sedatives

鎮静薬、鎮静剤

関

hypnotics、sedative、sedative drug、tranquilizing agent

WordNet

1. a drug that reduces excitability and calms a person (同)sedative_drug, depressant, downer

PrepTutorEJDIC

1. 鎮静効課のある,鎮静[作用]の / 鎮静剤

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/30 02:55:54」(JST)

wiki en

[Wiki en表示]

A sedative or tranquilizer (or tranquilliser, see American and British English spelling differences) is a substance that induces sedation by reducing irritability or excitement.

At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Doses of sedatives such as benzodiazepines, when used as a hypnotic to induce sleep, tend to be higher than amounts used to relieve anxiety, whereas only low doses are needed to provide a peaceful and calming sedative effect.

Sedatives can be misused to produce an overly-calming effect (alcohol being the classic and most common sedating drug). In the event of an overdose or if combined with another sedative, many of these drugs can cause unconsciousness (see hypnotic) and even death.

Terminology

There is some overlap between the terms "sedative" and "hypnotic". The terms describe distinct effects, but medications that cause one of these effects often also cause the other.

Advances in pharmacology have permitted more specific targeting of receptors, and greater selectivity of agents, which necessitates greater precision when describing these agents and their effects:

• Anxiolytic refers specifically to the effect upon anxiety. (However, some benzodiazepines can be all three: sedatives, hypnotics, and anxiolytics).
• Tranquilizer can refer to anxiolytics or antipsychotics.
• Soporific and sleeping pill are near-synonyms for hypnotics.

Types of sedatives

• Barbiturates
  • amobarbital (Amytal)
  • pentobarbital (Nembutal)
  • secobarbital (Seconal)
  • phenobarbital (Luminal)

• Benzodiazepines (trade names)
  • clonazepam (Klonopin N.America; Rivotril Europe, Asia )
  • diazepam (Valium)
  • estazolam (Prosom)
  • flunitrazepam (Rohypnol)
  • lorazepam (Ativan)
  • midazolam (Versed)
  • nitrazepam (Mogadon)
  • oxazepam (Serax)
  • triazolam (Halcion)
  • temazepam (Restoril, Normison, Planum, Tenox, and Temaze)
  • chlordiazepoxide (Librium)
  • alprazolam (Xanax)

• Nonbenzodiazepine "Z-drugs" sedatives
  • eszopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien)
  • zopiclone (Imovane, Zimovane)

• Antihistamines
  • diphenhydramine
  • dimenhydrinate
  • doxylamine
  • mirtazapine
  • promethazine

• Herbal sedatives
  • ashwagandha
  • Duboisia hopwoodii
  • Prostanthera striatiflora
  • catnip
  • kava (Piper methysticum)
  • valerian
  • cannabis
  • passiflora spp.(passiflora incarnata)

• Other
  • chloral hydrate
  • alcohol
  • trazodone
  • opiates and opioids
  • glutethimide

Therapeutic use

Doctors often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain in themselves, they can be a useful adjunct to analgesics in preparing patients for surgery, and are commonly given to patients before they are anaesthetized, or before other highly uncomfortable and invasive procedures like cardiac catheterization, colonoscopy or MRI. They increase tractability and compliance of children or troublesome or demanding patients.

Patients in intensive care units are almost always sedated (unless they are unconscious from their condition anyway).

Sedative dependence

Some sedatives can cause physiological and psychological dependence when taken regularly over a period of time, even at therapeutic doses. Dependent users may get withdrawal symptoms ranging from restlessness and insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although physical dependence does not necessarily occur, particularly with a short course of use. In both types of dependences, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy. (see Sedative Dependence).

Abuse

Main article: Drug overdose

Further information: Combined drug intoxication

See also: Benzodiazepine overdose and Barbiturate overdose

Many sedatives can be abused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Some heroin users may take them either to supplement their drug or to substitute for it. Stimulant users may take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with alcohol. In the U.S., in 1998, a total of 70,982 sedative exposures were reported to U.S. poison control centers, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs.

There are also serious paradoxical reactions that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.

The term "chemical cosh"

The term "chemical cosh" is sometimes used popularly for a strong sedative, particularly for:

• widespread dispensation of antipsychotic drugs in residential care to make people with dementia easier to manage.
• use of ritalin to calm children with attention deficit hyperactivity disorder.
  • See also Antipsychotic controversy

Dangers of combining sedatives and alcohol

Further information: Combined Drug Intoxication

Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration, the two substances compound each other's actions and this combination can prove fatal.

