抗精神失常药和概念和分类课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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.,objective掌握 氯丙嗪的药理作用、作用机制、临床,Why?,Why?,神经,兮兮,神经稀稀,神经搭错,神经兮兮神经稀稀神经搭错,Neuro,pathy,psycho,pathy,note,（神经病）,（精神病）,Neuropathypsychopathynote（神经病）,Introduction,1,、,Concept,Psychotic,disorders,various reason,severe mental disorders.,Introduction1、ConceptPsychotic,2,、,classification,1,、,schizophrenia,精神分裂症,2、,mania-depressive disorder,躁狂抑郁症,3、,anxiety,焦虑症,4、,others,2、classification1、schizophreni,1,）,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 ),1）the most familiar,Schizophr,Mania-depressive disorder,mania,5-,HT,NA,NA,1,）,Mania-depressive,2,）,depression,5-,HT,Mania-depressive disordermania,3,、,anxiety,焦虑症,4、,others,青春期、,周期性、,更年期,3、anxiety焦虑症4、others青春期、,10月10日是世界精神卫生日,健康体魄,+,健康心理,美好人生,10月10日是世界精神卫生日健康体魄+健康心理美好人生,Classification of drugs,Antipsychotic drugs,chlorpromazine,Antimanic drugs,lithium carbonate,Antidepressants,imipramine,Anxiolytics,diazepam,氯丙嗪,碳酸锂,米帕明,地西泮,Classification of drugs Antips,1,Antipsychotic Drugs,吩噻嗪类,：,chlorpromazine,硫杂蒽类,：,chlorprothixene,丁酰苯类,：,haloperidol,其他类,：,sulpiride，clozapine,1 Antipsychotic Drugs吩噻嗪类：ch,chlorpromazine,CPZ,氯丙嗪,（,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.,chlorpromazine,CPZ 氯丙,chlorpromazine,actions uses,I.,CNS,1、Antipsychotic effects,(,抗,精神病作用),characteristics,1),long use,cant produce tolerance,;,2),symptomatic treatment,(,对症治疗);,3),the onset of effect is,slow,(6W-6M),.,chlorpromazine actions us,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,antipsychotic effects,mechanism four important,Clinical uses,psychotic disorder：,1,）,schizophrenia-,first choice;,2,）,other psychotic states:,manic states;,delirium(,谵妄,)states.,no effect on depression.,(I type,II type ),Clinical uses psychoti,2、,Antiemetic effects,(镇吐作用),Antiemetic effect is strong;,But,no effect,on motion sickness,.,(,晕动性呕吐,),CPZ,low dosage,CTZ,（,催吐化学感受区）,(+),vomiting center,large dosage,vomit,c,hemoreceptor,t,rigger,z,one,2、Antiemetic effects(镇吐作用),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 uses,nausea and vomit induce,3、,influence of temperature regulation,characteristics:,1),temperature,normal person and,patients with fever;,2)action correlative with,environmental temperature,(环境温度),;,3）,produce fever,dispel,fever,(,散热),.,3、influence of temperature,Clinical 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 mixture,Clinical uses 1）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 。,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,配合物理降温使体温降至34以下 机体进入“冬眠,4、,the effects of CNS depressants,e.g.,general anaesthetics,sedative-hypnotics,analgesics,(,镇痛药,),alcohol,4、the effects of CNS depres,II.,autonomic nerve system,1、,cardiovascular,(-)-,R,(-),血管运动中枢,dilate the blood vessel directly,BP,orthostatic hypotension,体位性低血压,adrenaline reversal,cannot use in the hypertension:,tolerance,2、,(-),M R dry mouth,constipation,(,便秘,),blurred vision,(,视力模糊,),II.autonomic nerve system 1,III.endocrine system,CPZ,(-)D,2,-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 secretion of ACTH,;,（内分泌系统）,III.endocrine systemCPZ(,adverse reactions,1、,common adverse reaction,1),CNS,2)M-R,3),-,R,:,BP,orthostatic hypotension,4)local irritative,(,刺激性,),.,adverse reactions1、common,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,(,),nigrostriatal pathway D,2,-R,2.extrapyramidal system re,3.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.160,3.allergic reactions,brief summary,CPZ,blocking,中脑-皮质通路,D,2,-R,中脑-边缘叶通路,D,2,-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,brief summaryCPZ 中脑-皮质通路D2-R抗,other antipsychotic 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,other antipsychotic drugs,2,Antimanic drugs,lithium carbonate,碳酸锂,characteristics,1.,absorbed well；wide distribution；,2.Na,+,enhance the excretion of Li,+,;,incept,Na,+,renal,discharge,Li,+,3.,onset of effect is slow,individual variation,（个体差异）,;,2 Antimanic drugslithium ca,4.,mechanism is complex;,p.164,5.,mania and the manic state of schizophrenia,clinical first choice;,6.,adverse reaction