Introduction to Hibernation Spirit
Contents 1 Pinyin 2 English reference 3 Overview 4 Instructions for chlorpromazine 4.1 Drug name 4.2 English name 4.3 Alias of hibernating spirit 4.4 Classification 4.5 Dosage form 4.6 Pharmacological effects of chlorpromazine 4.7 Pharmacokinetics of chlorpromazine Study 4.8 Indications of chlorpromazine 4.9 Contraindications of chlorpromazine 4.10 Precautions 4.11 Adverse reactions of chlorpromazine 4.12 Usage and dosage of chlorpromazine 4.13 Interactions between Dongmeiling and other drugs 4.14 Expert comments 5 Chlorpromazine poisoning 5.1 Clinical Manifestations 5.2 Diagnosis 5.3 Treatment 6 References This is a redirect entry that shares the content of chlorpromazine. For the convenience of reading, chlorpromazine in the following text has been automatically replaced by hibernating spirit. You can click here to restore the original appearance, or use the note method to display 1 Pinyin
dōng mián líng 2 English reference
Chlorpromazin
Wintermin 3 Overview
Chlorpromazin extensively inhibits the central nervous system and exhibits stable, sedative and antipsychotic effects. This product has central dopamine receptor blocking effect and anti-cholinergic effect. It is well absorbed orally and can penetrate the blood-cerebrospinal fluid barrier. The concentration in the brain is higher than that in the blood. It is mainly used for short-term treatment of acute or chronic schizophrenia, mania, manic depression, impulsive violent behavior and severe anxiety. It can also be used to stop vomiting and eliminate tetanus spasms, primary muscle disorders and other conditions. Acute poisoning reactions can occur, with the main toxicity being in the cardiovascular system and central nervous system. 4 Instructions for Chlorpromazine 4.1 Drug name
Chlorpromazine
4.2 English name
Chlorpromazine 4.3 Alias of Chlorpromazine
Chlorpromazine ; Chlorpromazine; Clonidine; Calm; Chlorpromazium; Wintermin; Aminazine 4.4 Classification
Nervous system drugs> Antipsychotics, antidepressants, and anti-anxiety drugs> Phenothiazines 4.5 Dosage form
1.12.5mg, 25mg, 50mg;
2. Injection (powder): 10mg, 25mg, 50mg;
3. Compound preparation: compound Hibernation tablets: each tablet contains 12.5 mg of Hibernation hydrochloride and promethazine hydrochloride; compound injection: each 2 ml contains 25 mg of Hibernation hydrochloride and promethazine hydrochloride;
4. Hibernation mixture: Hibernation hydrochloride 50 mg each of promethazine hydrochloride and 100 mg pethidine are added to 5% glucose injection and infused intravenously for hibernation therapy. 4.6 Pharmacological effects of Dongmianling
1. Antipsychotic effect: It is currently believed that Dongmianling exerts antipsychotic effects by blocking dopamine receptors in the limbic system related to emotion and thinking. Blocking the alpha adrenergic receptors of the reticular formation ascending activating system is related to the sedative and tranquilizing effect. After taking a therapeutic dose, normal people will experience reactions such as quietness, reduced activity, apathy, reduced concentration, and disinterest in surrounding things. It can be induced to fall asleep when it is quiet, but it can be easily awakened. After being taken by mental patients, without excessive suppression, it can quickly control the manic symptoms of schizophrenia patients, reduce or eliminate symptoms such as hallucinations and delusions, and normalize thinking activities and behaviors.
2. Anti-emetic effect: A small dose can inhibit the dopamine receptors in the chemically sensitive area of the brain oblongata that induces vomiting. A large dose can directly inhibit the vomiting center, producing a powerful anti-emetic effect. But it is not effective for vomiting caused by *** vestibule.
3. Cooling effect: Dongmianling has a strong inhibitory effect on the hypothalamic temperature regulation center. It not only lowers the body temperature of fever patients, but also lowers normal body temperature. This is different from antipyretic and analgesic drugs. The patient only lowers the fever body temperature but not the normal body temperature. The cooling effect of Hibernating Spirit changes with the temperature of the external environment. The lower the ambient temperature, the more obvious the cooling effect. It has a synergistic effect with physical cooling. In hot weather, Hibernating Spirit can increase the body temperature, which interferes with the body's The result of normal heat dissipation.