Sedatives and amnesia

Sedatives can sometimes leave the patient with long-term or short-term amnesia. Lorazepam is one such pharmacological agent that can cause anterograde amnesia. Intensive care unit patients who receive higher doses over longer periods, typically via IV drip, are more likely to experience such side effects.

Sedatives and crime

Sedatives — most commonly alcohol but also GHB, Flunitrazepam (Rohypnol), and to a lesser extent, temazepam (Restoril), and midazolam (Versed) — are well known for their use as date rape drugs (also called a Mickey) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for robbing people.

Statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape. Cases of criminals taking rohypnol themselves before they commit crimes have also been reported^{[citation needed]}, as the loss of inhibitions from the drug may increase their confidence to commit the offence, and the amnesia produced by the drug makes it difficult for police to interrogate them if they are caught.

See also

• Hypnotic
• Antidepressants
• Benzodiazepine withdrawal syndrome
• Tranquilizer
• Tranquilizer gun
• Diphenhydramine citrate

References

Further reading

• Tone, Andrea. The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers (Basic Books, 2009) 288 pp.; ISBN 978-0-465-08658-0 excerpty and text search

UpToDate Contents

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• 1. 重症患者における鎮静鎮痛剤：選択、開始、維持、および離脱 sedative analgesic medications in critically ill patients selection initiation maintenance and withdrawal
• 2. 小児に対する手術室外での鎮静処置に使用する薬剤の選択 selection of medications for pediatric procedural sedation outside of the operating room
• 3. 苦痛緩和のための鎮静 palliative sedation
• 4. 小児に対する手術室外での鎮静処置に使用する薬剤 pharmacologic agents for pediatric procedural sedation outside of the operating room
• 5. 成人における処置時の鎮静 procedural sedation in adults

English Journal

• Remifentanil, ketamine, and fospropofol: a review of alterative continuous infusion agents for sedation in the critically ill.

• Mohrien KM1, Jones GM, Macdermott JR, Murphy CV.Author information 1Methodist University Hospital, Methodist Healthcare, Memphis, Tennessee (Drs Mohrien and Jones); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis (Dr Jones); and The Ohio State University Wexner Medical Center, Columbus (Ms MacDermott and Dr Murphy).AbstractSedation and analgesia are integral aspects in the care of critically ill patients admitted to the intensive care unit. In recent years, many of the commonly used sedative agents in the United States have experienced manufacturing and sterility issues leading to decreased availability. In addition, current practice has shifted to providing lighter levels of sedation as clinicians have gained a better understanding of the consequences of prolonged deep sedation. Benzodiazepines have fallen out of favor due to findings including increased delirium and duration of mechanical ventilation. Alterations in end-organ function in critically ill patients may also lead to varied responses to commonly used sedatives. With numerous factors impacting choice of sedation in the intensive care unit, fospropofol, ketamine, and remifentanil have been considered potential alternatives to standard therapy. The purpose of this review was to discuss strategies for the safe and effective use of fospropofol, ketamine, and remifentanil for continuous intravenous sedation in critically ill patients.
• Critical care nursing quarterly.Crit Care Nurs Q.2014 Apr-Jun;37(2):137-51. doi: 10.1097/CNQ.0000000000000012.
• Sedation and analgesia are integral aspects in the care of critically ill patients admitted to the intensive care unit. In recent years, many of the commonly used sedative agents in the United States have experienced manufacturing and sterility issues leading to decreased availability. In addition,
• PMID 24595251

• Factors that facilitate or constrain the use of continuous sedation at the end of life by physicians and nurses in Belgium: results from a focus group study.

