Sleeping pills Oxford Psychiatric Manual

Sleeping pills Oxford Psychiatric Manual sleeping pill

Contents

Sleeping pills Oxford Psychiatric Manual

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Of the other sleeping pills, you should call chloral hydrate, which is sometimes prescribed to children and the elderly. This drug irritates the gastric mucosa, so it should be diluted with appropriate (enveloping) substances. Dichloralphenazone is related to chloral, but less irritating. Chlormethiazole edizilat – a hypnotic with anticonvulsant properties. Therefore, many consider it suitable for the prevention of withdrawal symptoms in alcoholics. But such an opinion is wrong, because this medicine, like other hypnotics, can cause addiction. Glutethimide, although effective as a sleeping pill, is toxic in overdose and can therefore only be given in small doses (British Medical Journal 1976).

PHARMACOKINETICS

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Metabolism and excretion of benzodiazepines have been described previously. Barbiturates, another important group of sleeping pills, differ somewhat in their metabolism and excretion. Long-acting barbiturates are more water soluble and less lipophilic than medium-acting compounds, and therefore are mainly excreted by the kidneys in unchanged form. Medium-acting compounds are metabolized to a large extent in the liver and then excreted as complex hydroxyl compounds. Barbiturates induce enzymes that metabolize them, as well as induce liver enzymes involved in the metabolism of other drugs (see below).

UNDESIRABLE EFFECTS

The most sleeping pill high important undesirable effect of sleeping pills is their aftereffect, expressed in the fact that the patient the next day feels lethargy and drowsiness. Psychological tests for speed of reaction showed its slowness in the evening of the next day after a single nightly dose of barbiturate or a long-acting benzodiazepine (Bond, Lader 1973). A person with such a slow reaction, who is not always aware of this, can be a threat when working with potentially dangerous equipment or while driving vehicles, driving trains or airplanes. People who do not sleep well after a hard night also make similar complaints without taking sleeping pills, but these subjective sensations are not accompanied by comparable disorders detected when performing psychological tests. Patient complaints may reflect the cause of insomnia (for example, depression or excessive alcohol consumption the day before) to a greater extent than lack of sleep per se.

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CONTRAINDICATIONS

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Barbiturates and dichloralphenazone should not be administered to patients suffering from acute intermittent porphyria.

INTERACTION WITH OTHER MEDICINES

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The most important is the interaction of sleeping pills with alcohol. At first they potentiate each other’s actions, sometimes to a dangerous degree. After prolonged use, cross tolerance develops. Prolonged alcohol abuse is known to damage the liver and, thus, increases sensitivity to sleeping pills, disrupting their metabolism. The effect of long-acting benzodiazepines, potentiating the effect of alcohol, can also manifest itself the next day after taking the medicine (Saario et al. 1975). Barbiturates increase the metabolism of other drugs, including anticoagulants, tricyclic antidepressants and tetracycline. The interaction of chlormethiazole and alcohol is especially dangerous and can result in death due to respiratory paralysis. Therefore, when this medicine is used during alcohol withdrawal, careful monitoring is required. In no case should chloromethiazole be administered to people who continue to consume alcohol.

RECOMMENDATIONS FOR APPLICATION

Before prescribing sleeping pills, it is important to find out if the patient really does not sleep well, and if so, what are the reasons. Many people misunderstand how many hours they should sleep. For example, not everyone knows that the duration of sleep decreases in middle and old age. Some have the habit of “taking a nap” during the day and still want to sleep at night for a long time. Others ask to give them sleeping pills already when they did not sleep well for one or two nights, for example, during the trip. Such short-term sleep disturbances are compensated by prolonged sleep on subsequent nights, but vigor after waking up from such full sleep can be reduced due to the residual effect of the hypnotics. If the use of sleeping pills in such cases in general can be justified, then it is better to use a short-acting benzodiazepine.

ADVOCACY – THE JUDGE’S VIEW: SERIES 2, PART 2: BEING PERSUASIVE: “CONVOLUTED ARGUMENTS ARE SLEEPING PILLS ON PAPER”

Common causes of sleep disorders include caffeine and alcohol abuse, pain, cough, itching and shortness of breath, anxiety and depression. If the cause is known, then it should be eliminated, and not try to affect insomnia. If after careful research application of sleeping pills seems necessary, it should be appointed only for a few days. The doctor should explain this to the patient, warning him that after taking off sleeping pills, sleep for a few nights can be restless, but this should not push for the resumption of medication.

Appointment of sleeping pills for children is not justified, except in special cases of night fears and somnambulism. Sleeping pills should also be prescribed with great care by the elderly. They may have confusion; moreover, they may be injured if they get out of bed at night. Many patients often suffer from long-term states of dependence on sleeping pills, administered by him in the hospital for the sake of “routine nighttime sedation.” The administration of these drugs should never be routine; it must be dictated by real need and must certainly cease before the patient is discharged from the hospital.

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