抗精神失常药的概念和分类

抗精神失常药的概念和分类2023/5/27抗精神失常药的概念和分类Why?抗精神失常药的概念和分类神经兮兮

神经稀稀

神经搭错抗精神失常药的概念和分类Neuropathypsychopathynote（神经病）（精神病）≠抗精神失常药的概念和分类Introduction1、ConceptPsychoticdisorders

variousreasonseverementaldisorders.抗精神失常药的概念和分类2、classification1、schizophrenia精神分裂症2、mania-depressivedisorder躁狂抑郁症

3、anxiety焦虑症4、others抗精神失常药的概念和分类1）themostfamiliar,2）inpatient60~70%;3）thoughtandbehavior----cloven(分裂)4）limbicsystem(边缘系统)

DAfunction.Schizophrenia

(Itype,IItype)抗精神失常药的概念和分类Mania-depressivedisorder

mania5-HT↓NANA↓1）Mania-depressive

2）depression5-HT↓抗精神失常药的概念和分类3、anxiety焦虑症4、others青春期、周期性、更年期抗精神失常药的概念和分类10月10日是世界精神卫生日健康体魄+健康心理美好人生抗精神失常药的概念和分类ClassificationofdrugsAntipsychoticdrugschlorpromazineAntimanicdrugs

lithiumcarbonateAntidepressants

imipramineAnxiolytics

diazepam氯丙嗪碳酸锂米帕明地西泮抗精神失常药的概念和分类§1

AntipsychoticDrugs吩噻嗪类：chlorpromazine硫杂蒽类：chlorprothixene丁酰苯类：haloperidol其他类：sulpiride，clozapine…抗精神失常药的概念和分类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.抗精神失常药的概念和分类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).抗精神失常药的概念和分类

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→

antipsychoticeffects抗精神失常药的概念和分类Clinicaluses

psychoticdisorder：1）schizophrenia-----

firstchoice;2）otherpsychoticstates:

manicstates;delirium(谵妄)states.noeffectondepression.(Itype＞IItype)抗精神失常药的概念和分类

2、Antiemeticeffects

(镇吐作用)

Antiemeticeffectisstrong;Butnoeffectonmotionsickness.(晕动性呕吐)CPZlowdosage㈠CTZ（催吐化学感受区）(+)vomitingcenterlargedosage㈠vomitchemoreceptortriggerzone抗精神失常药的概念和分类

nauseaandvomit

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

stubbornhiccup

顽固性呃逆

Clinicaluses抗精神失常药的概念和分类

3、influenceoftemperatureregulationcharacteristics:1)

temperaturenormalpersonandpatientswithfever;2)actioncorrelativewithenvironmentaltemperature(环境温度);

3）producefever,dispelfever(散热).抗精神失常药的概念和分类Clinicaluses1）hypothermalanesthesia

低温麻醉

2）artificialhibernation

人工冬眠

CPZ+pethidine(哌替啶)

+promethazine(异丙嗪)hibernationmixture抗精神失常药的概念和分类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。

mostlyusedfor

严重感染、中毒性休克、高热惊厥、甲状腺危象等辅助治疗。人工冬眠抗精神失常药的概念和分类4、theeffectsofCNSdepressants

e.g.generalanaesthetics,sedative-hypnotics,analgesics(镇痛药),alcohol,……抗精神失常药的概念和分类

II.autonomicnervesystem

1、cardiovascular(-)-R(-)血管运动中枢dilatethebloodvesseldirectlyBP↓orthostatichypotension

体位性低血压adrenalinereversalcannotuseinthehypertension:tolerance2、(-)M–Rdrymouth,constipation(便秘),blurredvision(视力模糊)…抗精神失常药的概念和分类III.endocrinesystemCPZ

(-)D2-R

(tubero-infundibularpathway)

prolactininhibitoryfactor(催乳素释放抑制因子);

thesecretionofgrowthhormone;thesecretionofGnRH(促性腺激素);thesecretionofACTH;……（内分泌系统）抗精神失常药的概念和分类[adversereactions]1、

commonadversereaction1)㈠CNS,2)M-R㈠,3)-R㈠:BP,

orthostatichypotension…4)localirritative(刺激性).抗精神失常药的概念和分类

2.extrapyramidalsystemreactions

锥体外系反应1)parkinsonism帕金森综合征2)acutedystonia急性肌张力障碍

3)akathisia静坐不能

4)tardivedyskinesia迟发性运动障碍中枢抗胆碱药

CPZ

()

nigrostriatalpathwayD2-R

抗精神失常药的概念和分类3.allergicreactions4.acutetoxication

po.largedose:1~2g/time，clinicalsymptoms：narcoma，Bpshock，

（麻醉性昏睡）cardiacdamage,arrhythmia……

[contraindications]p.160抗精神失常药的概念和分类briefsummaryCPZ

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影响内分泌抗精神失常药的概念和分类

otherantipsychoticdrugsp.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

利培酮抗精神失常药的概念和分类§2Antimanicdrugslithiumcarbonate

碳酸锂

[characteristics]

1.absorbedwell；widedistribution；2.Na+enhancetheexcretionofLi+;

inceptNa+renaldischargeLi+3.onsetofeffectisslow,

individualvariation（个体差异）;抗精神失常药的概念和分类4.mechanismiscomplex;p.1645.maniaandthemanicstateofschizophreniaclinicalfirstchoice;6.adversereaction

safemarginisnarrow;commonadversereaction

acutetoxication:CNS(–)coma…,death.

withdrawal,treatment:

iv.0.9%NaClTDM

important!抗精神失常药的概念和分类§3AntidepressantdrugsImipramine米帕明（丙咪嗪）［characteristics］

1.po.absorbedwell；widedistribution；

2.Antidepressantselectivityhigh;actionslow;normal----CNS(–)