• Raus K1, Anquinet L, Rietjens J, Deliens L, Mortier F, Sterckx S.Author information 1End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Ghent, Belgium.AbstractContinuous sedation at the end of life (CS) is the practice whereby a physician uses sedatives to reduce or take away a patient's consciousness until death. Although the incidence of CS is rising, as of yet little research has been conducted on how the administration of CS is experienced by medical practitioners. Existing research shows that many differences exist between medical practitioners regarding how and how often they perform CS. We conducted a focus group study to find out which factors may facilitate or constrain the use of continuous sedation by physicians and nurses. The participants often had clear ideas on what could affect the likelihood that sedation would be used. The physicians and nurses in the focus groups testified that the use of continuous sedation was facilitated in cases where a patient has a very limited life expectancy, suffers intensely, makes an explicit request and has family members who can cope with the stress that accompanies sedation. However, this 'paradigm case' was considered to occur only rarely. Furthermore, deviations from the paradigm case were said to be sometimes due to physicians initiating the discussion on CS too late or not initiating it at all for fear of inducing the patient. Deviations from the paradigm case may also occur when sedation proves to be too difficult for family members who are said to sometimes pressure the medical practitioners to increase dosages and speed up the sedation.
• Journal of medical ethics.J Med Ethics.2014 Apr;40(4):230-4. doi: 10.1136/medethics-2012-100571. Epub 2012 Aug 14.
• Continuous sedation at the end of life (CS) is the practice whereby a physician uses sedatives to reduce or take away a patient's consciousness until death. Although the incidence of CS is rising, as of yet little research has been conducted on how the administration of CS is experienced by medical
• PMID 22893573

• Adverse drug events in critically ill patients with cancer: incidence, characteristics, and outcomes.

• Nazer LH1, Hawari F, Al-Najjar T.Author information 1Department of Pharmacy, King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan.AbstractObjective: To determine the incidence, characteristics, and outcomes of adverse drug events (ADEs) in critically ill patients with cancer. Methods: This was a 5-month prospective observational study. Patients who were admitted to the adult medical/surgical oncology intensive care unit (ICU) were evaluated for any drug-related adverse events during their ICU stay. An ADE was defined as injury or patient harm resulting from medical intervention related to a drug. Results: The incidence rate of ADEs was 96.5 per 1000 patient days and 35.3 per 100 ICU admissions. Of the reported ADEs, 57 (64.8%) were serious/life threatening, 30 (34.1%) were significant, 1 (1.1%) was fatal, and 14 (15.9%) of all ADEs were considered preventable. The most common drug classes associated with ADEs were antidiabetics, antibiotics, and analgesics/sedatives. The length of stay and presence of renal or respiratory failure were significantly associated with an increased number of ADEs. The length of stay and female sex were significantly associated with the likelihood of developing an ADE. Conclusion: Critically ill patients with cancer are at high risk of developing ADEs. Strategies that reduce the incidence and severity of ADEs are essential to improve the outcomes of this patient population.
• Journal of pharmacy practice.J Pharm Pract.2014 Apr;27(2):208-13. doi: 10.1177/0897190013513302. Epub 2013 Dec 6.
• Objective: To determine the incidence, characteristics, and outcomes of adverse drug events (ADEs) in critically ill patients with cancer. Methods: This was a 5-month prospective observational study. Patients who were admitted to the adult medical/surgical oncology intensive care unit (ICU) were eva
• PMID 24319079

Japanese Journal

• 「鎮痛薬と鎮静薬の使い方」ガイドラインから「疼痛・不穏・せん妄管理」ガイドラインへ (特集 重症患者の鎮痛・鎮静管理を考える : 米国版ガイドライン改訂を受けて)

• 布宮 伸
• ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 37(10), 727-730, 2013-10
• NAID 40019858069

• 催眠剤、鎮静剤、麻酔剤使用後の小児について転倒・転落に注意を要する時間の指標 : デルファイ法を用いた看護師の判断基準の調査

• 藤田 優一,藤原 千惠子
• 日本小児看護学会誌 22(2), 54-60, 2013-07-20
• 看護師が判断する小児の催眠剤、鎮静剤、麻酔剤使用後の転倒・転落に注意が必要な時間の指標を明らかにすることを目的として調査を行った。小児看護経験が5年以上の看護師(平均8.3年)を対象に2回のデルファイ法を実施した。第1回調査では23施設の121名に、催眠剤、鎮静剤、麻酔剤を調査票に示して「薬剤投与後は経験的に何時間後まで転倒・転落の危険があると判断するか」を質問し、第2回調査では65名に第1回と同 …
• NAID 110009634899

• 催眠剤、鎮静剤、麻酔剤使用後の小児について転倒・転落に注意を要する時間の指標 : デルファイ法を用いた看護師の判断基準の調査

• 藤田 優一,藤原 千惠子
• 日本小児看護学会誌 = Journal of Japanese Society of Child Health Nursing 22(2), 54-60, 2013-07
• NAID 40019767600

Related Links

• Sedatives | Psychology Today

Sedatives work by slowing down brain activity resulting in drowsiness or relaxation. Many types, though, including barbiturates (like Nembutal) and benzodiazepines (like Valium and Xanax) have the potential for abuse and severe ...

