2026-2027 | Live Session | Sedatives-Hypnotics: Board Review | September 2026-Sedatives-Hypnotics: Board Review Presentation

Sedatives-Hypnotics: Board Review Presentation

Pdf Summary

This slide deck reviews sedative-hypnotic use disorders, focusing on benzodiazepines, Z-drugs, barbiturates, and newer “designer” sedatives. It begins with clinical cases showing how heavy alcohol or sedative use can lead to respiratory arrest, seizures, confusion, or withdrawal. The presentation emphasizes that sedative-hypnotics depress the CNS and can cause a continuum from calming and hypnosis to coma and death.<br /><br />Key topics include screening, DSM-5 diagnoses, epidemiology, and pharmacology. Benzodiazepines and barbiturates act on the GABA-A receptor, but benzodiazepines increase the frequency of chloride channel opening, while barbiturates increase duration. Z-drugs (zolpidem, zaleplon, eszopiclone) are non-benzodiazepine receptor agonists with similar GABA-A effects and are also associated with dependence, falls, amnesia, and complex sleep behaviors.<br /><br />The slides highlight major public health concerns: widespread benzodiazepine prescribing, misuse, overdose risk, and the dangerous combination of sedatives with opioids and alcohol. Internet access and international travel are increasingly common sources of misused benzodiazepines. Certain groups, including older adults and some LGBTQ populations, may have elevated misuse risk.<br /><br />Withdrawal is a central theme. Symptoms include anxiety, tremor, insomnia, autonomic instability, hallucinations, delirium, and seizures. Withdrawal severity depends on dose, duration, and half-life. Management strategies include substitution with a longer-acting benzodiazepine or phenobarbital, anticonvulsants in some cases, and gradual tapering. The ASAM 2025 guideline recommends individualized, supervised tapering rather than abrupt discontinuation after more than a month of use.<br /><br />The presentation also addresses protracted withdrawal and benzodiazepine-induced neurological dysfunction, which may persist for months or longer. Finally, it discusses case-based treatment planning for a flight attendant with high-dose alprazolam and zolpidem use, illustrating inpatient detoxification with phenobarbital followed by longer-term treatment of underlying anxiety and insomnia using non-addictive medications.

Keywords

sedative-hypnotic use disorder

benzodiazepines

Z-drugs

barbiturates

GABA-A receptor

withdrawal

phenobarbital

opioid overdose risk

DSM-5 diagnosis

gradual tapering