4. Block peripheral adrenergic receptors, directly dilate blood vessels, and cause blood pressure to drop. Large doses can cause orthostatic hypotension. It can also relieve spasm of small arteries and small veins, improve microcirculation, and thus play an anti-shock role. At the same time, because the dilation of large veins is greater than the dilation of arteries, it can reduce cardiac preload and thereby improve cardiac function (especially left ventricular failure).
5. Endocrine system: It can block the D2 subtype receptor in the nodule infundibulum system, thereby increasing the concentration of prolactin in the blood and causing vaginal enlargement and galactorrhea. Inhibits gonadotropin release, corticotropin and growth hormone secretion, delaying ovulation. Since Hibernian Ling also inhibits the secretion of pituitary growth hormone, it can be used in the treatment of gigantism.
6. The blocking effect on M bile receptors is weak and can cause adverse reactions such as dry mouth, constipation and blurred vision. 4.7 Pharmacokinetics of Dongmianling
Oral absorption is slow and irregular, while intramuscular injection is rapidly absorbed. The effective drug concentration for treating schizophrenia is 100-300ng/ml. The blood concentration after intramuscular injection is 4 to 10 times that after oral administration. There are large individual differences in blood drug concentrations and clinical effects among different patients. The peak time is 2.8 hours for oral administration, 1 to 4 hours for intramuscular injection, and 2 to 4 hours for intravenous administration. The duration of efficacy of a single oral dose is about 6 hours. The oral bioavailability is 32%, the protein binding rate is 90% to 99%, and the distribution volume is 8 to 160L/kg. Dongmianling is distributed throughout the body, and is more abundant in the brain, lungs, liver, spleen, and kidneys. The concentration in cerebrospinal fluid (CSF) is five times that of plasma. The protein binding rate of hibiscus in cerebrospinal fluid is between 19% and 72%. It can enter the fetus through the placental barrier. Dongmianling has high fat solubility and is easy to accumulate in adipose tissue. Hibiscus Ling has first-pass metabolism. Most of it is metabolized in the liver by oxidation or conjugation with glucuronic acid, and is also metabolized to varying degrees in the small intestinal wall. The biotransformation of hibernating spirit is faster in children (0.3-17 years old) than in adults. 23% of the drug is excreted by the kidneys. Can be excreted in breast milk. The elimination half-life of the parent drug is 6 hours, but 6 months after stopping the drug, the metabolite of Hibernator can still be detected in the urine. Liver disease does not significantly affect half-life. Dongmianling cannot be eliminated by blood induction analysis or peritoneal dialysis. 4.8 Indications of Dongmianling
1. It is used to control schizophrenia, mainly used for type I schizophrenia (mainly psychomotor excitement and hallucinations and delusions), especially for acute patients. But it cannot be cured. It has poor efficacy on patients with chronic schizophrenia, and is ineffective on patients with type II schizophrenia, and may even aggravate their condition. It can also be used to treat symptoms of excitement, restlessness, nervousness, hallucinations, delusions and other symptoms of other mental illnesses. It is less effective in treating symptoms of depression and stupor.
2. Antiemetic: Effective for vomiting caused by almost all causes, such as uremia, gastroenteritis, cancer, pregnancy and drug-induced vomiting. It can also treat stubborn hiccups. But it is not effective for motion sickness and vomiting.
3. Low-temperature anesthesia and artificial hibernation: It can prevent shock when used in low-temperature anesthesia. During artificial hibernation, it is used as a hibernation mixture with pethidine and promethazine for the auxiliary treatment of traumatic shock, toxic shock, burns, high fever and thyroid storm.
4. It can be used in combination with analgesics to treat severe pain in patients with advanced cancer.
5. Treat heart failure.
6. Tried to treat acromegaly (giantism). 4.9 Contraindications of Dongmianling
1. It is contraindicated in patients with a history of phenothiazine allergy and bone marrow suppression.
2. It is forbidden for patients with angle-closure glaucoma, prostatic hyperplasia and coma.
3. It is contraindicated in patients with uremia, severe cardiovascular disease and liver damage.
4. Patients with a history of epilepsy or organic brain lesions should use it with caution or should not use it.
5. People with diabetes and hypothyroidism should use it with caution and should not use it. 4.10 Precautions
1. (1) Patients with poor liver function; (2) Patients with uremia; (3) Patients with severe cardiovascular diseases (such as hypertension and coronary heart disease); (4) Patients with glaucoma ; (5) Patients with prostatic hypertrophy and urinary retention; (6) Patients with severe respiratory diseases (especially children); (7) Patients with paralysis shaking; (8) Pregnant and breastfeeding women; (9) People exposed to high heat, Organophosphorus pesticides and patients receiving atropine or related drugs; (10) Patients with a history of malignant syndrome caused by nerve blockers; (11) Patients with signs and symptoms of Reye's syndrome; (12) Breast cancer patients.
