Hypnotics (from Greek Hypnos , sleeping) or soporific supplements , commonly known as sleeping pills , is a class of drugs psychoactive drug whose primary function is to induce sleep and be used in the treatment of insomnia (sleeplessness), or surgical anesthesia.
This group is associated with sedatives . While the term "sedative" describes a drug that serves to soothe or alleviate anxiety, the term hypnotics generally describes a drug whose primary purpose is to start, maintain, or prolong sleep. Because these two functions often overlap, and since drugs in this class generally produce dose-dependent effects (from ansiolysis to loss of consciousness), they are often referred collectively as sedative-hypnotic drugs.
Hypnosis drugs are regularly prescribed for insomnia and other sleep disorders, with over 95% of hypnotic prescribed insomnia patients in some countries. Many hypnotic medicines make up the habit and, due to the large number of factors known to interfere with human sleep patterns, doctors may even recommend changes in the environment before and during sleep, better sleep hygiene, caffeine avoidance or other stimulants. , or behavioral interventions such as Cognitive Behavior Therapy for Insomnia (CBT-I) before prescribing sleep medications. When prescribed, hypnotic drugs should be used for the shortest period of time required.
Among individuals with sleep disorders, 13.7% took or determined nonbenzodiazepines, while 10.8% took benzodiazepines, in 2010. The initial class of drugs, such as barbiturates, is not used in most practices but is still prescribed for some patients. In children, hypnotic prescription is not acceptable unless it is used to treat night terrors or somnambulism. The elderly are more sensitive to the potential side effects of daytime fatigue and cognitive impairment, and meta-analysis finds that the risk is generally greater than the marginal benefit of hypnotics in the elderly. The literature review of benzodiazepine and Z-drug hypnotics concludes that these drugs can have side effects, such as dependence and accidents, and that optimal treatment uses the lowest effective dose for the shortest therapy period, with gradual cessation to improve health without worsening sleep.
Falling outside the category mentioned above, hormone-neuro-melatonin has hypnotic function.
Video Hypnotic
Histori
Hypnotics is a class of drugs and odd substances tested in medicine in the 1890s and later, including: Urethane, Acetal, Methyl, Sulfonal, Paraldehyde, Amylenhydrate, Hypnon, Chloralurethan and Ohloralamid or Chloralimid.
Research on using drugs to treat insomnia evolved throughout the last half of the 20th century. Treatment for insomnia in psychiatry began in 1869 when chloral hydrate was first used as a soporific. Barbiturates emerged as the first class of drugs that emerged in the early 1900s, after which chemical substitution allowed derived compounds. Although the best family of drugs at the time (less toxic and with fewer side effects) they were dangerous in overdose and tended to cause physical and psychological dependence.
During the 1970s, quinazolinones and benzodiazepines were introduced as a safer alternative to replace barbiturates; in the late 1970s, benzodiazepines emerged as safer drugs.
Benzodiazepines are not without their flaws; substance dependence is possible, and deaths from overdose occasionally occur, especially in combination with alcohol and/or other depressants. The question has been asked, whether it interferes with the sleeping architecture.
Nonbenzodiazepines are the latest developments (1990s now). Although it is clear that they are less toxic than their predecessors, barbiturates, the comparative efficacy of benzodiazepines has not yet been established. Without a longitudinal study, it is difficult to determine; But some psychiatrists recommend these drugs, citing studies that show they are equally strong with less potential abuse.
Other sleeping pills that can be considered "hypnotic sedatives" exist; psychiatrists will sometimes prescribe illicit drugs if they have a sedative effect. Examples include mirtazapine (antidepressants), clonidine (commonly prescribed to regulate blood pressure), quetiapine (antipsychotics), and over-the-counter diphenhydramine sleep aid (Benadryl - antihistamine). Off-label sleep medications are particularly useful when first-line treatment is unsuccessful or unsafe (for example, in patients with a history of substance abuse).
Maps Hypnotic
Type
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a broad spectrum effect, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotic, and anticonvulsalgesic effects; However, this effect is rather weak, preventing barbiturates used in surgery in the absence of other analgesics. They have dependency responsibilities, both physical and psychological. Barbiturates now have largely been replaced by benzodiazepines in routine medical practice - for example, in the treatment of anxiety and insomnia - especially since benzodiazepines are significantly less dangerous in overdose. However, barbiturates are still used in general anesthesia, for epilepsy, and assist suicide. Barbiturates are derivatives of barbituric acid.
The main mechanism of barbiturate action is believed to be a positive alosteric modulation of the GABA receptor A .
Contohnya termasuk amobarbital, pentobarbital, phenobarbital, secobarbital, dan natrium thiopental.
Quinazolinones
Quinazolinones is also a class of drugs that serve as hypnotics/sedatives containing 4-quinazolinone nuclei. Its use has also been proposed in the treatment of cancer.
Examples of quinazolinones include cloroqualone, diproqualone, etaqualone (Aolan, Athinazone, Ethinazone), mebroqualone, mecloqualone (Nubarene, Casfen), and methaqualone (Quaalude).
