MindMap Gallery Antimanic depression drugs
Exploring the chemical code behind emotional fluctuations: a new perspective on drug treatment for manic depression. By inhibiting the myocardium's reuptake of NA, the NA concentration is increased, and antimanic depression drugs such as MAOA inhibitors and NA/5HT reuptake inhibitors effectively regulate monoamine function and alleviate pathological fluctuations in emotional activities. Lithium salts such as lithium carbonate significantly control manic symptoms through the regulation of IP3 and DAG in neurons. However, patients with cardiovascular disease should use it with caution, as the drug may cause the T wave to be inverted or flat. From monoamine theory to drug action mechanism, research in this field is still in-depth, providing new hope for the treatment of emotional and mental disorders.
Edited at 2025-03-10 15:21:30Rumi: 10 dimensions of spiritual awakening. When you stop looking for yourself, you will find the entire universe because what you are looking for is also looking for you. Anything you do persevere every day can open a door to the depths of your spirit. In silence, I slipped into the secret realm, and I enjoyed everything to observe the magic around me, and didn't make any noise. Why do you like to crawl when you are born with wings? The soul has its own ears and can hear things that the mind cannot understand. Seek inward for the answer to everything, everything in the universe is in you. Lovers do not end up meeting somewhere, and there is no parting in this world. A wound is where light enters your heart.
Chronic heart failure is not just a problem of the speed of heart rate! It is caused by the decrease in myocardial contraction and diastolic function, which leads to insufficient cardiac output, which in turn causes congestion in the pulmonary circulation and congestion in the systemic circulation. From causes, inducement to compensation mechanisms, the pathophysiological processes of heart failure are complex and diverse. By controlling edema, reducing the heart's front and afterload, improving cardiac comfort function, and preventing and treating basic causes, we can effectively respond to this challenge. Only by understanding the mechanisms and clinical manifestations of heart failure and mastering prevention and treatment strategies can we better protect heart health.
Ischemia-reperfusion injury is a phenomenon that cellular function and metabolic disorders and structural damage will worsen after organs or tissues restore blood supply. Its main mechanisms include increased free radical generation, calcium overload, and the role of microvascular and leukocytes. The heart and brain are common damaged organs, manifested as changes in myocardial metabolism and ultrastructural changes, decreased cardiac function, etc. Prevention and control measures include removing free radicals, reducing calcium overload, improving metabolism and controlling reperfusion conditions, such as low sodium, low temperature, low pressure, etc. Understanding these mechanisms can help develop effective treatment options and alleviate ischemic injury.
Rumi: 10 dimensions of spiritual awakening. When you stop looking for yourself, you will find the entire universe because what you are looking for is also looking for you. Anything you do persevere every day can open a door to the depths of your spirit. In silence, I slipped into the secret realm, and I enjoyed everything to observe the magic around me, and didn't make any noise. Why do you like to crawl when you are born with wings? The soul has its own ears and can hear things that the mind cannot understand. Seek inward for the answer to everything, everything in the universe is in you. Lovers do not end up meeting somewhere, and there is no parting in this world. A wound is where light enters your heart.
Chronic heart failure is not just a problem of the speed of heart rate! It is caused by the decrease in myocardial contraction and diastolic function, which leads to insufficient cardiac output, which in turn causes congestion in the pulmonary circulation and congestion in the systemic circulation. From causes, inducement to compensation mechanisms, the pathophysiological processes of heart failure are complex and diverse. By controlling edema, reducing the heart's front and afterload, improving cardiac comfort function, and preventing and treating basic causes, we can effectively respond to this challenge. Only by understanding the mechanisms and clinical manifestations of heart failure and mastering prevention and treatment strategies can we better protect heart health.
Ischemia-reperfusion injury is a phenomenon that cellular function and metabolic disorders and structural damage will worsen after organs or tissues restore blood supply. Its main mechanisms include increased free radical generation, calcium overload, and the role of microvascular and leukocytes. The heart and brain are common damaged organs, manifested as changes in myocardial metabolism and ultrastructural changes, decreased cardiac function, etc. Prevention and control measures include removing free radicals, reducing calcium overload, improving metabolism and controlling reperfusion conditions, such as low sodium, low temperature, low pressure, etc. Understanding these mechanisms can help develop effective treatment options and alleviate ischemic injury.
