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Anxiolytic/Sedative-Hypnotics

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Critical Care Toxicology

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Abstract

Prescription anxiolytic/sedative-hypnotic (ASH) drug toxicity, and withdrawal, is commonly encountered by health care providers in many clinical settings. Although the pharmacokinetic and epidemiologic characteristics of the agents involved have changed over several decades, the essential features of ASH poisoning (and withdrawal) remain unchanged since the introduction of chloral hydrate (CH) in the mid-nineteenth century. Today, ASH drugs are ubiquitous and used for numerous indications by inducing anxiolysis and sedation that result in drowsiness or sleep. Overall, this drug group consists of benzodiazepine (e.g., diazepam) and benzodiazepine-like drugs (e.g., zolpidem), barbiturate (e.g., butalbital) and barbiturate-like drugs (e.g., meprobamate), and drugs (e.g., dexmedetomidine) with different mechanisms of action. The toxic effects of barbiturates are discussed in detail in another chapter (Barbiturates). Other agents, such as dexmedetomidine, are discussed in greater detail elsewhere (see chapter on “Centrally Acting Alpha Agonists”).

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Authors and Affiliations

  1. Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA

    C. William Heise

  2. Department of Medical Toxicology, Banner – UMCP, Phoenix, AZ, USA

    C. William Heise

  3. Banner Poison and Drug Information Center Clinical, Department of Medicine, Banner – University Medical Center Phoenix, Phoenix, AZ, USA

    Daniel E. Brooks

Authors
  1. C. William Heise
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  2. Daniel E. Brooks
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Correspondence to C. William Heise .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies, and case reports, or reports of expert committees.

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Heise, C.W., Brooks, D.E. (2015). Anxiolytic/Sedative-Hypnotics. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_35-1

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  • DOI: https://doi.org/10.1007/978-3-319-20790-2_35-1

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20790-2

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