antipsychotic-drugsPPT课件

Chapter25AntipsychoticDrugs,1,.,Antipsychoticdrugs,Schizophrenia精神分裂症literaltranslation“splitmind”separateemotionalsidefromintellectualsideemotional&cognitiveprocessesdontfunctiontogetheragroupofseveredisorderscharacterizedby:disorganizedanddelusionalthinking（妄想）disturbedperceptionsinappropriateemotions&action,2,.,PsychotropicDrugs抗精神失常药,Classification：antipsychoticdrugs抗精神病药物neurotropicdrugs神经安定剂antimanicdrugs抗躁狂药物antidepressants抗抑郁药物anxiolytics抗焦虑药物,3,.,Natureofpsychosis/schizophreniaThedopaminehypothesisexcessivedopaminergicactivityplaysaroleinthedisorder.Theenhancementoffunctionof5-HT2DopaminergicSystemsThenigrostriatalpathway(coordinationofvoluntarymovement),4,.,Mesolimbic-mesocortical(behavior)Tuberoinfundibular-pituitarysystem(endocrine)Themedullaoblongata(vomit)Medullary-periventricularpathway(eatingbehavior),5,.,AntipsychoticdrugsClassification：Phenothiazin吩噻嗪类(氯丙嗪chloropromazine)Thioxanthenes硫杂蒽类(chlorprothixene氯普噻吨（泰尔登）)Butyrophenones丁酰苯类(haloperidol氟哌啶醇)Others,6,.,Antipsychotic/Neuroleptics,Phenothiazin吩噻嗪类chlorpromazine氯丙嗪(wintermine冬眠灵),PharmacologiceffectsblockingDA2、M、5HT2、H1receptors,7,.,neurolepticeffect(神经安定作用),BlockingMesolimbicsystemandmesocorticalD2-RMoreeffectivefortreatingpositivesymptomSubstantianigra-corpusstriatum-extrapyramidaleffects锥体外系反应Node-funnel-endocrinesystemaction,8,.,powerfulantiemeticaction镇吐作用blockingCTZ催吐化学感受区D2-R(smalldosage)directlyinhibitingvomitingcenter呕吐中枢(largedosage)alteringtemperature-regulatingmechanismsdecreasetemperaturenomatternormalorhightemperaturebodytemperaturevarieswiththeenvironment,9,.,autonomicNSeffectsblocking-Rvasodilatation“epinephrinereversal”blockingM-Ratropine-likeactionendocrinesystemactionincreasingprolactin催乳素secretioninhibitinggonadotropichormone促性腺激素，growthhormone生长激素secretion,10,.,Therapeuticuses,schizophrenia精神分裂症moreeffectiveintreatingpositivesymptomsseverenauseaandvomitingusefulinthetreatmentofdrug-inducednauseahypothermicanesthesia低温麻醉andartificialhibernation人工冬眠chlorpromazinepromethazinepethidine（氯丙嗪异丙嗪哌替啶）,11,.,AdverseeffectscommonadverseeffectsCNSdepression(drowsiness,indifference)M-Rblock(blurredvision,drymouth)-Rblock(orthostatichypotension体位性低血压)extrapyramidalreaction锥体外系反应Parkinsonssyndromakathisia静坐不能acutedystonia急性肌张力障碍treatedbyantimuscarinicdrugs(artane,安坦),12,.,tardivedyskinesia迟发性运动障碍treatedbyantidopaminedrugs(clozapine,氯氮平)Neuralantagonistseveresymdromedrug-inducedmindabnormalityconvulsion惊厥andepilepsy癫痫allergicreactionacutehypogranulocytosis(粒细胞减少症)cardiovascularandendocrinesystemreactionacutepoisoning急性中毒,13,.,Thioxanthenes硫杂蒽类chlorprothixene氯普噻吨（泰尔登）Butyrophenones丁酰苯类haloperidol氟哌啶醇Otherspenfluridol五氟利多clozapine氯氮平,14,.,Clozapine(氯氮平)BenzodiazepinesPharmacologicaleffectBlocking5-HT,D2receptorStrongefficacy,rapidlyNoextrapyramidalreactionBlockingH1,Mandreceptorhypogranulocytosis,15,.,Antimanicdrugs,Bipolaraffectivedisorder（双极性情感障碍）Cyclicmanicattacks（往复性躁狂发作）Inhighspirit（情绪高涨）Overactivity（过度活动）Paranoidthoughts（妄想）,16,.,LithiumCarbonate（碳酸锂）,ClinicaluseBasedontheLi+treatmentforbipolardisordermanicphaseparticularlyprophylacticLimayblockbothmanicanddepressive,17,.,AdverseeffectsGItractnausea,vomiting,diarrheamentalconfusion,tremor,aphasia失语症,choreoathetosis舞蹈症,comaManagementofLioverdosage:peritonealdialysis腹膜透析orhemodialysisivNaCl,18,.,AntidepressantsTricyclicantidepressants三环类抗抑郁药（抑制NA、5-羟色胺再摄取）NAreuptakeinhibitorNA再摄取抑制剂Serotoninreuptakeinhibitor5-羟色胺再摄取抑制剂Others,19,.,Tricyclicantidepressantsimipramine丙咪嗪（米帕明）ActionCNS:inhibitNAand5-HTreuptakenormalindividals:depressanteffectdepression:moodelevation,spiritexcitationTheonsetofthemood-elevationisslow,23weeksautonomicnervesystemBlockingM-Reffects:blurredvision,drymouth,constipation,urinaryretention,20,.,cardiovascularsystemlowbloodpressurearrhythmiaClinicalusesdepressionvariouskindsespeciallyendogenous，involutionaldepressionenuresis遗尿症inchildrenolderthansixphobicanxiety恐惧性焦虑(症),21,.,Adverseeffectsdrymouth,mydrasis,blurredvision,orthostatichypotension体位性低血压agranulocytosis粒细胞缺乏症urinaryretentionocularpressureincreaseContraindicationProstatichypertrophyandglaucoma青光眼,22,.,NAreuptakeinhibitordesipramine地昔帕明,去甲丙咪嗪inhibitNAreuptakeselectivelytreatmild,moderatedepressionsedationandhypotensionsideeffectisslightcomparedwithimipramineoverdosecancauselowbloodpressure,arrhythmia,drymouth,constipation,23,.,5-HTreuptakeinhibitorfluoxetine氟西汀,百忧解inhibit5-HTreuptakeselectivelytreatdepression:improveattentionemotionadverseeffects:GItractreaction,tremorriskoflife-threatening“serotonin-syndrome”co-administeredwithMAOinhibitors,24,.,MAOinhibitorPhenelzine苯乙肼inhibitMAOnons