抗精神失常药和概念和分类.ppt

1、objective,掌握 氯丙嗪的药理作用、作用机制、临床应用与主要不良反应等。 熟悉 抗精神失常药的概念和分类; 其他抗精神病药的作用特点; 碳酸锂、米帕明的药理作用特点。 了解 精神失常的概念、分型.,Why ?,神经兮兮,神经稀稀,神经搭错,Neuropathy,psychopathy,note,（神经病）,（精神病）,Introduction,1、Concept,Psychotic disorders,various reason severe mental disorders .,2、classification,1、schizophrenia 精神分裂症 2、mania-depre

2、ssive disorder 躁狂抑郁症 3、anxiety 焦虑症 4、 others,1）the most familiar, 2）inpatient 6070%; 3）thought and behavior -cloven(分裂) 4） limbic system (边缘系统) DA function.,Schizophrenia ( I type, II type ),Mania-depressive disorder,mania,5-HT ,NA ,NA ,1） Mania-depressive,2）,depression,5-HT ,3、anxiety,焦虑症,4、 others

3、,青春期、 周期性、 更年期,10月10日是世界精神卫生日,健康体魄,+,健康心理,美好人生,Classification of drugs,Antipsychotic drugs chlorpromazine Antimanic drugs lithium carbonate Antidepressants imipramine Anxiolytics diazepam,氯丙嗪,碳酸锂,米帕明,地西泮,1 Antipsychotic Drugs,吩噻嗪类：chlorpromazine 硫杂蒽类： chlorprothixene 丁酰苯类： haloperidol 其他类： sulpiride

4、，clozapine,chlorpromazine, CPZ 氯丙嗪 （wintermin 冬眠灵）, 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.,chlorpromazine, actions uses I. CNS 1、Antipsychotic effec

5、ts (抗精神病作用) characteristics 1) long use, cant produce tolerance ; 2) symptomatic treatment (对症治疗); 3) the onset of effect is slow ( 6W-6M).,mechanism,four important dopaminergic pathways: 1) mesolimbic pathway 中脑边缘系统 2) mesocortical pathway 中脑皮质通路 3) nigrostriatal pathway 黑质纹状体通路 4) tubero-infundibu

6、lar pathway 结节漏斗通路,CPZ,() D2-R antipsychotic effects,Clinical uses,psychotic disorder ： 1）schizophrenia- first choice; 2）other psychotic states: manic states; delirium (谵妄)states. no effect on depression.,( I typeII type ),2、Antiemetic effects (镇吐作用),Antiemetic effect is strong; But no effect on mot

7、ion sickness. (晕动性呕吐),CPZ,low dosage,CTZ（催吐化学感受区）,(+),vomiting center,large dosage,vomit,chemoreceptor trigger zone, nausea and vomit induced by uremia(尿毒症), cancer, pregnant toxemia(妊娠毒血症), radiation(辐射) and some drugs. stubborn hiccup 顽固性呃逆,Clinical uses,3、influence of temperature regulation,chara

8、cteristics: 1) temperature,normal person and patients with fever;,2) action correlative with environmental temperature (环境温度);,3） produce fever , dispel fever(散热).,Clinical uses,1）hypothermal anesthesia 低温麻醉 2）artificial hibernation 人工冬眠 CPZ + pethidine(哌替啶) + promethazine (异丙嗪),hibernation mixture,

9、配合物理降温使体温降至34以下 机体进入“冬眠”状态。BMR，对各种病理刺激的反应性，组织对缺氧的耐受力 。,mostly used for 严重感染、中毒性休克、高热惊厥、甲状腺危象等辅助治疗。,人工冬眠,4、 the effects of CNS depressants,e.g. general anaesthetics, sedative-hypnotics, analgesics(镇痛药), alcohol, ,II. autonomic nerve system,1、cardiovascular,(-) - R (-)血管运动中枢 dilate the blood vessel di

10、rectly,BP,orthostatic hypotension 体位性低血压,adrenaline reversal,cannot use in the hypertension:tolerance,2、(-) M R dry mouth, constipation(便秘), blurred vision (视力模糊),III. endocrine system,CPZ (-) D2-R (tubero-infundibular pathway) prolactin inhibitory factor (催乳素释放抑制因子) ; the secretion of growth hormon

11、e; the secretion of GnRH (促性腺激素); the secretion of ACTH ; ,（内分泌系统）,adverse reactions,1、 common adverse reaction 1) CNS, 2) M-R , 3) -R : BP , orthostatic hypotension 4) local irritative(刺激性).,2. extrapyramidal system reactions 锥体外系反应,1) parkinsonism 帕金森综合征 2) acute dystonia 急性肌张力障碍 3) akathisia 静坐不能

12、 4) tardive dyskinesia 迟发性运动障碍,中枢抗胆碱药,CPZ () nigrostriatal pathway D2-R,3.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.160,brief summary,CPZ blocking,中脑-皮质通路D2-R 中脑-边缘叶通路D2-R,抗精神病作用,黑质-

13、纹状体通路DA-R,锥体外系反应,结节-漏斗通路DA-R,影响内分泌,other antipsychotic drugs p.161-163,硫杂蒽类 tardan 泰尔登 丁酰苯类 haloperidol 氟哌啶醇 其他口服长效类 penfluridol 五氟利多 sulpiride 舒必利 clozapine 氯氮平 risperidone 利培酮,2 Antimanic drugs,lithium carbonate 碳酸锂 characteristics 1.absorbed well；wide distribution ； 2. Na+ enhance the excretion o

14、f Li+ ; incept Na+ renal discharge Li+ 3. onset of effect is slow, individual variation（个体差异）;,4. mechanism is complex; p.164 5. 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 .

15、withdrawal, treatment: iv. 0.9% NaCl,TDM important !,3 Antidepressant drugs,Imipramine 米帕明（丙咪嗪） characteristics 1. po.absorbed well；wide distribution ； 2.Antidepressant selectivity high; action slow; normal-CNS() depressed-uplift (情绪高涨),. mechanism： inhibit the reuptake of NA、5-HT in the brain. 4. Clinical uses: different types of depression, enuresis(遗尿症), anxiety and phobia(恐怖症). 5. Adverse reactions: M-R (), CNS symptom drug interaction p.165,Other drugs p.