抗精神失常藥的概念和分類

1、 objective掌握 氯丙嗪的藥理作用、作用機制、臨床應(yīng)用與主要不良反應(yīng)等。熟悉 抗精神失常藥的概念和分類; 其他抗精神病藥的作用特點; 碳酸鋰、米帕明的藥理作用特點。了解 精神失常的概念、分型.1Why ?2神經(jīng)兮兮 神經(jīng)稀稀 神經(jīng)搭錯3Neuropathypsychopathynote（神經(jīng)?。ň癫。?Introduction1、ConceptPsychotic disorders various reason severe mental disorders .52、classification1、schizophrenia 精神分裂癥2、mania-depressive diso

2、rder 躁狂抑郁癥 3、anxiety 焦慮癥4、 others61）the most familiar, 2）inpatient 6070%;3）thought and behavior -cloven(分裂)4） limbic system (邊緣系統(tǒng)) DA function.Schizophrenia ( I type, II type )7Mania-depressive disorder mania5-HT NA NA 1） Mania-depressive 2）depression5-HT 83、anxiety焦慮癥4、 others青春期、 周期性、 更年期910月10日是世

3、界精神衛(wèi)生日健康體魄+健康心理美好人生10Classification of drugs Antipsychotic drugs chlorpromazineAntimanic drugs lithium carbonateAntidepressants imipramineAnxiolytics diazepam氯丙嗪碳酸鋰米帕明地西泮111 Antipsychotic Drugs吩噻嗪類：chlorpromazine硫雜蒽類： chlorprothixene丁酰苯類： haloperidol其他類： sulpiride，clozapine12 chlorpromazine, CPZ 氯丙嗪

4、 （wintermin 冬眠靈） pharmacokinetics 1、po. slow and irregular, F variable , im. absorb quickly ； 2、pass BBB easily, distribution is wide (in brain higher) ; 3、metabolize mainly in liver ; 4、elimination： kidney.13chlorpromazine actions uses I. CNS 1、Antipsychotic effects (抗精神病作用) characteristics 1) long

5、 use, cant produce tolerance ; 2) symptomatic treatment (對癥治療); 3) the onset of effect is slow ( 6W-6M).14 mechanism four important dopaminergic pathways: 1) mesolimbic pathway 中腦邊緣系統(tǒng) 2) mesocortical pathway 中腦皮質(zhì)通路 3) nigrostriatal pathway 黑質(zhì)紋狀體通路 4) tubero-infundibular pathway 結(jié)節(jié)漏斗通路CPZ() D2-R anti

6、psychotic effects15 Clinical uses psychotic disorder ： 1）schizophrenia- first choice; 2）other psychotic states: manic states; delirium (譫妄)states. no effect on depression. ( I typeII type )16 2、Antiemetic effects (鎮(zhèn)吐作用)Antiemetic effect is strong;But no effect on motion sickness. (暈動性嘔吐)CPZlow dosag

7、eCTZ（催吐化學(xué)感受區(qū)）(+)vomiting centerlarge dosagevomitchemoreceptor trigger zone 17 nausea and vomit induced by uremia(尿毒癥), cancer, pregnant toxemia(妊娠毒血癥), radiation(輻射) and some drugs. stubborn hiccup 頑固性呃逆 Clinical uses18 3、influence of temperature regulationcharacteristics:1) temperaturenormal person

8、 and patients with fever;2) action correlative with environmental temperature (環(huán)境溫度); 3） produce fever , dispel fever(散熱).19Clinical uses 1）hypothermal anesthesia 低溫麻醉 2）artificial hibernation 人工冬眠 CPZ + pethidine(哌替啶) + promethazine (異丙嗪)hibernation mixture20 配合物理降溫使體溫降至34以下 機體進入“冬眠”狀態(tài)。BMR，對各種病理刺激的

9、反應(yīng)性，組織對缺氧的耐受力 。 mostly used for 嚴重感染、中毒性休克、高熱驚厥、甲狀腺危象等輔助治療。人工冬眠214、 the effects of CNS depressants e.g. general anaesthetics, sedative-hypnotics, analgesics(鎮(zhèn)痛藥), alcohol, 22 II. autonomic nerve system 1、cardiovascular(-) - R(-)血管運動中樞dilate the blood vessel directlyBPorthostatic hypotension 體位性低血壓ad

10、renaline reversalcannot use in the hypertension:tolerance2、(-) M R dry mouth, constipation(便秘), blurred vision (視力模糊)23 III. endocrine systemCPZ (-) D2-R (tubero-infundibular pathway) prolactin inhibitory factor (催乳素釋放抑制因子) ; the secretion of growth hormone; the secretion of GnRH (促性腺激素); the secret

11、ion of ACTH ; （內(nèi)分泌系統(tǒng)）24 adverse reactions1、 common adverse reaction 1) CNS, 2) M-R , 3) -R : BP , orthostatic hypotension 4) local irritative(刺激性). 25 2. extrapyramidal system reactions 錐體外系反應(yīng) 1) parkinsonism 帕金森綜合征 2) acute dystonia 急性肌張力障礙 3) akathisia 靜坐不能 4) tardive dyskinesia 遲發(fā)性運動障礙中樞抗膽堿藥 CPZ

12、() nigrostriatal pathway D2-R 263.allergic reactions 4.acute toxication po. large dose: 12 g / time， clinical symptoms： narcoma ，Bp shock， （麻醉性昏睡） cardiac damage, arrhythmia contraindications p.16027brief summaryCPZ blocking中腦-皮質(zhì)通路D2-R中腦-邊緣葉通路D2-R抗精神病作用黑質(zhì)-紋狀體通路DA-R錐體外系反應(yīng)結(jié)節(jié)-漏斗通路DA-R影響內(nèi)分泌28 other anti

13、psychotic drugs p.161-163 硫雜蒽類 tardan 泰爾登 丁酰苯類 haloperidol 氟哌啶醇 其他口服長效類 penfluridol 五氟利多 sulpiride 舒必利 clozapine 氯氮平 risperidone 利培酮292 Antimanic drugslithium carbonate 碳酸鋰 characteristics 1.absorbed well；wide distribution ； 2. Na+ enhance the excretion of Li+ ; incept Na+ renal discharge Li+ 3. ons

14、et of effect is slow, individual variation（個體差異）; 304. mechanism is complex; p.1645. mania and the manic state of schizophrenia clinical first choice;6. adverse reaction safe margin is narrow; common adverse reaction acute toxication: CNS() coma, death . withdrawal, treatment: iv. 0.9% NaClTDM impor

15、tant !313 Antidepressant drugsImipramine 米帕明（丙咪嗪） characteristics 1. po.absorbed well；wide distribution ； 2.Antidepressant selectivity high; action slow; normal-CNS() depressed-uplift (情緒高漲)32. mechanism： inhibit the reuptake of NA、5-HT in the brain. 4. Clinical uses: different types of depression, enuresis(遺尿癥), anxiety and phobia(恐怖癥).5. Adverse reactions: M-R (), CNS symptom drug interaction p.16533Other drugs p.16