镇静催眠药毒课件.pptVIP

Toxicity, Sedative-Hypnotics  Background Sedative-hypnotics are a group of drugs that cause CNS depression. Benzodiazepines (BZD) barbiturates nonbarbiturate nonbenzodiazepine sedative-hypnotics (NBNB) Background acute sedative-hypnotics poisoning withdrawal syndrome Etiology Etiology Barbiturates Ultrashort acting Methohexital (Brevital甲己炔巴比妥) thiopental (Pentothal硫喷妥那) Short acting pentobarbital (Nembutal戊巴比妥) secobarbital (Seconal司可巴比妥) Intermediate acting Amobarbital (Amytal异戊巴比妥) butalbital (Fioricet, Fiorinal异丁巴比妥) Long acting Phenobarbital (Luminal鲁米那) Nonbarbiturate, nonbenzodiazepine sedative-hypnotics (NBNB) Chloral hydrate (水合氯醛) Ethchlorvynol (乙氯维诺) Glutethimide (导眠能) Methyprylon (甲乙哌酮) Meprobamate (眠尔通) Pathogenesis Pathogenesis 2、Pharmacokinetics of Barbiturates Barbiturates with low lipid solubility are excreted in the unchanged form by the kidneys. ie phenobarbital（苯巴比妥）. Barbiturates with high lipid solubility are metabolized to more polar compounds in the liver before being excreted via the kidneys. ie thiopental （硫喷妥）. Pathogenesis 3、Pharmacokinetics of NBNB Most NBNB are extensively metabolized by the liver Clinical Benzodiazepine blurred vision, dizziness, confusion, drowsiness, anxiety, agitation, and unresponsiveness or coma. BZD overdose in itself is remarkably safe. most patients with benzodiazepine overdose can be managed in the ED and released home after appropriate care. When combined with other sedatives (most frequently alcohol), patients with benzodiazepine overdose can present with profoundly depressed levels of consciousness. . ? Clinical Barbiturates Mild intoxication is characterized by ataxia, incoordination, nystagmus, slurred speech, and altered level of consciousness. Moderate poisoning leads to respiratory depression and hyporeflexia. Severe poisoning leads to flaccid areflexic coma, apnea, and hypotension. Occasionally, hyperreflexia, rigidity, clonus, and Babinski signs are pres