace barbiturates. Benzodiazepines are not without their drawbacks, substance dependence is possible, questions have been raised as to whether they disturb sleep architecture. Nonbenzodiazepines are the most recent development, although its clear that they are less toxic than their predecessors, barbiturates, comparative efficacy over benzodiazepines have not been established. Without longitudinal studies, it is hard to determine, however some psychiatrists recommend these drugs, other sleep remedies that may be considered sedative-hypnotics exist, psychiatrists will sometimes prescribe medicines off-label if they have sedating effects. Examples of these include mirtazapine, clonidine, quetiapine, and the over-the-counter sleep aid diphenhydramine, off-label sleep remedies are particularly useful when first-line treatment is unsuccessful or deemed unsafe. Barbiturates are drugs that act as central nervous system depressants, and can produce a wide spectrum of effects. They are also effective as anxiolytics, hypnotics, and anticonvulsants, barbiturates also have analgesic effects, however, these effects are somewhat weak, preventing barbiturates from being used in surgery in the absence of other analgesics. They have dependence liability, both physical and psychological, however, barbiturates are still used in general anesthesia, for epilepsy, and assisted suicide. Barbiturates are derivatives of barbituric acid, the principal mechanism of action of barbiturates is believed to be positive allosteric modulation of GABAA receptors. Examples include amobarbital, pentobarbital, phenobarbital, secobarbital, and sodium thiopental, quinazolinones are also a class of drugs which function as hypnotic/sedatives that contain a 4-quinazolinone core
6.
Sleep
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It is distinguished from wakefulness by a decreased ability to react to stimuli, but is more easily reversed than the state of being comatose. Sleep occurs in repeating periods, in which the body alternates between two distinct modes known as non-REM and REM sleep. Although REM stands for rapid eye movement, sleep affects other brain-body functions, during sleep, most systems are in an anabolic state, helping to restore the immune, nervous, skeletal, and muscular systems. The internal circadian clock promotes sleep daily at night, however, sleep patterns vary among individuals. In the last century, artificial light has substantially altered sleep timing in industrialized countries, the diverse purposes and mechanisms of sleep are the subject of substantial ongoing research. Sleep seems to assist with improvements in the body and mind, Research in the 21st century is investigating whether sleep is a period of maintenance for removing metabolic waste compounds from the brain. Sleep is sometimes confused with unconsciousness, but is different in terms of the thought process. REM and non-REM sleep are so different that physiologists classify them as distinct behavioral states, REM sleep is associated with desynchronized and fast brain waves, loss of muscle tone, and suspension of homeostasis. NREM is considered to be sleep, it shows no prominent eye movement or muscle paralysis. Sleep occurs in cycles of approximately 90 minutes and this rhythm is called the ultradian sleep cycle. Sleep proceeds in cycles of NREM and REM, normally in that order, the American Academy of Sleep Medicine divides NREM into three stages, N1, N2, and N3, the last of which is also called delta sleep or slow-wave sleep. The whole period normally proceeds in the order, N1 → N2 → N3 → N2 → REM, REM sleep occurs as a person returns to stage 2 or 1 from a deep sleep. An adult reaches REM approximately every 90 minutes, REM sleep usually lasts for longer during latter half of sleep than in the part of the sleep episode. There is an amount of deep sleep earlier in the night. Key physiological indicators in sleep include EEG of brain waves, electrooculography of eye movements, simultaneous collection of these measurements is called polysomnography, and can be performed in a specialized sleep laboratory. In other words, sleeping persons perceive fewer stimuli, however, they can generally still respond to loud noises and other salient sensory events. Awakening can mean the end of sleep, or simply a moment to survey the environment, sleepers typically awaken from slow-wave sleep, soon after the end of a REM phase or sometimes in the middle of REM. Internal circadian indicators, along with reduction of homeostatic sleep need, typically bring about awakening
7.
Alcohol (drug)
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Ethanol, also called alcohol, ethyl alcohol, and drinking alcohol, is the principal type of alcohol found in alcoholic beverages. It is a volatile, flammable, colorless liquid with a characteristic odor. Its chemical formula is C 2H 6O, which can be written also as CH 3-CH 2-OH or C 2H 5-OH, ethanol is mostly produced by the fermentation of sugars by yeasts, or by petrochemical processes. It is a psychoactive drug, causing a characteristic intoxication. It is widely used as a solvent, as fuel, and as a feedstock for synthesis of other chemicals, the eth- prefix and the qualifier ethyl in ethyl alcohol originally come from the name ethyl assigned in 1834 to the group C 2H 5- by Justus Liebig. He coined the word from the German name Aether of the compound C 2H 5-O-C 2H5, according to the Oxford English Dictionary, Ethyl is a contraction of the Ancient Greek αἰθήρ and the Greek word ύλη. The name ethanol was coined as a result of a resolution that was adopted at the International Conference on Chemical Nomenclature that was held in April 1892 in Geneva, Switzerland. The term alcohol now refers to a class of substances in chemistry nomenclature. The Oxford English Dictionary claims that it is a loan from Arabic al-kuḥl, a powdered ore of antimony used since aniquity as a cosmetic. The use of alcohol for ethanol is modern, first recorded 1753, the systematic use in chemistry dates to 1850. Ethanol is used in medical wipes and most common antibacterial hand sanitizer gels as an antiseptic, ethanol kills organisms by denaturing their proteins and dissolving their lipids and is effective against most bacteria and fungi, and many viruses. However, ethanol is ineffective against bacterial spores, ethanol may be administered as an antidote to methanol and ethylene glycol poisoning. Ethanol, often in high concentrations, is used to dissolve many water-insoluble medications, as a central nervous system depressant, ethanol is one of the most commonly consumed psychoactive drugs. The amount of ethanol in the body is typically quantified by blood alcohol content, small doses of ethanol, in general, produce euphoria and relaxation, people experiencing these symptoms tend to become talkative and less inhibited, and may exhibit poor judgment. Ethanol is commonly consumed as a drug, especially while socializing. The largest single use of ethanol is as a fuel and fuel additive. Brazil in particular relies heavily upon the use of ethanol as an engine fuel, gasoline sold in Brazil contains at least 25% anhydrous ethanol. Hydrous ethanol can be used as fuel in more than 90% of new gasoline fueled cars sold in the country, Brazilian ethanol is produced from sugar cane and noted for high carbon sequestration
8.