Chapter 16 Antipsychotic drugs
Mental disorder
Diseases of mental activity caused by various causes,
common
Schizophrenia
Currently it is believed that the dopamine function of CNS is mainly related to the strong
Manic depression
Anxiety
Treatment medicine
Antipsychotic drugs
Antimanic depression drugs
Anti-anxiety drugs
Antipsychotic drugs
Mainly treat schizophrenia
Emotional-intellectual separation
Main medicine
phenothiazines
Chlorpromazine/Hidden
Pharmacological effects
main
Anti-psychotic
Mainly manifested in the impact on mental activities and behaviors
Generally, it can show symptoms after taking 100mg orally
Quiet
Emotionally stable
Indifferent feelings, no interest in the things around you, slow answering questions in a single language
Easy to induce to fall asleep
Have a good awakening response to stimulation and have clear consciousness
Maintain advanced neurological function and do not cause anesthesia at large doses (center depression)
Quickly control manic symptoms
Eliminate hallucinations and delusions
Restore rationality, take care of one's own life, and have a strong and stable effect
Anti-emetic effect
Inhibition of CTZ (chemoreceptive zone of ememetosis)
High doses directly inhibit vomiting center
Mainly related to blocking D2 receptors
Note: Ineffective for vomiting caused by vestibular
That is, it is ineffective against vomiting caused by motion sickness and seasickness
Hiccups and reversal effects
The mechanism is not yet clear
Inhibiting the temperature regulation center
Strong effect on hypothalamic thermoregulation center
lead to
Normal people increase or decrease with changes in external temperature
Strengthen the role of central inhibitor drugs
e.g.Sedative hypnosis, pain medication, etc.
Effects on autonomic nerve and cardiovascular system
BP↓
Block α receptor → vasodilation
Adrenaline flip
Inhibiting the center of vascular movement
Directly dilate vascular smooth muscle
Strong antihypertensive drugs → There are many adverse reactions, so no antihypertensive drugs
Block M receptor
Produce a similar effect to atropine
Dry mouth, constipation, blurred vision, etc.
Impact on the endocrine system
Block D2 receptors in the funnel at the nodule
Reduce the release of prolactin inhibitors
Prolactin↑→Breast enlargement, lactation
Inhibit gonadotropin secretion
Follicle hormone, luteinizing hormone↓→Mental disorders
Inhibit ATCH release
Glucocorticoids↓
Inhibit growth hormone secretion
Growth hormone↓
The effects on endocrine in treating psychiatric disorders are adverse side effects
Mechanism of action
Block multiple receptors
α receptor
H1 (Histamine) receptor
5-HT2 receptor
M receptor
Wide effects, but not strong selectivity → many side effects
D2 receptors in the brain
Main mechanism
脑内有4条DA能神经通路
黑质-纹状体通路
与锥体外系运动能有关
中脑-边缘系统通路
中脑-皮质通路
Related to mental and emotional activities and behavioral activities
结节-漏斗通路
与内分泌活动有关
Clinical application
Various types of schizophrenia
Better treatment for acute patients
Generally not cured, it needs to be taken for a long time
Antiemetic and stubborn hiccups
e.g. Vomiting, morning sickness, and medication caused by radiotherapy/chemotherapy caused by vomiting, morning sickness, and vomiting caused by drugs caused by vomiting.
e.g. Diaphragm spasm
Used for low-temperature anesthesia in combination with physical cooling
Significance: metabolism of important organs such as the heart and brain↓→Oxygen consumption↓
Constitute "hibernation" mixture
Hibernation mixture = chlorpromazine Promethazine Petidine (Dalemine)
Used for "artificial hibernation therapy"
Adverse reactions
General adverse reactions
Central sedation
Lethargy, indifference
Block M receptors, similar to atropine
Blurred vision, dry mouth and constipation, etc.
Block alpha receptors
Symptoms of α receptor blockade, such as nasal congestion, orthostatic hypotension
Block D2 receptor
Amenorrhea, breast enlargement, etc.
Extracone system reaction
mechanism
Long-term blockade of substantia nigra-striatal pathway → relative enhancement of cholinergic nerve function
Main performance
Parkinson's syndrome
More common in middle-aged and elderly people
Sluggish expressions, slow movements, muscle tremors, drooling, etc.
Can't sit still
More common among young and middle-aged people
Sub-theme
Acute dystonia
More common in teenagers
Dystonia/spasm in certain areas → weird movements
After stopping the drug, it can return to normal, and can also be relieved by anticholinergic drugs.
Tardial dyskinesia
Main symptoms
Oral-tongue-cheek trilogy
Suck
Stick your tongue
chew
Dance of all limbs
Involuntary stereotypes, the drug cannot return to normal after stopping
mechanism
Long-term blockade of D receptor leads to its sensitivity, quantity
treat
Can only gradually reduce the drug and use clozapine (the effect of blocking D2 receptors is weak) to relieve it
Malignant syndrome of tranquilizer
Characterized by temperature regulation disorder and severe extrapyramidal reactions
Heart abnormality
Atrioventricular block
Ventricular arrhythmia
EKG has QT interval prolongation, ST segment and T wave abnormalities
Eye complications
Cleropromazine crystal precipitation in cornea and lens
Promote lens aging → cataracts, etc.