Benzodiazepines
Benzodiazepines may be useful for the treatment of short-term insomnia. Its use beyond 2 to 4 weeks is not recommended because of the risk of dependence. It is preferred that benzodiazepines are intermittently taken and at the lowest effective dose. They fix sleep-related problems by shortening the time spent in bed before falling asleep, lengthening bedtime, and, in general, reducing awareness. Like alcohol, benzodiazepines are commonly used to treat insomnia in the short term (both prescribed and self-medication), but worsen sleep in the long run. While benzodiazepines can make people fall asleep (ie, inhibit NREM stage 1 and 2 sleep), while asleep, medications interfere with sleep architecture: reduce sleep time, delay REM sleep time, and reduce deep slow wave sleep (most restore parts) sleeping for energy and mood).
Other disadvantages of hypnotics, including benzodiazepines, are the possible tolerances for their effects, rebound insomnia, and decreased slow-wave sleep and withdrawal periods characterized by rebound insomnia and anxiety and agitation periods prolonged. The list of approved benzodiazepines for the treatment of insomnia is quite similar in most countries, but benzodiazepines that are officially designated as first-line hypnotics prescribed for the treatment of insomnia may vary by country. Again-acting benzodiazepines such as nitrazepam and diazepam have residual effects that can persist into the next day and, in general, are not recommended.
It is unclear whether the new nonbenzodiazepine (Z-drug) hypnotics are better than short-acting benzodiazepines. The efficacy of both groups of drugs is similar. According to the US Agency for Healthcare Research and Quality, indirect comparisons suggest that the side effects of benzodiazepines may be about twice as frequent as nonbenzodiazepine. Some experts recommend the use of nonbenzodiazepine as a long-term treatment of insomnia. However, the UK National Institute for Health and Clinical Excellence (NICE) found no convincing evidence to support Z-drugs. The NICE study showed that Z-drug short acting was less precise than in clinical trials with long-acting benzodiazepines. There have been no trials comparing short-acting Z-drugs with appropriate short-acting benzodiazepines. Based on this, NICE recommends choosing hypnosis based on patient costs and preferences.
Older adults should not use benzodiazepines to treat insomnia unless other treatments fail effectively. When benzodiazepines are used, patients, their caregivers and their doctors should discuss the increased risk of harm, including evidence that shows twice the incidence of traffic crashes among patients who are driving as well as fractures and hips for all older patients.
Their mechanism of action is mainly on GABA receptors A .
Nonbenzodiazepines
Nonbenzodiazepine is a class of psychoactive drugs that is very "benzodiazepine-like" in nature. Pharmacodynamic nonbenzodiazepines are almost entirely the same as benzodiazepine drugs and therefore require the same benefits, side effects, and risks. Nonbenzodiazepines, however, have different or completely different chemical structures, and are therefore unrelated to benzodiazepines at the molecular level.
Contohnya termasuk zopiclone (Imovane, Zimovane), eszopiclone (Lunesta), zaleplon (Sonata), dan zolpidem (Ambien, Stilnox, Stilnoct).
Research on nonbenzodiazepines is new and contradictory. A review by the research team showed the use of these drugs for people who had trouble falling asleep but did not remain asleep, as the next day's disorder was minimal. The team noted that the safety of these drugs had been established, but called for further research into their long-term efficacy in treating insomnia. Other evidence suggests that tolerance to nonbenzodiazepines may be slower to develop compared with benzodiazepines. Different teams are more skeptical, finding less benefit than benzodiazepines.
More
Melatonin
Melatonin, a hormone produced in the pineal gland in the brain and secreted in dim light and darkness, among other functions, promotes sleep in diurnal mammals.
Antihistamines
In general use, the term antihistamine only refers to a compound that inhibits action in H 1 (and not H 2 ) receptors.
Clinically, H 1 antagonists are used to treat certain allergies. Sedation is a common side effect, and some H 1 antagonists, such as diphenhydramine (Benadryl) and doxylamine, are also used to treat insomnia.
Second generation antihistamines cross the blood-brain barrier to a much lower level than the first. This causes them to primarily affect peripheral histamine receptors, and therefore has a much lower sedative effect. High doses can still induce the effects of the central nervous system from drowsiness.
Antidepressants
Some antidepressants have a sedative effect. Some may improve the actual (biologically) sleep quality different from benzodiazepines that degrade the quality.
Contohnya termasuk:
- Antagonis serotonin reuptake inhibitor
- Trazodone
- Antidepresan trisiklik
- Amitriptyline
- Doxepin
- Trimipramine
- Antidepresan tetrasiklik
- Mianserin
- Mirtazapine
Contohnya termasuk:
- Selective serotonin reuptake inhibitor
- Serotonin-norepinephrine reuptake inhibitor
- Norepinephrine reuptake inhibitor
Antipsikotik
Source of the article : Wikipedia
0 Comments