Death
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Death is the cessation of all biological functions that sustain a living organism. Bodies of living organisms begin to decompose shortly after death, other concerns include fear of death, necrophobia, anxiety, sorrow, grief, emotional pain, depression, sympathy, compassion, solitude, or saudade. The potential for an afterlife is of concern for some humans, the word death comes from Old English deað, which in turn comes from Proto-Germanic *dauthuz. This comes from the Proto-Indo-European stem *dheu- meaning the Process, act, when a person has died, it is also said they have passed away, passed on, expired, or are gone, among numerous other socially accepted, religiously specific, slang, and irreverent terms. Bereft of life, the person is then a corpse, cadaver, a body, a set of remains, and when all flesh has rotted away. The terms carrion and carcass can also be used, though more often connote the remains of non-human animals. As a polite reference to a person, it has become common practice to use the participle form of decease, as in the deceased. The ashes left after a cremation are sometimes referred to by the neologism cremains, senescence refers to a scenario when a living being is able to survive all calamities, but eventually dies due to causes relating to old age. Almost all animals who survive external hazards to their biological functioning eventually die from biological aging, some organisms experience negligible senescence, even exhibiting biological immortality. These include the jellyfish Turritopsis dohrnii, the hydra, and the planarian, unnatural causes of death include suicide and homicide. From all causes, roughly 150,000 people die around the world each day, physiological death is now seen as a process, more than an event, conditions once considered indicative of death are now reversible. Where in the process a dividing line is drawn between life and death depends on factors beyond the presence or absence of vital signs, in general, clinical death is neither necessary nor sufficient for a determination of legal death. A patient with working heart and lungs determined to be dead can be pronounced legally dead without clinical death occurring. As scientific knowledge and medicine advance, formulating a precise definition of death becomes more difficult. The concept of death is a key to understanding of the phenomenon. There are many approaches to the concept. For example, brain death, as practiced in medical science, One of the challenges in defining death is in distinguishing it from life. As a point in time, death would seem to refer to the moment at which life ends, determining when death has occurred requires drawing precise conceptual boundaries between life and death
9.
Antipsychotic
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Antipsychotics also known as neuroleptics or major tranquilizers, are a class of medication primarily used to manage psychosis, principally in schizophrenia and bipolar disorder. They are increasingly being used in the management of non-psychotic disorders, antipsychotics are usually effective in relieving symptoms of psychosis in the short term. The long-term use of antipsychotics is associated with effects such as involuntary movement disorders, gynecomastia. They are also associated with increased mortality in people with dementia. First-generation antipsychotics, known as typical antipsychotics, were discovered in the 1950s, both generations of medication tend to block receptors in the brains dopamine pathways, but atypicals tend to act on serotonin receptors as well. Neuroleptic, which originates from the Greek word νεῦρον neuron and λῆψις lepsis, is a reference to neurological side effects, antipsychotics are most frequently used for the following conditions, Schizophrenia Schizoaffective disorder most commonly in conjunction with either an antidepressant or a mood stabiliser. In this indication it is a practice for the psychiatrist to prescribe a combination of an atypical antipsychotic. Treatment-resistant major depression as an adjunct to antidepressant therapy. They are not recommended for dementia or insomnia unless other treatments have not worked and they are not recommended in children unless other treatments are not effective or unless the child has psychosis. The main effect of treatment with antipsychotics is to reduce the positive symptoms. There is mixed evidence to support a significant impact of antipsychotic use on negative symptoms or on the symptoms of schizophrenia. In general, the efficacy of treatment in reducing both positive and negative symptoms appears to increase with increasing severity of baseline symptoms. Used in combination with family history information, these tests can identify a high risk group having a 20–40% risk of progression to frank psychosis within 2 years. These patients are treated with low doses of antipsychotic drugs with the goal of reducing their symptoms. NICE recommends that all persons presenting with a first episode of frank psychosis be treated with both a drug and cognitive-behavioral therapy. NICE further recommends that those expressing a preference for CBT alone be informed that treatment is more efficacious. A diagnosis of schizophrenia is not normally made at this time, the goals of treatment of these patients include reducing symptoms and potentially improving long-term treatment outcomes. Evidence that early treatment has an effect on long term outcomes is equivocal
10.
