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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.,Why?,神经,兮兮,神经稀稀,神经搭错,Neuro,pathy,psycho,pathy,note,（神经病）,（精神病）,Introduction,1,、,Concept,Psychotic,disorders,various reason,severe mental disorders.,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,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 ),Mania-depressive disorder,mania,5-,HT,NA,NA,1,）,Mania-depressive,2,）,depression,5-,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,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,1,Antipsychotic Drugs,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.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,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),.,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,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 ),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,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,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),.,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,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,4、,the effects of CNS depressants,e.g.,general,anaesthetics,sedative-hypnotics,analgesics,(,镇痛药,),alcohol,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,),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）,adverse reactions,1、,common adverse reaction,1),CNS,2)M-R,3),-,R,:,BP,orthostatic hypotension,4)local,irritative,(,刺激性,),.,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,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,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,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,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）,;,4.,mechanism is complex;,p.164,5.,mania and the manic state of schizophrenia,clinical first choice;,6.,adverse reaction,safe margin is narrow;,common adverse reaction,acute,toxication,:CNS(,)coma,death,.,withdrawal,treatment:,iv.0.9%,NaCl,TDM,important!,3,Anti,depressant,drugs,Imipramine,米帕明,（丙咪嗪）,characteristics,1.,po.,absorbed,well；wide,distribution；,2,.,Antidepressant,selectivity,high;,action slow;,normal-CNS(,),depressed,-,uplift,(,情绪高涨,),.,mechanism：,inhibit the reuptake of NA、5-HT in the brain.,4,.Clinical uses:,different types of depression,enuresis,(,遗尿症),anxiety and phobia,(,恐怖症).,5.Adverse reactions:M-R,(,),CNS symptom,drug interaction,p.165,Other,drugs,p.166-170,amitriptyline,阿米替林,maprotiline,马普替林,mianserin,米安色林,1.Describe the actions and uses of,CPZ.,2.,Please explain the effects and,adverse reactions of CPZ by receptor theory.,3.List the name used for mania or
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