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Sedatives & Hypnotics • • Sedatives – calming effect Hypnotics –produce sleep • They include Chloral Hydrate & Barbiturates BARBITURATES USES: As sedatives Hypnotics. Anaesthetic when given I / V. In psychiatric disorders, strychnine poisoning epilepsy and CLASSIFICATION Long acting: 1 8 to 12 hrs e.g. Barbitone, Phenobarbitone Intermediate acting: e.g. Amylobarbitone ½ 4 to 8 hrs Short acting: ¼ 2 to 4 hrs e.g. Cyclobarbitone Ultra short acting: (for on set of action immediate . e.g. Thiopentone Sodium anaesthesia) ABSORPTION: From GIT including rectum Subcutaneous tissue METABOLISM: They are concentrated in liver for sometime and then evenly distributed into body fluids. EXCRETION : By kidney SIGN & SYMPTOM ACUTE POISONING Drowsiness Confusion, excitement, delirium, hallucinations Ataxia, Vertigo, Slurred speech & stupor Headache Paraesthesias Decreased peristalsis in deep coma (bad sign) bowel sounds absent. Hypothermia Barbiturate blisters on the skin BP falls Cheyne Stokes breathing Oliguria. BARBITURATE BLISTERS Barbiturate blisters are found on sites of friction or pressure. Blisters are commonly found at interdigital clefts, axilla and inner aspects of the knees and calves. BARBITURATE AUTOMATISM Normal doses of barbiturates induce natural sleep but occasionally instead of sleep there is mental confusion. This Phenomenon is observed in cases where insomnia is due to pain & is not countered by analgesics. In these cases patient automatically increases the dose and frequency of barbiturate in order to induce sleep but acquires mental confusion rather than the desired effect The concept of automatism is recently questioned now. They feel that confusion or forgetfulness cannot account for over whelming over dosage. It is possible that these are cases of intentional suicide or alcoholics. CHRONIC POISONING Chronic poisoning (may lead to addiction). It may occur when barbiturates are used therapeutically in epilepsy or psychoneurotic patients. Tremors Ataxia Delirium, hallucinations. Vertigo Emotional instability General mental deterioration Urine may show albumin, sugar and casts Drug dependence is both physical and psychological Fatal Dose: Short acting 1–2g Medium acting 2–3g Long acting 3–4g Fatal Period: 1 – 2 days TREATMENT Gartic lavage with warm water mixed with Potassium permanganate and suspension of animal charcoal or tannic acid. For purgation concentrated MgSo4 should be left in stomach. Keep the patient warm. Keep the airways clean solution of Artificial respiration O2 administration Amphetamine sulphate 10mg I/V every 30 minutes . Forced osmotic diuresis with IV mannitol Antibiotics MEDICOLEGAL ASPECTS Mostly suicidal. Accidental. Rarely for homicidal purpose. Judicial execution in USA is carried out by a lethal intravenous injection of which sodium pentothal is the chief ingredient, the other ingredients being saline, Pavulon (muscle relaxant) and potassium chloride.