Soporific
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This group is related to sedatives. Whereas the term sedative describes drugs that serve to calm or relieve anxiety, because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects they are often referred to collectively as sedative-hypnotic drugs. Hypnotic drugs are prescribed for insomnia and other sleep disorders. When prescribed, hypnotic medication should be used for the shortest period of time necessary, most hypnotics prescribed today are either benzodiazepines or nonbenzodiazepines. Among individuals with sleep disorders,13. 7% are taking or prescribed nonbenzodiazepines, while 10. 8% are taking benzodiazepines, early classes of drugs, such as barbiturates, have fallen out of use in most practices but are still prescribed for some patients. In children, prescribing hypnotics is not yet acceptable unless used to treat night terrors or somnambulism, falling outside of the above-mentioned categories, the neuro-hormone melatonin has a hypnotic function. Research about using medications to treat insomnia evolved throughout the last half of the 20th century, treatment for insomnia in psychiatry dates back to 1869 when chloral hydrate was first used as a soporific. Barbiturates emerged as the first class of drugs that emerged in the early 1900s, although the best drug family at the time they were dangerous in overdose. During the 1970s, quinazolinones and benzodiazepines were introduced as alternatives to replace barbiturates. Benzodiazepines are not without their drawbacks, substance dependence is possible, questions have been raised as to whether they disturb sleep architecture. Nonbenzodiazepines are the most recent development, although its clear that they are less toxic than their predecessors, barbiturates, comparative efficacy over benzodiazepines have not been established. Without longitudinal studies, it is hard to determine, however some psychiatrists recommend these drugs, other sleep remedies that may be considered sedative-hypnotics exist, psychiatrists will sometimes prescribe medicines off-label if they have sedating effects. Examples of these include mirtazapine, clonidine, quetiapine, and the over-the-counter sleep aid diphenhydramine, off-label sleep remedies are particularly useful when first-line treatment is unsuccessful or deemed unsafe. Barbiturates are drugs that act as central nervous system depressants, and can produce a wide spectrum of effects. They are also effective as anxiolytics, hypnotics, and anticonvulsants, barbiturates also have analgesic effects, however, these effects are somewhat weak, preventing barbiturates from being used in surgery in the absence of other analgesics. They have dependence liability, both physical and psychological, however, barbiturates are still used in general anesthesia, for epilepsy, and assisted suicide. Barbiturates are derivatives of barbituric acid, the principal mechanism of action of barbiturates is believed to be positive allosteric modulation of GABAA receptors. Examples include amobarbital, pentobarbital, phenobarbital, secobarbital, and sodium thiopental, quinazolinones are also a class of drugs which function as hypnotic/sedatives that contain a 4-quinazolinone core
11.
Club (weapon)
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A club is among the simplest of all weapons, a short staff or stick, usually made of wood, wielded as a weapon since prehistoric times. In popular culture, clubs are associated with cultures, especially cavemen. Most clubs are small enough to be swung with one hand, Various specialized clubs are used in martial arts and other fields, including the law-enforcement baton. The military mace is a more sophisticated descendant of the club, typically made of metal, the wounds inflicted by a club are generally known as bludgeoning or blunt-force trauma injuries. Police forces and their predecessors have traditionally favored the use, whenever possible, of weapons than guns or blades to impose public order or to subdue. Short, flexible clubs are often used, especially by plainclothes officers who need to avoid notice. These are known colloquially as blackjacks, saps, or coshes, in addition, Shaolin monks and members of other religious orders around the world have employed cudgels from time to time as defensive weapons. Though perhaps the simplest of all weapons, there are varieties of club, including. Aklys – a club with a leather thong, used to return it to the hand after snapping it at an opponent. Used by the legions of the Roman Empire, ball club – These clubs were used by the Native Americans. There are two types, the stone clubs that were used mostly by early Plains, Plateau and Southwest Native Indians. These consisted of a relatively free-moving head of rounded stone or wood attached to a wooden handle, baseball, cricket and T-ball bats – The baseball bat is often used as an improvised weapon, much like the pickaxe handle. In countries where baseball is not commonly played, baseball bats are often first thought of as weapons, tee ball bats are also used in this manner. Their smaller size and lighter weight make the bat easier to handle in one hand than a baseball bat, clava – a traditional stone hand-club used by Mapuche Indians in Chile, featuring a long flat body. In Spanish, it is known as clava cefalomorfa and it has some ritual importance as a special sign of distinction carried by the tribal chief. Cosh, A weapon made of covered metal similar to a blackjack, any of various sorts of blunt instrument such as bludgeon, truncheon or the like. Cudgel – A stout stick carried by peasants during the Middle Ages and it functioned as a walking staff and a weapon for both self-defence and wartime. Regiments of clubmen were raised as late as the English Civil War, the cudgel is also known as the singlestick
12.
