Sedatives-Hypnotics: Board Review (2025-2026 Recording)-Sedatives-Hypnotics: Board Review Recording

Video Transcription

Video Summary

The session was a board-review lecture on sedative-hypnotic use disorders led by Dr. Beth Howell, with cases presented by addiction medicine fellows. It covered the major drug classes: benzodiazepines, Z-drugs, barbiturates, and a few special substances such as meprobamate, designer benzodiazepines, phenibut, and tianeptine. The talk reviewed clinical uses, epidemiology, DSM-5 diagnosis, neurobiology, and withdrawal management.<br /><br />A key theme was that sedative effects are additive and can become dangerous when combined with alcohol or opioids. One case illustrated respiratory arrest after midazolam was given to a patient with severe alcohol intoxication. Another case involved a flight attendant using extremely high doses of alprazolam and zolpidem, emphasizing the need for inpatient detoxification rather than a slow outpatient taper.<br /><br />The neuropharmacology section explained that benzodiazepines and related drugs act at the GABA-A receptor as positive allosteric modulators. Benzodiazepines increase the frequency of chloride channel opening, while barbiturates increase duration and are less selective, which contributes to their higher overdose risk. The lecture also reviewed tolerance, dependence, intoxication, withdrawal, and protracted withdrawal syndromes, including persistent symptoms like anxiety, depression, cognitive issues, and sensory disturbances.<br /><br />Treatment focused on stabilization with cross-tolerant agents such as diazepam or phenobarbital, monitoring for severe withdrawal complications like seizures or delirium, and using adjuncts such as gabapentin when needed. For relapse prevention, the main approach is treating the underlying condition with non-addictive alternatives, since there is no established anti-craving medication for sedative use disorder. The talk concluded with practical resources, tapering guidelines, and equivalency charts.

Keywords

sedative-hypnotic use disorder

benzodiazepines

Z-drugs

barbiturates

GABA-A receptor

withdrawal management

cross-tolerant agents

diazepam

phenobarbital

alcohol intoxication

respiratory depression

protracted withdrawal

addiction medicine