2. Effects of drugs on the elderly: The elderly have reduced tolerance to this type of drugs and are prone to hypotension, excessive sedation, and tardive dyskinesia that is not easy to eliminate.
3. The impact of drugs on test values or diagnosis: ECG abnormalities may occur during treatment, such as Q wave or T wave changes; sometimes it may affect immune pregnancy tests and cause false positive reactions; urinary bilirubin False positives can also occur during measurement.
4. Check or monitor before and after medication and during medication: (1) White blood cell count and classification should be checked regularly during long-term treatment or large dosage; (2) Liver function; (3) Urinary bilirubin; (4) Eye examinations should be carried out when using it in large quantities for a long time. Routine inspection once every six months.
5. Injection administration is limited to patients with acute excitement and agitation, and close observation and monitoring is required to prevent hypotension.
6. It takes about 2 weeks for the medicine to be fully effective.
7. Intramuscular injection should be done slowly and deeply.
To prevent orthostatic hypotension, you should lie still for 1 to 2 hours after taking the drug. When the blood pressure is too low, norepinephrine or ephedrine can be infused intravenously to increase blood pressure. But do not use epinephrine to prevent blood pressure from falling even lower.
8. Do not stop the medication suddenly, otherwise it may cause nausea, vomiting, stomach swelling, headache, rapid heartbeat, insomnia or worsening of the condition. When discontinuation of medication is required after long-term treatment, the dosage should be gradually reduced within a few weeks.
9. The drug should be stopped immediately when neutropenia occurs; the drug should be stopped at least 48 hours before spinal X-ray photography.
10. The dosage must start with a small dose and adjust the increase according to the principle of individualization. After several days or weeks, after the mental state has improved significantly, treatment must be consolidated for at least two weeks, and then gradually reduced to the minimum effective maintenance dose. The duration of maintenance dosage must be determined based on clinical needs.
11. When the local pain caused by intramuscular injection is severe, 1% procaine can be added.
12. If there is only corneal and lens opacity but no visual impairment, Hibernate can be used under observation; if there is skin or retinal pigmentation or unexplained visual impairment, the dose should be reduced to Less than 40mg per day or substitute with other antipsychotics. When applying hibernation spirit in large doses, you should pay attention to sun protection in summer, and it is best to wear sunglasses to protect the cornea and lens.
13. Overdose symptoms include central nervous system depression, including coma, hypotension and movement disorders.
14. Overdose treatment mainly includes symptomatic treatment and supportive treatment. If necessary, take the following measures: gastric lavage and/or administration of medicinal charcoal suspension and salt laxatives as soon as possible. Do not induce vomiting. Monitor body temperature and cardiovascular function for at least 5 days. Inject phenytoin 9 to 11 mg/kg intravenously to control arrhythmia. Treat heart failure with digitalis. Administer norepinephrine or phenylephrine to treat hypotension. ECG monitoring was performed; diazepam, followed by phenytoin 15 mg/kg, was administered to control convulsions. Give benztropine or diphenhydramine to manage possible parkinsonian symptoms. 4.11 Adverse reactions of Dongmianling
1. When administered in large doses, orthostatic hypotension may occur due to the blocking effect of α-adrenergic receptors.
2. Extrapyramidal reactions: Long-term use of large doses can cause extrapyramidal symptoms, with an incidence rate of about 30%. In addition to tardive dyskinesia, the symptoms can be relieved by applying anti-biliary drugs such as trihexyphenidyl (Antan), benztropine, and scopolamine; or appropriately reducing the dosage.
3. Allergic reactions: urticaria and contact dermatitis may occur. Exfoliative dermatitis, lupus erythematosus-like symptoms, and acute hepatitis-like symptoms are occasionally seen, accompanied by liver parenchymal cell damage, abnormal liver function, and obstructive jaundice. Pigmentation of the skin and eyes, and opacification of the cornea and lens may also occur.
4. Endocrine system: Long-term use can cause endocrine disorders, manifested as male breast hyperplasia, lactation, amenorrhea, weight gain, depression in children, etc.
