抗精神失常药的概念和分类

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Neuropathypsychopathynote（神经病）（精神病）≠Introduction1、ConceptPsychoticdisorders

variousreason

severementaldisorders.2、classification1、schizophrenia精神分裂症2、mania-depressivedisorder躁狂抑郁症

3、anxiety焦虑症4、others1）themostfamiliar,2）inpatient60~70%;3）thoughtandbehavior----cloven(分裂)4）limbicsystem(边缘系统)

DAfunction.Schizophrenia

(Itype,IItype)Mania-depressivedisorder

mania5-HT↓NANA↓1）Mania-depressive

2）depression5-HT↓3、anxiety焦虑症4、others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ClassificationofdrugsAntipsychoticdrugschlorpromazineAntimanicdrugs

lithiumcarbonateAntidepressants

imipramineAnxiolytics

diazepam氯丙嗪碳酸锂米帕明地西泮§1

AntipsychoticDrugs吩噻嗪类：chlorpromazine硫杂蒽类：chlorprothixene丁酰苯类：haloperidol其他类：sulpiride，clozapine…chlorpromazine,CPZ

氯丙嗪

（wintermin冬眠灵）[pharmacokinetics]

1、po.slowandirregular,Fvariable,im.absorb

quickly；2、passBBBeasily,

distributioniswide(inbrainhigher);

3、metabolizemainlyinliver;4、elimination：kidney.chlorpromazine[actions＆uses]I.

CNS1、Antipsychoticeffects(抗精神病作用)

characteristics

1)longuse,can’tproducetolerance;2)symptomatictreatment(对症治疗);3)theonsetofeffectisslow(6W-6M).

mechanism

fourimportantdopaminergicpathways:

1)mesolimbicpathway

中脑－边缘系统

2)mesocorticalpathway

中脑－皮质通路

3)nigrostriatalpathway

黑质－纹状体通路

4)tubero-infundibularpathway

结节－漏斗通路CPZ(－)D2-R→

antipsychoticeffectsClinicaluses

psychoticdisorder：1）schizophrenia-----

firstchoice;2）otherpsychoticstates:

manicstates;delirium(谵妄)states.noeffectondepression.(Itype＞IItype)

2、Antiemeticeffects

(镇吐作用)

Antiemeticeffectisstrong;Butnoeffectonmotionsickness.(晕动性呕吐)CPZlowdosage㈠CTZ（催吐化学感受区）(+)vomitingcenterlargedosage㈠vomitchemoreceptortriggerzone

nauseaandvomit

inducedbyuremia(尿毒症),cancer,pregnanttoxemia(妊娠毒血症),radiation(辐射)

andsomedrugs.

stubbornhiccup

顽固性呃逆

Clinicaluses

3、influenceoftemperatureregulationcharacteristics:1)

temperaturenormalpersonandpatientswithfever;2)actioncorrelativewithenvironmentaltemperature(环境温度);

3）

producefever,dispel

fever(散热).Clinicaluses1）hypothermalanesthesia

低温麻醉

2）artificialhibernation

人工冬眠

CPZ+pethidine(哌替啶)

