抗精神失常药的概念和分类

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.1Why ?2神经兮兮 神经稀稀 神经搭错3Neuropathypsychopathynote（神经病）（精神病）4Introduction1、ConceptPsychotic disorders various reason severe mental disorders .52、classification1、schizophrenia 精神分裂症2、mania-depressive diso

2、rder 躁狂抑郁症 3、anxiety 焦虑症4、 others61）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 )7Mania-depressive disorder mania5-HT NA NA 1） Mania-depressive 2）depression5-HT 83、anxiety焦虑症4、 others青春期、 周期性、 更年期910月10日是世

3、界精神卫生日健康体魄+健康心理美好人生10Classification of drugs Antipsychotic drugs chlorpromazineAntimanic drugs lithium carbonateAntidepressants imipramineAnxiolytics diazepam氯丙嗪碳酸锂米帕明地西泮111 Antipsychotic Drugs吩噻嗪类：chlorpromazine硫杂蒽类： chlorprothixene丁酰苯类： haloperidol其他类： sulpiride，clozapine12 chlorpromazine, CPZ 氯丙嗪

4、 （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.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 (对症治疗); 3) the onset of effect is slow ( 6W-6M).14 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-infundibular pathway 结节漏斗通路CPZ() D2-R anti

6、psychotic effects15 Clinical uses psychotic disorder ： 1）schizophrenia- first choice; 2）other psychotic states: manic states; delirium (谵妄)states. no effect on depression. ( I typeII type )16 2、Antiemetic effects (镇吐作用)Antiemetic effect is strong;But no effect on motion sickness. (晕动性呕吐)CPZlow dosag

7、eCTZ（催吐化学感受区）(+)vomiting centerlarge dosagevomitchemoreceptor trigger zone 17 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 uses18 3、influence of temperature regulationcharacteristics:1) temperaturenormal person

8、 and patients with fever;2) action correlative with environmental temperature (环境温度); 3） produce fever , dispel fever(散热).19Clinical 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 mixture20 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

9、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214、 the effects of CNS depressants e.g. general anaesthetics, sedative-hypnotics, analgesics(镇痛药), alcohol, 22 II. autonomic nerve system 1、cardiovascular(-) - R(-)血管运动中枢dilate the blood vessel directlyBPorthostatic hypotension 体位性低血压ad

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

11、ion of ACTH ; （内分泌系统）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 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 4) tardive dyskinesia 迟发性运动障碍中枢抗胆碱药 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中脑-皮质通路D2-R中脑-边缘叶通路D2-R抗精神病作用黑质-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28 other anti

13、psychotic 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292 Antimanic drugslithium carbonate 碳酸锂 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（个体差异）; 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 (情绪高涨)32. 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.16533Other drugs p.16