Barbiturate
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A barbiturate is a drug that acts as a central nervous system depressant, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics, and anticonvulsants and these effects, however, are somewhat weak, and may react with a patients other medications or sedatives. This fact precludes barbiturates from being used in surgery or in the presence of other analgesics, in mice, barbiturates are hyperalgesic, increasing the sensitivity to pain. Barbiturates have addiction potential, both physical and psychological, Barbiturates are derivatives of barbituric acid. However, barbiturates are still used as anticonvulsants, as para-operative sedatives, Barbiturates in high doses are used for physician-assisted suicide, and in combination with a muscle relaxant for euthanasia and for capital punishment by lethal injection. Barbiturates are frequently employed as euthanizing agents in veterinary medicine. Thiopental is a barbiturate that is marketed under the name sodium pentothal. When dissolved in water, sodium amytal can be swallowed, or it can be administered by intravenous injection, the memory-impairing effects and cognitive impairments induced by the drug are thought to reduce a subjects ability to invent and remember lies. There are special risks to consider for older adults, women who are pregnant, when a person ages, the body becomes less able to rid itself of barbiturates. As a result, people over the age of sixty-five are at risk of experiencing the harmful effects of barbiturates, including drug dependence. When barbiturates are taken during pregnancy, the passes through the mothers gastric juice to her fetus. After the baby is born, it may experience withdrawal symptoms and have trouble breathing, in addition, nursing mothers who take barbiturates may transmit the drug to their babies through breast milk. A rare adverse reaction to barbiturates is Stevens-Johnson syndrome, which affects the mucous membranes. With regular use, tolerance to the effects of barbiturates develops, similar to benzodiazepines the longer acting barbiturates produce a less severe withdrawal syndrome than short acting and ultra short acting barbiturates. Withdrawal symptoms are dose-dependent with heavier users being affected worse than lower-dose addicts, mental cravings for barbiturates can last for months or years in some cases and counselling/support groups are highly encouraged by addiction specialists. The lethal dosage of barbiturates varies greatly with tolerance and from one individual to another, tolerance to the anticonvulsant effects tends to correlate more with tolerance to physiological effects, however, meaning that they are still a viable option for long-term epilepsy treatment. Barbiturates in overdose with other CNS depressants are even more due to additive CNS. The longest-acting barbiturates have half-lives of a day or more, Barbiturates induce a number of hepatic CYP enzymes, leading to exaggerated effects from many prodrugs and decreased effects from drugs which are metabolized by these enzymes to inactive metabolites
13.
Amobarbital
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Amobarbital is a drug that is a barbiturate derivative. It is a crystalline powder with no odor and a slightly bitter taste. It was first synthesized in Germany in 1923, if amobarbital is taken for extended periods of time, physical and psychological dependence can develop. Amobarbital withdrawal mimics delirium tremens and may be life-threatening, Amobarbital has been used in a study to inhibit mitochondrial electron transport in the rat heart. A1988 study found that amobarbital increases benzodiazepine receptor binding in vivo with less potency than secobarbital and pentobarbital and it has an LD50 in mice of 212 mg/kg s. c. Amobarbital undergoes both hydroxylation to form 3-hydroxyamobarbital, and N-glucosidation to form 1-amobarbital, anxiety Epilepsy Insomnia Wada test When given slowly by an intravenous route, sodium amobarbital has a reputation for acting as a so-called truth serum. Under the influence, a person will divulge information that under normal circumstances they would block, as such, the drug was first employed clinically by Dr. William Bleckwenn at the University of Wisconsin to circumvent inhibitions in psychiatric patients. The use of amobarbital as a truth serum has lost credibility due to the discovery that a subject can be coerced into having a memory of the event. The drug may be used intravenously to interview patients with catatonic mutism and it was used by the United States armed forces during World War II in an attempt to treat shell shock and return soldiers to the front-line duties. This use has since been discontinued as the powerful sedation, cognitive impairment, being chemically related to phenobarbital, it might also do the same thing to digitoxin, a cardiac glycoside. Amobarbital, like all barbiturates, is synthesized by reacting malonic acid derivatives with urea derivatives, in particular, in order to make amobarbital, α-ethyl-α-isoamylmalonic ester is reacted with urea. It has been used to convict alleged murderers such as Andres English-Howard and he was surreptitiously administered the drug by his lawyer, and under the influence of it he revealed why he strangled her and under what circumstances. A year later he confessed on the stand and was convicted on the basis of these statements. He later committed suicide in his cell, on the night of August 28,1951, Robert Walkers housekeeper found the actor in an emotional state. She called Walkers psychiatrist who arrived and administered amobarbital for sedation, walker was allegedly drinking prior to his emotional outburst, and it is believed the combination of amobarbital and alcohol resulted in a severe reaction. As a result, he passed out and stopped breathing, walker died at 32 years old. Street names for Amobarbital include blues, blue angles, blue birds, and blue devils
14.