+promethazine(异丙嗪)hibernationmixture配合物理旁降温使体温户降至34℃以下便机体进入圈“冬眠”迫状态。BMR，对各种病绝理刺激的沈反应性飞，组织对气缺氧的耐稍受力恨。mos侮tly宇us偏ed较for严重感染茫、中毒性岁休克、高掌热惊厥、嗓甲状腺危袖象等辅助治疗。人工冬眠4、the淋effe偶cts喝of沃CNS虏depr倦essa三ntse.g阿.gene颠ral壁anae封sthe冈tics瓜,sed垦ati昌ve-堂hyp膛not颜ics素,ana核lge妻sic闭s(镇痛药),alco肝hol,……II.aut拆ono盲mic乞ne乌rve计sy庭ste听m1、car赶dio参vas险cul维ar(-)烟-R(-)血管运动栏中枢dila锯tet趣heb突lood悲ves也sel肠dire佩ctlyBP↓ort孔hos逃tat还ic乒hyp索ote嘉nsi贞on体位性涌低血压adr渔ena封lin往er轿eve堆rsa康lcan稼not甚us计ei报nt牙he押hyp杰ert期ens厘ion效:tol争era柏nce2、(-)M–酬R仓dr照ym资out膊h,版con踢sti艘pat骗ion(便秘),blu耍rre胃dv待isi代on(视力模糊)…III信.e咽ndo失cri肉ne沟sys刘temCPZ(-)码D2-R(tub梯ero-眠infu性ndib间ular必pat岸hway传)pro丧lac蔬tin句in项hib执ito躲ry份fac仰tor舅(催乳素释管放抑制因朵子);the结se完cre录tio僻no除fg叼row京th乐hor她mon冶e;the稿secr蹦etio占nof斑GnR构H(促性腺激爪素);the族se班cre铲tio洲no龄fA持CTH;……（内分找泌系统庙）[adv斤ers龙e蛛rea兄cti腥ons众]1、comm江ona蒜dver矩ser芽eact销ion1)称㈠CNS续,2)寄M-R弟㈠,3)-R㈠:BP,orth贵osta透tic限hypo黑tens授ion…4)乡丰loc授al赌irr蛋ita殿tiv倦e(刺激性).2.ext尝rap叹yra尺mid盐al敌sys哪tem营re赏act宽ion器s锥体外裙系反应1)park印inso风nism帕金森在综合征2)acu材te腔dys奴ton诵ia急性肌弟张力障秋碍3)akat埋hisi旬a静坐不能4)tard浑ive垮dysk农ines忠ia迟发性运积动障碍中枢抗胆搂碱药CPZ()nig范ros如tri耍ata兆lp钱ath纸way冈D2-R3.a等lle羽rgi经cr货eac俗tio军ns4.a主cut匆et霸oxi栽cat衡ionpo.胶larg疮edo卸se:辰1~2葱g/箭time营，cli绕nic俱al今sym存pto娱ms：narc剪oma，Bpshoc见k，（麻醉性绢昏睡）car妥dia田cd识ama皆ge,哥ar退rhy累thm键ia…攻…[con监tra辱ind侧ica制tio瓜ns]谷p.摄160brie于fsu克mmar狮yCPZbloc泄king中脑-岂皮质通阻路D2-R中脑-边泳缘叶通路D2-R抗精神病抵作用黑质-凉纹状体生通路DA-R锥体外系反应结节-漏四斗通路DA-R影响内检分泌oth煤er束ant枯ips堪ych陶oti暴c名dr钟ugsp.1棚61-累163硫杂蒽类tard欲an泰尔登丁酰苯巷类halo余peri幅dol氟哌啶醇其他口服丈长效类pen检flu肺rid州ol五氟利位多sul暮pir刻ide舒必利clo损zap姿ine氯氮平ris捡per计ido卸ne利培酮§2Ant呜ima胃nic臂dr投ugslit兰hiu砖m念car妄bon段ate碳酸锂[ch崖ara贴cte急ris装tic蜜s]1.abso糕rbed脂wel面l；wi死ded逐istr差ibut蚂ion末；2.N晓a+enha胁nce陆the错excr咽etio宜nof半Li+;inc爪eptNa+ren奴aldis映cha核rgeLi+3.onse肝tof葛eff委ect介iss杯low,ind值ivi筹dua妙lv迈ari掌ati谎on（个体差郑异）;4.mech糕anis尺mis当com黄plex激;p.16惑45.mani增aan己dth车ema奇nic箩stat数eof浴sch似izop冈hren涉iacli色nic喘al捕fir愉st正cho户ice岭;6.adv粘ers右er损eac漆tio博nsa乱fe啄mar垂gin允is康na抛rro疑w;com优mon赖ad何ver举se总rea低cti企onacu辈te惩tox梨ica壮tio泻n:吐CNS梨(–)寻coma蹲…,d敲eath.with戚draw段al,t贵rea森tme来nt:iv.址0.9%牵NaC剧lTDMimpo羽rtan脾t!§3Ant橡idep吐res唤san腹tdrug劈燕sImip午rami量ne米帕明（丙咪千嗪）［cha钟rac伏ter优ist税ics术］1.po.abso压rbed其wel某l；wi遗ded结istr词ibut贷ion惯；2.Anti书depr汁essa毛ntsele锋ctiv映ityhig有h;acti隙ons想low;nor菠mal贝---壁-CN扇S(–)depr碗esse提d----upli若ft(情绪高慢涨)３.mec瞎han肉ism阵：inhi葡bit烂the炼reup告take薄of紫NA、5盛-HT杏int类heb道rain脆.4.Cl理inic丘alu笋ses:dif秤fer弊ent仍ty老pes郑of鉴de芬pre蒸ssi敢on,壮en停ure船sis(遗尿症)肢,anxi欲ety氧and根phob封ia(恐怖症牙).5.A劫dver蛮ser概eact