姚晨玲－镇静催眠药中毒

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1、Toxicity,Sedative-Hypnotics中山急诊姚晨玲BackgroundSedative-hypnoticsareagroupofdrugsthatcauseCNSdepression.Benzodiazepines(BZD)barbituratesnonbarbituratenonbenzodiazepinesedative-hypnotics(NBNB)themostcommonlyusedagentsBackgroundacutesedative-hypnoticspoisoningwithdrawalsyndromeEtiologyBenzodiazep

2、ines(BZD)Longacting(halflife>30h):chlordiazepoxide(利眠宁)diazepam（地西泮、安定）flurazepam（氟安定）Shortacting(halflife6-30h):alprazolam(阿普唑仑)Ultrashortacting:triazolam(三唑仑)EtiologyBarbituratesUltrashortactingMethohexital(Brevital甲己炔巴比妥)thiopental(Pentothal硫喷妥那)Shortactingpentobarbital(Nembutal戊巴比妥)secob

3、arbital(Seconal司可巴比妥)IntermediateactingAmobarbital(Amytal异戊巴比妥)butalbital(Fioricet,Fiorinal异丁巴比妥)LongactingPhenobarbital(Luminal鲁米那)Nonbarbiturate,nonbenzodiazepinesedative-hypnotics(NBNB)Chloralhydrate(水合氯醛)Ethchlorvynol(乙氯维诺)Glutethimide(导眠能)Methyprylon(甲乙哌酮)Meprobamate(眠尔通)Etiology一、Pharm

4、acokinetics：1、PharmacokineticsoftheBZDMostBZDareextensivelymetabolizedbytheliver.Somearemetabolizedtoproductswhichareactiveandmayhaveamuchlongerhalflifethantheparentdrug.ThemajorrouteofmetabolismisN-demethylation.intheelderlyCimetidinePathogenesisPathogenesis2、PharmacokineticsofBarbituratesB

5、arbiturateswithlowlipidsolubilityareexcretedintheunchangedformbythekidneys.iephenobarbital（苯巴比妥）.Barbiturateswithhighlipidsolubilityaremetabolizedtomorepolarcompoundsintheliverbeforebeingexcretedviathekidneys.iethiopental（硫喷妥）.3、PharmacokineticsofNBNBMostNBNBareextensivelymetabolizedbytheliv

6、erPathogenesisBZDIntheCNS,benzodiazepinesexerttheirclinicaleffectbyenhancingtheactivityoftheinhibitoryneurotransmitterGABA.(TheclinicaleffectsofGABAreleaseandGABA-gatedchloridechannelsincludesleepinductionandexcitementinhibition)BarbituratesinprolongationofthedurationofopeningofGABA-gatedchl

7、oridechannels,leadingtohyperpolarizationofthemembraneandsuppressionofneurotransmission.。NBNBsimilartotheactionofBarbiturates二、ThemechanismofactionPathogenesisBZDGABAchloridechannelCl-Cl-＋＋＋＋＋－－－－－hyperpolarizationClinicalBenzodiazepineblurredvision