Sodium thiopental
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Sodium thiopental, also known as Sodium Pentothal, thiopental, thiopentone, or Trapanal, is a rapid-onset short-acting barbiturate general anesthetic that is an analogue of thiobarbital. Sodium thiopental was a medicine in the World Health Organizations Essential Drugs List, which is a list of minimum medical needs for a basic healthcare system. Sodium thiopental is an ultra-short-acting barbiturate and has been used commonly in the phase of general anesthesia. Its use has largely replaced with that of propofol, but retains popularity as an induction agent for rapid sequence intubation. Following intravenous injection, the drug reaches the brain and causes unconsciousness within 30–45 seconds. At one minute, the drug attains a peak concentration of about 60% of the dose in the brain. Thereafter, the drug distributes to the rest of the body, a normal dose of sodium thiopental given to a pregnant woman for operative delivery rapidly makes her unconscious, but the baby in her uterus remains conscious. However, larger or repeated doses can depress the baby, instead, anesthesia is usually maintained with an inhaled anesthetic agent. Inhaled anesthetics are eliminated quickly, so that stopping the inhaled anesthetic will allow rapid return of consciousness. Sodium thiopental would have to be given in large amounts to maintain an anesthetic plane, in veterinary medicine, sodium thiopental is used to induce anesthesia in animals. Since it is redistributed to fat, certain breeds of dogs such as sight hounds will have prolonged recoveries from sodium thiopental due to their lack of body fat. Conversely, obese animals will have rapid recoveries, but it will be some time before it is removed from their bodies. Sodium thiopental is always administered intravenously, as it can be irritating, severe tissue necrosis. Sodium thiopental decreases the stroke volume, which results in a decrease in cardiac output. The decrease in cardiac output occurs in conjunction with a decrease in vascular resistance. However, in comparison with propofol, the reflex tachycardia seen during states of hypotension is relatively spared, in addition to anesthesia induction, sodium thiopental was historically used to induce medical comas. It has now superseded by drugs such as propofol because their effects wear off more quickly than thiopental. Patients with brain swelling, causing elevation of pressure, either secondary to trauma or following surgery
15.
Flunitrazepam
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Flunitrazepam, also known as Rohypnol among others, is an intermediate acting benzodiazepine used in some countries to treat severe insomnia and in fever, early in anesthesia. Just as with other hypnotics, flunitrazepam should be used only on a short-term basis or by those with chronic insomnia on an occasional basis. Flunitrazepam has been referred to as a date rape drug even though its incidence is rare in cases that have been reported. In countries where the drug is used, it is used for treatment of insomnia, and in some countries to begin anesthesia as well. Because of the latter, flunitrazepam is commonly used in suicide, when used in pregnancy, it might cause hypotonia. Flunitrazepam as with other benzodiazepines can lead to drug dependence and benzodiazepine withdrawal syndrome, discontinuation may result in the appearance of withdrawal symptoms when the drug is discontinued. Abrupt withdrawal may lead to a withdrawal syndrome characterised by seizures, psychosis, insomnia. Rebound insomnia, worse than baseline insomnia, typically occur after discontinuation of flunitrazepam even after short-term single nightly dose therapy, flunitrazepam produces a decrease in delta wave activity. The effect of drugs on delta waves, however, may not be mediated via benzodiazepine receptors. Delta activity is an indicator of depth of sleep within non-REM sleep, thus, flunitrazepam and other benzodiazepines cause a deterioration in sleep quality. Cyproheptadine may be superior to benzodiazepines in the treatment of insomnia as it enhances sleep quality based on EEG studies, paradoxical adverse effects may even lead to criminal behaviour. Benzodiazepines such as flunitrazepam are lipophilic and rapidly penetrate membranes and, therefore, use of benzodiazepines including flunitrazepam in late pregnancy, especially high doses, may result in hypotonia, also known as floppy baby syndrome. This may appear as lack of concentration, confusion and anterograde amnesia and it can be described as a hangover-like effect which can persist to the next day. It also impairs psychomotor functions similar to benzodiazepines and nonbenzodiazepine hypnotic drugs, falls. The combination with alcohol increases these impairments, partial, but incomplete tolerance develops to these impairments. Impairment of driving skills with a resultant increased risk of traffic accidents is probably the most important adverse effect. This side-effect is not unique to flunitrazepam but also occurs with other hypnotic drugs, flunitrazepam seems to have a particularly high risk of road traffic accidents compared to other hypnotic drugs. Extreme caution should be exercised by drivers after taking flunitrazepam, the use of flunitrazepam in combination with alcoholic beverages synergizes the adverse effects, and can lead to toxicity and death
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Nitrazepam
