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A chemically diverse group of agents are classified as sedative-hypnotics, linked by the ability to induce calm, sedation, sleep, respiratory depression, and coma. (For a detailed review of the pharmacology, see Ciraulo 2014.) Many of the drugs share the property of exerting their pharmacological effects at the gamma-aminobutyric acid (GABA) receptor, but recent research has revealed that these actions at the receptor differ among the agents. Furthermore, emphasis on GABA proved overly simplistic, ignoring both the variety of receptor subtypes and other neurotransmitter systems that have a profound influence on clinical activity and addiction potential. Therefore, in this chapter I address each class of agents individually, emphasizing shared properties and unique characteristics that often explain clinical differences in action. The discussion that follows is limited to agents that act at the GABAA receptor, including benzodiazepines, the Z drug hypnotics, and barbiturates.
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