抗精神失常药课件

第18章抗精神失常药

药学系药理教研室1谢谢观赏2019-6-29第18章抗精神失常药

药学系药理教研室1谢谢观赏2019-6Chapter18

AntipsychoticdisordersdrugsZhuxiaoguang2谢谢观赏2019-6-29Chapter18

Antipsychoticdisobjecter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.3谢谢观赏2019-6-29objecter掌握氯丙嗪的药理作用、作用机制、临床应Why?4谢谢观赏2019-6-29Why?4谢谢观赏2019-6-29神经兮兮

神经稀稀

神经搭错5谢谢观赏2019-6-29神经兮兮神经稀稀神经搭错5谢谢观赏2019-6-29Neuropathypsychopathynote（神经病）（精神病）≠6谢谢观赏2019-6-29Neuropathypsychopathynote（神经病）Introduction1、ConceptPsychoticdisorders

variousreason

severementaldisorders.7谢谢观赏2019-6-29Introduction1、ConceptPsychotic2、classification1、schizophrenia精神分裂症2、mania-depressivedisorder躁狂抑郁症

3、anxiety焦虑症4、others8谢谢观赏2019-6-292、classification1、schizophreni1）themostfamiliar,2）inpatient60~70%;3）thoughtandbehavior----cloven(分裂)4）limbicsystem(边缘系统)

DAfunction.Schizophrenia

(Itype,IItype)9谢谢观赏2019-6-291）themostfamiliar,SchizophrMania-depressivedisorder

mania5-HT↓NA

NA↓1）Mania-depressive

2）depression5-HT↓10谢谢观赏2019-6-29Mania-depressivedisordermania3、anxiety焦虑症4、others青春期、周期性、更年期11谢谢观赏2019-6-293、anxiety焦虑症4、others青春期、11谢谢观10月10日是世界精神卫生日健康体魄+健康心理美好人生12谢谢观赏2019-6-2910月10日是世界精神卫生日健康体魄+健康心理美好人生12谢ClassificationofdrugsAntipsychoticdrugschlorpromazineAntimanicdrugs

lithiumcarbonateAntidepressants

imipramineAnxiolytics

diazepam氯丙嗪碳酸锂米帕明地西泮13谢谢观赏2019-6-29ClassificationofdrugsAntips§1

AntipsychoticDrugs吩噻嗪类：chlorpromazine硫杂蒽类：chlorprothixene丁酰苯类：haloperidol其他类：sulpiride，clozapine…14谢谢观赏2019-6-29§1AntipsychoticDrugs吩噻嗪类：chchlorpromazine,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.15谢谢观赏2019-6-29chlorpromazine,CPZ氯丙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).16谢谢观赏2019-6-29chlorpromazine[actions＆us

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→

antipsychoticeffects17谢谢观赏2019-6-29mechanismfourimportantClinicaluses

psychoticdisorder：1）schizophrenia-----

firstchoice;2）otherpsychoticstates:

manicstates;delirium(谵妄)states.noeffectondepression.(Itype＞IItype)18谢谢观赏2019-6-29Clinicalusespsychoti

2、Antiemeticeffects

(镇吐作用)

Antiemeticeffectisstrong;Butnoeffectonmotionsickness.(晕动性呕吐)CPZlowdosage㈠CTZ（催吐化学感受区）(+)vomitingcenterlargedosage㈠vomitchemoreceptortriggerzone19谢谢观赏2019-6-292、Antiemeticeffects(镇吐作用)

nauseaandvomit

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

andsomedrugs.

stubbornhiccup

顽固性呃逆

Clinicaluses20谢谢观赏2019-6-29nauseaandvomitinduce

3、influenceoftemperatureregulationcharacteristics:1)

temperaturenormalpersonandpatientswithfever;2)actioncorrelativewithenvironmentaltemperature(环境温度);

3）

producefever,

dispel

fever(散热).21谢谢观赏2019-6-293、influenceoftemperatureClinicaluses1）hypothermalanesthesia

低温麻醉

2）artificialhibernation

人工冬眠

CPZ+pethidine(哌替啶)

+promethazine(异丙嗪)hibernationmixture22谢谢观赏2019-6-29Clinicaluses1）hypothermal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23谢谢观赏2019-6-29配合物理降温使体温降至34℃以下机体进入“冬眠4、

theeffectsofCNSdepressants

e.g.generalanaesthetics,sedative-hypnotics,analgesics(镇痛药),alcohol,……24谢谢观赏2019-6-294、theeffectsofCNSdepres

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)…25谢谢观赏2019-6-29II.autonomicnervesystem1III.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）26谢谢观赏2019-6-29III.endocrinesystemCPZ([adversereactions]1、

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

,

orthostatichypotension…4)localirritative(刺激性).27谢谢观赏2019-6-29[adversereactions]1、common

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

28谢谢观赏2019-6-292.extrapyramidalsystemre3.allergicreactions4.acutetoxication

po.largedose:1~2g/time，

clinicalsymptoms：narcoma，Bp

shock，

（麻醉性昏睡）cardiacdamage,arrhythmia……

[contraindications]p.16029谢谢观赏2019-6-293.allergicreactions29谢谢观赏201briefsummaryCPZ

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30谢谢观赏2019-6-29briefsummaryCPZ中脑-皮质通路D2-R抗

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31谢谢观赏2019-6-29otherantipsychoticdrugs§2Antimanicdrugslithiumcarbonate

碳酸锂

[characteristics]

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

incept

Na+

renaldischarge

Li+

3.onsetofeffectisslow,

individualvariation（个体差异）;32谢谢观赏2019-6-29§2Antimanicdrugslithiumca4.mechanismiscomplex;p.1645.maniaandthemanicstateofschizophreniaclinicalfirstchoice;6.adversereaction

safemarginisnarrow;

commonadversereaction

acutetoxication:CNS(–)coma…,death.

withdrawal,treatment:

iv.0.9%NaClTDM

important!33谢谢观赏2019-6-294.mechanismiscomplex;p§3AntidepressantdrugsImipramine米帕明（丙咪嗪）［characteristics］

1.po.absorbedwell；widedistribution；

2.Antidepressantselectivity

high;actionslow;