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Nitrazepam is a hypnotic drug of the benzodiazepine class, indicated for the short-term relief of severe, disabling anxiety and insomnia. It also has sedative and motor-impairing properties, as well as amnestic, anticonvulsant and it is marketed under the trade names, Alodorm, Apodorm, Arem, Insoma, Insomin, Mogadon, Nitrados, Nitrazadon, Nitrosun, Ormodon, Paxadorm, Remnos, and Somnite. Nitrazepam is used to treat short-term sleeping problems, namely difficulty falling asleep, frequent awakening, early awakening, Nitrazepam is sometimes tried to treat epilepsy when other medications fail. It has been found to be effective than clonazepam in the treatment of West syndrome. In uncontrolled studies, nitrazepam has shown effectiveness in infantile spasms and is considered when other anti-seizure drugs have failed. However, drowsiness, hypotonia, and most significantly tolerance to anti-seizure effects typically develop long term treatment. Unpleasant dreams and rebound insomnia have also been reported, Nitrazepam is a long-acting benzodiazepine with an elimination half-life of 15–38 hours. Less common side effects may include, Hypotension, faintness, palpitation, rash or pruritus, gastrointestinal disturbances, very infrequently, paradoxical reactions may occur, for example, excitement, stimulation, hallucinations, hyperactivity, and insomnia. Also, depressed or increased dreaming, disorientation, severe sedation, retrograde amnesia, headache, hypothermia, severe liver toxicity has also been reported. Tolerance to nitrazepams effects occurs with regular use, increased levels of GABA in cerebral tissue and alterations in the activity state of the serotoninergic system occur as a result of nitrazepam tolerance. Tolerance to the effects of nitrazepam occurs after about seven days. Nitrazepam can cause dependence, addiction, and benzodiazepine withdrawal syndrome, withdrawal from nitrazepam may lead to withdrawal symptoms which are similar to those seen with alcohol and barbiturates. Common withdrawal symptoms include anxiety, insomnia, concentration problems, discontinuation of nitrazepam produced rebound insomnia after short-term single nightly dose therapy. Benzodiazepines require special precautions if used in alcohol- or drug-dependent individuals and individuals with comorbid psychiatric disorders, Nitrazepam in doses of 5 mg or more causes significant deterioration in vigilance performance combined with increased feelings of sleepiness. Nitrazepam at doses of 5 mg or higher impairs driving skills and like other hypnotic drugs, in the elderly, nitrazepam is associated with an increased risk of falls and hip fractures due to impairments of body balance. The elimination half-life of nitrazepam is 40 hours in the elderly and 29 hours in younger adults, Nitrazepam is commonly taken in overdose by drug abusers or suicidal individuals, sometimes leading to death. Nitrazepam is teratogenic if taken in overdose during pregnancy with 30% of births showing congenital abnormalities and it is a popular drug of abuse in countries where it is available. Doses as low as 5 mg can impair driving skills, therefore, people driving or conducting activities which require vigilance should exercise caution in using nitrazepam or possibly avoid it altogether
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Oxazepam
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Oxazepam is used for the treatment of anxiety and insomnia and in the control of symptoms of alcohol withdrawal. Oxazepam was initially patented and marketed in 1965 and it is an intermediate-acting benzodiazepine with a slow onset of action, so it is usually prescribed to individuals who have trouble staying asleep, rather than falling asleep. It is commonly prescribed for anxiety disorders with associated tension, irritability and it is also prescribed for drug and alcohol withdrawal, and for anxiety associated with depression. Physicians may use oxazepam outside its approved indications to treat social phobia, post-traumatic stress disorder, insomnia, premenstrual syndrome, Oxazepam, as with other benzodiazepine drugs, can cause tolerance, physical dependence, addiction, and benzodiazepine withdrawal syndrome. Withdrawal from oxazepam or other benzodiazepines often leads to withdrawal symptoms which are similar to those seen during alcohol, the higher the dose and the longer the drug is taken, the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can occur, though, at standard dosages and also after short-term use, benzodiazepine treatment should be discontinued as soon as possible by a slow and gradual dose reduction regimen. Oxazepam is contraindicated in myasthenia gravis, chronic obstructive pulmonary disease, benzodiazepines require special precautions if used in the elderly, during pregnancy, in children, alcohol- or drug-dependent individuals, and individuals with comorbid psychiatric disorders. Benzodiazepines including oxazepam are lipophilic drugs and rapidly penetrate membranes, so rapidly crosses over into the placenta with significant uptake of the drug, use of benzodiazepines in late pregnancy, especially high doses, may result in floppy infant syndrome. Floppy infant syndrome and sedation in the newborn may also occur, symptoms of floppy infant syndrome and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth. As oxazepam is a metabolite of diazepam, an overlap in possible interactions is likely with other drugs or food. Precautions and following the prescription are required when taking oxazepam in combinations with antidepressant medication, concurrent use of these medicines can interact in a way that is difficult to predict. Drinking alcohol when taking oxazepam is not recommended, Oxazepam is generally less toxic in overdose than other benzodiazepines. Important factors which affect the severity of a benzodiazepine overdose include the dose ingested, the age of the patient, benzodiazepine overdoses can be much more dangerous if a coingestion of other CNS depressants such as opiates or alcohol has occurred. The half-life of oxazepam is four to 15 hours and it has been shown to suppress cortisol levels. Oxazepam is the most slowly absorbed and has the slowest onset of action of all the common benzodiazepines according to one British study, Oxazepam is an active metabolite formed during the breakdown of diazepam, nordazepam, and certain similar drugs. Oxazepam is similar to lorazepam in this respect, preferential storage of oxazepam occurs in some organs, including the heart of the neonate. Oxazepam exists as a racemic mixture, early attempts to isolate enantiomers were unsuccessful, the corresponding acetate has been isolated as a single enantiomer. Oxazepam has the potential for misuse, defined as taking the drug to achieve a high, benzodiazepines, including diazepam, oxazepam, nitrazepam, and flunitrazepam, accounted for the largest volume of forged drug prescriptions in Sweden from 1982 to 1986