5. Granulocytopenia, hemolytic anemia, aplastic anemia, thrombocytopenic purpura, leukopenia, and even fatal granulocytopenia can occur in the blood system. Most of the reports are related to allergies and often occur during treatment. The first 4 to 10 weeks.
6. Acute poisoning reaction: Symptoms include coma, respiratory depression, drop in blood pressure, shock, myocardial damage and cardiac arrest.
7. Drug withdrawal reaction: long-term use of large doses, sudden drug withdrawal may cause nausea, vomiting, gastritis and tremor.
8. Occasionally it can induce epilepsy.
9. Neuroleptic malignant syndrome (NMS) is the most severe fatality caused by antipsychotics (also including dopamine antagonists such as metoclopramide) Adverse reactions. Clinical manifestations include high fever, severe extrapyramidal system reactions including muscle stiffness, autonomic nervous system dysfunction, and unconsciousness; skeletal muscle damage may occur and cause myoglobinuria, which in turn leads to renal failure. However, there is no unified standard for this syndrome. When this syndrome is suspected, the drug should be stopped immediately and active symptomatic treatment should be taken to prevent the condition from worsening. 4.12 Dosage of Dongmianling
1. (1) Take 25 to 75 mg orally, 2 to 3 times a day, gradually increase to 400 to 600 mg per day within 1 to 2 weeks, 2 to 3 divided doses. The maintenance dose is 100 to 300 mg per day, 2 to 3 times divided. (2) Intramuscular injection: It can be used to control severe symptoms, usually 25 to 50 mg each time, deep intramuscular injection. (3) Intravenous injection: Occasionally, it can be used for extremely agitated patients, no more than 50 mg each time, dilute with 20 ml of 0.9% sodium chloride injection, and inject slowly.
2. Antiemetic or hiccup: (1) Adult oral administration: 12.5 to 50 mg, 3 to 4 times a day; intramuscular injection of 25 to 50 mg each time. If symptoms persist, 25 to 50 mg of hibernating spirit can be added to 500 ml of 0.9% sodium chloride injection and infused slowly. (2) Children: The intramuscular injection or infusion dose is 0.5 to 1 mg/kg each time. (3) Preoperative administration: 25 to 50 mg plus pethidine 50 to 100 mg, intramuscular injection before general anesthesia.
4.13 Drug interactions
1. Tricyclic antidepressants (such as amoxapine, dotiapine, doxepin, amitriptyline, chlorimipramine, tripipramine, doxepin, When fepramine, desipramine, imipramine, nortriptyline, protriptyline, etc.) are combined with hibernating spirit, the two can affect each other's metabolism, leading to an increase in drug concentration and enhanced toxicity. In addition, both have anti-biliary activity, and when combined, the anti-biliary effect is enhanced. Therefore, caution should be used when using them together.
2. Combined with belladonna, the anti-biliary effect is enhanced.
3. Betel nut has a cholergic effect and can increase the extrapyramidal reactions of Hibernian when used together with Hibernian.
4. When Dongmianling is combined with captopril and trazodone, it will produce a synergistic antihypertensive effect and may lead to hypotension.
5. When atenolol, metoprolol and Dongmianling are used together, the two inhibit each other's metabolism and increase the blood concentration of the drugs, leading to hypotension and/or increased toxicity of Dongmianling. .
6. Cisapride, dofetilide, sotalol, pimozide, spafloxacin, gatifloxacin, moxifloxacin, grefloxacin, levofloxacin , levomethadone, halofantrine, etc., when combined with Dongmianling, will increase the toxicity to the heart, so they should not be used together.
7. The combination of hibernating spirit and diazoxide may cause hyperglycemia.
8. Hibernator can induce or inhibit the metabolism of phenytoin, while phenytoin induces the metabolism of Hibernian. Therefore, the concentration of phenytoin may increase or decrease when used together, while the concentration of Hibernian may increase or decrease. reduce.
9. When combined with epinephrine, it may cause hypotension and tachycardia.
10. The risk of arrhythmia increases when Ibutilide is used in combination with Hibernator.
11. When kava root is combined with hibernation spirit, the antagonism to dopamine increases, resulting in an increase in the therapeutic effect and/or adverse reactions of hibernation spirit.
12. The combination of Dongmianling and lithium (especially when the dosage of Dongmianling is large) may lead to weakness, movement disorders, exacerbation of extrapyramidal reactions, encephalopathy and brain damage.
