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.神经兮兮神经稀稀神经搭错Neuropathypsychopathynote（神经病）（精神病）≠Introduction1、ConceptPsychoticdisordersvariousreason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-depressivedisordermania5-HT↓NANA↓1）Mania-depressive2）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Classificationofdrugs•Antipsychoticdrugschlorpromazine•Antimanicdrugslithiumcarbonate•Antidepressantsimipramine•Anxiolyticsdiazepam氯丙嗪碳酸锂米帕明地西泮§1AntipsychoticDrugs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.absorbquickly；2、passBBBeasily,distributioniswide(inbrainhigher);3、metabolizemainlyinliver;4、elimination：kidney.chlorpromazine•[actions＆uses]I.CNS1、Antipsychoticeffects(抗精神病作用)characteristics1)longuse,can’tproducetolerance;2)symptomatictreatment(对症治疗);3)theonsetofeffectisslow(6W-6M).mechanismfourimportantdopaminergicpathways: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→antipsychoticeffectsClinicalusespsychoticdisorder：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)CPZCTZ（催吐化学感受区）(+)vomitingcentervomitchemoreceptortriggerzonenauseaandvomitinducedbyuremia(尿毒症),cancer,pregnanttoxemia(妊娠毒血症),radiation(辐射)andsomedrugs.stubbornhiccup顽固性呃逆Clinicaluses3、influenceoftemperatureregulationcharacteristics:1)temperaturenormalpersonandpatientswithfever;2)actioncorrelativewithenvironmentaltemperature(环境温度);3）producefever,dispelfever(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4、theeffectsofCNSdepressantse.g.generalanaesthetics,sedative-hypnotics,analgesics(镇痛药),alcohol,……II.autonomicnervesystem1、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)…III.endocrinesystem•CPZ(-)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）[adversereactions]•1、commonadversereaction1)㈠CNS,2)M-R㈠,3)-R㈠:BP,orthostatichypotension…4)localirritative(刺激性).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-R3.allergicreactions4.acutetoxicationpo.largedose:1~2g/time，clinicalsymptoms：narcoma，Bpshock，（麻醉性昏睡）cardiacdamage,arrhythmia……[contraindications]p.160briefsummaryCPZblocking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§2Antimanicdrugs•lithiumcarbonate碳酸锂[characteristics]1.absorbedwell；widedistribution；2.Na+enhancetheexcretionofLi+;inceptNa+renaldischargeLi+3.onsetofeffectisslow,individualvariation（个体差异）;4.mechanismiscomplex;p.1645.maniaandthemanicstateofschizophreniaclinicalfirstchoice;6.adversereactionsafemarginisnarrow;commonadversereactionacutetoxication:CNS(–)coma…,death.withdrawal,treatment:iv.0.9%NaClTDMimportant!§3Antidepressantdrugs•Imipramine米帕明（丙咪嗪）［characteristics］1.po.absorbedwell；widedistribution；2.Antidepressantselectivityhigh;actionslow;normal----CNS(–)depressed----uplift(情绪高涨)３.mechanism：inhibitthereuptakeofNA、5-HTinthebrain.4.Clinicaluses:differenttypesofdepression,enuresis(遗尿症),anxietyandphobia(恐怖症).5.Adversereactions:M-R(–),CNSsymptom…[druginteraction]p.165Otherdrugsp.166-170amitriptyline阿米替林maprotiline马普替林mianserin米安色林……1.DescribetheactionsandusesofCPZ.2.PleaseexplaintheeffectsandadversereactionsofCPZbyreceptortheory.3.Listthenameusedformaniaordepressive.