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Clobazam
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Clobazam is a benzodiazepine that has been marketed as an anxiolytic since 1975 and an anticonvulsant since 1984. It is unclear if there are any benefits to clobazam over other medications for children with Rolandic epilepsy or other epileptic syndromes. As of 2005, clobazam is approved in Canada for add-on use in tonic-clonic, complex partial and it is also approved for treatment of anxiety. In India, clobazam is approved for use as a therapy in epilepsy and in acute. In Japan, clobazam is approved for adjunctive therapy in treatment-resistant epilepsy featuring complex partial seizures. It was not approved in the US until October 25,2011 and it is also approved for adjunctive therapy for epilepsy in patients who have not responded to first-line drugs and in children who are refractory to first-line drugs. It is not recommended for use in children between the ages of six months and three years, unless there is a compelling need. In addition to epilepsy and severe anxiety, clobazam is approved as a short-term adjunctive agent in schizophrenia. Clobazam is also available as a suspension in the UK. Clobazam is sometimes used for refractory epilepsies, however, long-term prophylactic treatment of epilepsy has considerable drawbacks, most importantly loss of antiepileptic effects due to tolerance which may render long-term therapy ineffective. Other antiepileptic drugs may therefore be preferred for the management of epilepsy. Common side effects include fever, lethargy or sleepiness, drooling, the risk of a fatal outcome is increased in cases of combined poisoning with other CNS depressants, including alcohol. Clobazam in animal studies has shown to increase reward seeking behaviours which may suggest an increased risk of addictive behavioural patterns. Significant clobazam abuse has been reported in countries, according to a 1983 World Health Organisation report. In humans tolerance to the anticonvulsant effects of clobazam may occur, clobazam as with other benzodiazepine drugs can lead to physical dependence, addiction and what is known as the benzodiazepine withdrawal syndrome. Withdrawal from clobazam or other benzodiazepines after regular use often leads to withdrawal symptoms which are similar to those seen during alcohol, the higher the dose and the longer the drug is taken for, the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can, however, occur from standard dosages and also after short-term use, benzodiazepine treatment should be discontinued as soon as possible via a slow and gradual dose reduction regimen. Clobazam is a 1, 5-benzodiazepine, meaning that its diazepine ring has nitrogen atoms at the 1 and 5 positions and it is not soluble in water and is available in oral form only
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Etizolam
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The etizolam molecule differs from a benzodiazepine in that the benzene ring has been replaced by a thiophene ring and triazole ring has been fused, making the drug a thienotriazolodiazepine. It possesses amnesic, anxiolytic, anticonvulsant, hypnotic, sedative, neuroleptic malignant syndrome, a rare event in benzodiazepine withdrawal, has been documented in a case of abrupt withdrawal from etizolam. This is particularly relevant given etizolams short half life relative to such as diazepam resulting in a more rapid drug level decrease in blood plasma levels. Administering.5 mg etizolam twice daily did not induce cognitive deficits over 3 weeks when compared to placebo, tolerance to the anticonvulsant effects of lorazepam was observed, but no significant tolerance to the anticonvulsant effects of etizolam was observed. Etizolam therefore has a liability to induce tolerance, and dependence. Etizolam, a derivative, is absorbed fairly rapidly, with peak plasma levels achieved between 30 minutes and 2 hours. It has an elimination half life of about 3.5 hours. Etizolam possesses potent hypnotic properties, and is comparable with other short-acting benzodiazepines, etizolam acts as a full agonist at the benzodiazepine receptor to produce its range of therapeutic and adverse effects. According to the Italian P. I. sheet, etizolam belongs to a new class of diazepines, thienotriazolodiazepines and this new class is easily oxidized, rapidly metabolized, and has a lower risk of accumulation, even after prolonged treatment. Etizolam has an anxiolytic action about 6 times greater than that of diazepam, etizolam produces, especially at higher dosages, a reduction in time taken to fall asleep, an increase in total sleep time, and a reduction in the number of awakenings. During tests, there were no changes in deep sleep, however. In EEG tests of healthy volunteers, etizolam showed some characteristics to tricyclic antidepressants. Etizolam is controlled in Denmark under the Danish Misuse of Drugs Act, etizolam was controlled in Germany in July 2013. Etizolam also called Depas, is restricted as an analog in Japan from October 2016 onwards. Unlike other thienodiazepines such as brotizolam and clotiazepam, etizolam is not controlled under the Misuse of Drugs Act 1971 or licensed as a medicine in the United Kingdom. Etizolam may, however, fall under the scope of the Psychoactive Substances Act 2016, thus making its importation. It could therefore be argued that Etizolam—at least, in its medicinal product form—would not fall under the scope of the Psychoactive Substances Act. Etizolam is not authorized by the FDA for medical use in the U. S. However, as of March 2016, etizolam is a controlled substance in the following states, Alabama, Arkansas, Florida, Mississippi, Virginia, and Georgia
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Nonbenzodiazepine