• Compare 35 Sedation Medications | Drugs.com

... sedatives and hypnotics, antihistamines For consumers: dosage, interactions, side effects Butisol Sodium Rx D 3 X Add review Add Generic name: butabarbital systemic dosage dexmedetomidine Rx C N X Add review ...

Related Pictures

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★リンクテーブル★

リンク元	「薬物濫用」「鎮静薬」「hypnotics」「sedative drug」「tranquilizing agent」
関連記事	「sedative」

「薬物濫用」

　　[★]

英

drug abuse, substance abuse

同

薬物乱用

関

薬物依存、薬物嗜癖、物質乱用、物質依存症、薬物使用、接着剤吸引

薬物使用が身体に及ぼす効果

• 濫用 substance abuse：a pattern of abnormal substance use that leads to impairment of occupational, physical, or social functioning(BBS.73)
• 依存 substance dependence：ub stance abuse puls withdrawal symptoms, tolerance, or a pattern of repetitive use(BBS.73)
• 離脱 withdrawal：the development of physical or pschological symptoms after the reduction or cessation of intake of a substance(BBS.73)
• 耐性 tolerance：the need for increased amounts of the substance to achieve the same positive psychological effect(BBS.73)
• 交差耐性 cross-tolerance：the development of tolerance to one substance as the result of using another substance(BBS.73)

薬物

• 1. 中枢神経興奮薬(覚醒剤を含む) stimulants　　身体依存はないとされている

• カフェイン caffeine
• ニコチン nicotine
• amphetamines　精神依存有り。身体依存無し

• アンフェタミン amphetamine　精神依存有り。身体依存無し。耐性は連用で出現
• デキストロアンフェタミン dextroamphetamine Dexedrine
• メタンフェタミン methamphetamine Desoxyn speed ice ヒロポン　精神依存有り。身体依存無し。耐性は連用で出現　　←　以前、日本で多く使われた
• メチルフェニデート methylphenidate Ritalin
• methylene dioxymethamphetamine MDMA ecstasy

• コカイン cocaine crack freebase　精神依存有り。身体依存無し　精神依存生じやすい。耐性発現殆ど無し　コカ

• 2. sedatives

• alcohol　　精神依存有り。身体依存有り。
• barbiturates
• benzodiazepines

• ⇔flumazenil Mazicon Romazicon

• 3. opioids

• morphine　精神依存・身体依存有り　けし
• heroin　精神依存・身体依存が強い。耐性発現早い。離脱症状激しい
• codeine
• pethidine
• fentanyl
• methadone
• l-alpha-acetylmethadol acetate LAMM
• buprenorphine Temgesic

• 4. hallucinogens and related agents

• cannabis(marijuana(tetrahydrocannabinol THC,hashish)　精神依存有り。身体依存無し　精神依存軽度。耐性は長期使用で軽度出現　大麻草
• lysergic acid diethylamide LSD
• phencyclidine PCP angel dust
• psilocybin
• mescaline

精神依存、身体依存

	精神依存	身体依存
コカイン、アンフェタミン類(アンフェタミン、メチルフェタミン)、大麻	○
麻薬(モルヒネ、ヘロイン、コデイン)、バルビツール酸系(フェノバルビタール、チオペンタール)、アルコール	○	○

「鎮静薬」

　　[★]

英

sedative, sedatives, sedative drug

ラ

sedativa

同

鎮静剤

関

中枢神経抑制薬。鎮静

[show details]

鎮静剤 : 約 605,000 件
鎮静薬 : 約 301,000 件

「hypnotics」

　　[★]

• np.

• 睡眠薬、催眠薬、睡眠剤、催眠剤

関

hypnotic、sedatives

「sedative drug」

　　[★]

• 鎮静薬、鎮静剤

関

sedative、sedatives、tranquilizing agent

「tranquilizing agent」

　　[★]

• 鎮静薬

関

ataractic、sedative、sedative drug、sedatives

「sedative」

　　[★]

• adj.

• 鎮静の

• n.

• 鎮静薬、鎮静剤

関

sedate、sedation、sedative drug、sedatives、subside、tranquilizing agent

関

specific agents