Allergic reactions
Rash, allergic dermatitis
Granopenia, hemolysis, aplastic anemia
Liver function impairment
Fluphenazine, trifluoroprazine
Both antipsychotic and extrapyramidal effects are strong, but the cardiovascular effects are mild
Sulphur cypress
Fluperitixol, clopithrothixol
Selective blockade of DA receptors
Strong antipsychotic effects but weak extrapyramidal effects
Strong effect and quick effect
Butyrylbenzene
Haloperidol
Blocking D2 receptors is most obvious
Antipsychotic and extrapyramidal systems are the most effective
However, the blocking of α receptor is weak → basically no sedation effect
Strong antiemetic and hiccups
Other categories
Supri
Selectively block D2 receptors in the limbic system and cortex
Weak effect on striatal D2 receptor
clozapine
Weak affinity for D2 receptors, strong affinity for D4 receptors and 5-HT receptors
Almost no extraconical reaction
Patients whose other drugs are ineffective are still effective
Risperidone
Same as clozapine, and has stronger effect
Antimanic depression drugs
Manic depression
concept
It's also an emotional and mental disorder
Emotional activities are pathologically over-high (mania), over-low (depression), or alternately
Pathogenesis
Monoamine theory
Biochemical foundation is 5-HT deficiency
Hyperfunction of NA → Mania
Depression NA
Main medicine
Antimania drugs
Causes of mania
Synaptic cleft monoamine↑
IP3, DAG↑ in neurons
Hyperfunction of NA
Main medicine
Lithium salts (lithium carbonate, lithium acetate, lithium citrate, etc.)
Pharmacological effects
The therapeutic dose has no effect on normal people, but can significantly control manic symptoms of mania and schizophrenia.
Have a preventive effect
Mechanism of action
Not completely clear
Currently it is believed that it is mainly used for Li
Reduce the concentration of synaptic cleft NA
Implementation method
Inhibit NA release in the brain
Promote the reuptake of NA by synaptic membranes
Functions against NA neurons
Update rate of NA and DA↓→Central cholinergic neural function↑→Restrict NA nervous function
Inhibiting the effect of phosphatase → PIP2 generation ↓ → IP3 and DAG synthesis ↓ → NA
Adverse reactions
many
Gastrointestinal symptoms such as nausea, vomiting, diarrhea
In severe cases
Tired and weak, trembling, unclear speech
Blurred vision or even convulsions
Coma, shock
Small safety range
Effective blood drug concentration
0.8-1.5mmol/L
Poisoning concentration
>2mmol/L
No special rescue medicine →
Symptom-based treatment
Li The physical and chemical properties are similar to that of Na → Injection of NaCl during poisoning can accelerate its excretion
Antidepressants
NA/5-HT reuptake inhibitor
Three rings
Improzine (Mipamine)
Pharmacological effects
CNS
A central depression for normal people
Sleepiness, drowsiness, dizziness, blurred vision, etc.
Inattention, decreased thinking, unstable gait, etc.
It has obvious emotional improvement and mental boosting effects on people with depression
But it is slow to take effect (continuous medication for 2-3 weeks) → not used for acute treatment
Autonomous nervous system
Block M receptor → Atropine-like anticholine effect
Dry mouth, inhibited gland secretion, slowed gastrointestinal motility, blurred vision, etc.
Cardiovascular system
↓BP
Inhibit multiple cardiovascular reactions
Inhibiting myocardium's reuptake of NA → NA concentration ↑
Causes orthostatic hypotension and tachycardia
Prone to arrhythmia
T-wave inverted or low flat
Quinidine-like effect on myocardial
Use with caution in patients with cardiovascular disease
Mechanism of action
Inhibiting the reuptake of NA and 5-HT by presynaptic membrane → NA function increase
Clinical application
Depression of various causes
Better for menopause depression
Enuresis in children
Anxiety, horror
Adverse reactions
Atropine sample effect
Dry mouth, constipation, blurred vision, palpitations, etc.
Urinary retention
Prostate enlargement is prohibited
Increase eye pressure
Contraindicated for patients with glaucoma
Some people with depression may turn into mania
Very few can cause allergic reactions
Rash, granulocyte deficiency and jaundice
Drug interactions
Enhance the effects of central inhibitors
Enhance the pressure-up effect of sympathomimetic amine
e.g.catecholamine
Antihypertensive effects of guanethidine and coladin
5-HT reuptake inhibitor
Fluvoxamine
Strong selective 5-HT reuptake inhibitor
NA reuptake inhibitor
Maprotiline
Selective NA reuptake inhibitors
MAO-A inhibitor
Maclobemide
Only when tyramine is >150mg in the body will it react
Selective and reversible inhibition of MAO-A → reduce 5-HT and NA metabolism