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Nonbenzodiazepines are a class of psychoactive drugs that are very benzodiazepine-like in nature. Nonbenzodiazepine pharmacodynamics are almost entirely the same as benzodiazepine drugs and therefore employ similar benefits, side-effects, however, nonbenzodiazepines have dissimilar or entirely different chemical structures and are therefore unrelated to benzodiazepines on a molecular level. Like the benzodiazepines, they exert their effects by binding to, many of these compounds are subtype selective providing novel anxiolytics with little to no hypnotic and amnesiac effects and novel hypnotics with little or no anxiolytic effects. Nonbenzodiazepines have demonstrated efficacy in treating sleep disorders, there is some limited evidence that suggests that tolerance to nonbenzodiazepines is slower to develop than with benzodiazepines. However, data is limited so no conclusions can be drawn, data is also limited into the long-term effects of nonbenzodiazepines. Further research into the safety of nonbenzodiazepines and long-term effectiveness of nonbenzodiazepines has been recommended in a review of the literature, some differences exist between the Z-drugs, for example tolerance and rebound effects may not occur with zaleplon. The first three nonbenzodiazepine drugs to enter the market were the Z-drugs, zopiclone, zolpidem and zaleplon and these three drugs are all sedatives used exclusively for the treatment of mild insomnia. This has led to the Z-drugs becoming widely prescribed for the treatment of insomnia particularly in elderly patients, a little under a third of all Americans over 65 years of age are taking Z-drugs. Long-term use is not recommended as tolerance and addiction can occur, efficacy also did not differ between benzodiazepine and Z drug users. While this effect is rare, it can be potentially hazardous, daytime withdrawal-related anxiety can also occur from chronic nightly nonbenzodiazepine hypnotic usage such as with zopiclone. Side-effects can differ within the class due to differences in metabolism. It has been claimed that insomnia causes depression and hypothesized that insomnia medications may help to treat depression, hypnotic drugs, therefore, may be contraindicated in patients suffering from or at risk of depression. Hypnotics were found to be likely to cause depression than to help it. Studies have found that users of sedative hypnotic drugs have a markedly raised suicide risk as well as an overall increased mortality risk. Cognitive-behavioral therapy for insomnia, on the hand, has been found to both improve sleep quality as well as general mental health. Treatment usually entails gradually reducing the dosage over a period of weeks or several months depending on the individual, dosage, if this approach fails, a crossover to a benzodiazepine equivalent dose of a long-acting benzodiazepine can be tried followed by a gradual reduction in dosage. In extreme cases and, in particular, where severe addiction and/or abuse is manifested, the review found that almost all trials of sleep disorders and drugs are sponsored by the pharmaceutical industry. The paper found that there is research into hypnotics that is independent from the drug manufacturers
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Hypnotics
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This group is related to sedatives. Whereas the term sedative describes drugs that serve to calm or relieve anxiety, because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects they are often referred to collectively as sedative-hypnotic drugs. Hypnotic drugs are prescribed for insomnia and other sleep disorders. When prescribed, hypnotic medication should be used for the shortest period of time necessary, most hypnotics prescribed today are either benzodiazepines or nonbenzodiazepines. Among individuals with sleep disorders,13. 7% are taking or prescribed nonbenzodiazepines, while 10. 8% are taking benzodiazepines, early classes of drugs, such as barbiturates, have fallen out of use in most practices but are still prescribed for some patients. In children, prescribing hypnotics is not yet acceptable unless used to treat night terrors or somnambulism, falling outside of the above-mentioned categories, the neuro-hormone melatonin has a hypnotic function. Research about using medications to treat insomnia evolved throughout the last half of the 20th century, treatment for insomnia in psychiatry dates back to 1869 when chloral hydrate was first used as a soporific. Barbiturates emerged as the first class of drugs that emerged in the early 1900s, although the best drug family at the time they were dangerous in overdose. During the 1970s, quinazolinones and benzodiazepines were introduced as alternatives to replace barbiturates. Benzodiazepines are not without their drawbacks, substance dependence is possible, questions have been raised as to whether they disturb sleep architecture. Nonbenzodiazepines are the most recent development, although its clear that they are less toxic than their predecessors, barbiturates, comparative efficacy over benzodiazepines have not been established. Without longitudinal studies, it is hard to determine, however some psychiatrists recommend these drugs, other sleep remedies that may be considered sedative-hypnotics exist, psychiatrists will sometimes prescribe medicines off-label if they have sedating effects. Examples of these include mirtazapine, clonidine, quetiapine, and the over-the-counter sleep aid diphenhydramine, off-label sleep remedies are particularly useful when first-line treatment is unsuccessful or deemed unsafe. Barbiturates are drugs that act as central nervous system depressants, and can produce a wide spectrum of effects. They are also effective as anxiolytics, hypnotics, and anticonvulsants, barbiturates also have analgesic effects, however, these effects are somewhat weak, preventing barbiturates from being used in surgery in the absence of other analgesics. They have dependence liability, both physical and psychological, however, barbiturates are still used in general anesthesia, for epilepsy, and assisted suicide. Barbiturates are derivatives of barbituric acid, the principal mechanism of action of barbiturates is believed to be positive allosteric modulation of GABAA receptors. Examples include amobarbital, pentobarbital, phenobarbital, secobarbital, and sodium thiopental, quinazolinones are also a class of drugs which function as hypnotic/sedatives that contain a 4-quinazolinone core
. PMID 11468961.