13. When combined with pethidine, the inhibitory effect on the central nervous system and respiration is enhanced.
14. Both porphyrin sodium and hibernate can cause photosensitivity, and their combined use can aggravate the intracellular damage of photosensitive tissues.
15. Propranolol can reduce the metabolism of hibernating spirit and increase the toxicity of hibernating spirit.
16. When tranexamic acid and hibiscus are combined to treat subarachnoid hemorrhage, there are reports of cerebral vasospasm and cerebral ischemia. This may be due to the sympathomimetic effects of both. .
17. When amphetamine is combined with Dongmianling, the efficacy of both is reduced, and the risk of convulsions is increased. However, the antipsychotic effect of Dongmianling is reduced, so combined use is not recommended.
18. The adsorption effect of antacids on Hibernian Ling can reduce the absorption of Hibernian Ling, so the efficacy of Hibernian Ling will be reduced when used together. Antacids should be taken at least 1 hour before or 2 hours after taking Dongmianling.
19. Benztropine, orphenadrine, procyclidine, and Antan can delay gastric emptying, increase the intestinal wall metabolism of Dongmianling, and reduce absorption, resulting in the plasma concentration of Dongmianling. When it decreases, the efficacy of the drug is weakened, while the anti-biliary effect is enhanced.
20. Cabergoline is a dopamine D2 receptor agonist and should not be used simultaneously with dopamine D2 antagonists such as hibernator. If both are used together, the therapeutic effect will be reduced.
21. Cimetidine can reduce the efficacy of Dongmianling, and the mechanism of action is (yet unclear).
22. Prasterone can reduce the efficacy of hibernating spirit.
23. Hibernation can antagonize the effect of dextroamphetamine and inhibit its food-phobic effect. Therefore, Hibernian is often used to reverse the adverse reactions of the central nervous system caused by amphetamine overdose.
24. Dongmianling can reduce the efficacy of guanethidine, norepinephrine, and femetrezin. It can also render levodopa ineffective.
25. Phenobarbital can induce microsomal enzymes in the liver, reducing the efficacy of Hibernian.
26. Dongmianling can reduce the efficacy of phenprocoumon and warfarin, and the mechanism is unclear.
27. Long-term use of hibiscus may significantly reduce the response of thyroid stimulating hormone (TSH) to prorelin.
28. In an experiment, citalopram and hibernating were combined, and no effect on the pharmacokinetics of the two was observed. But further research is needed to confirm.
29. Hibiscus may inhibit the antihypertensive effect of guanadol.
30. When combined with evening primrose oil, meglumine, tramadol, and zotepine, the risk of convulsions increases.
31. Dongmianling can increase the blood concentration of valproic acid when used with it, but it has no clinical significance.
32. The combined use of zolpidem and hibernator will not cause any pharmacokinetic changes.
33. The peak drug concentration and area under the curve of smokers are slightly lower than that of non-smokers; the drowsiness effect of smokers will be reduced when taking hibiscus.
34. When used in combination with alcohol, the inhibitory effect on the central nervous system is enhanced.
35. When there is food in the stomach, the absorption of Hibernating Spirit will be affected.
4.14 Expert comments
Dongmianling is effective in treating acute and chronic schizophrenia, mania, or other mental illnesses with positive symptoms such as excitement, hallucinations, and delusions. However, it has poor effect on negative symptoms such as apathy, withdrawal, and lack of speech. Adverse reactions may occur. In short, this drug is an older generation drug for the treatment of mental illness. It has been used clinically for a long time and is also the most commonly used antipsychotic drug. It has certain efficacy and relatively low price. However, it is prone to adverse reactions and has a tendency to be replaced by a new generation of antipsychotic drugs in clinical practice. 5 Dongmianling poisoning
Dongmianling (chlorpromazine, chlorpromazine, clonidine) extensively inhibits the central nervous system, causing stability, sedation, and antipsychotic effects. This product has central dopamine receptor blocking effect and anti-cholinergic effect. It is well absorbed after oral administration, with a plasma protein binding rate >95%, a distribution volume of 7L/kg, and a plasma half-life of 16 to 30 hours. This product can penetrate the blood-cerebrospinal fluid barrier, and its concentration in the brain is higher than that in the blood. It is mainly used for short-term treatment of acute or chronic schizophrenia, mania, manic depression, impulsive violent behavior and severe anxiety. It can also be used to stop vomiting and eliminate tetanus spasms, primary muscle disorders and other conditions. The therapeutic blood concentration is 0.5mg/L. The usual daily dosage for adults is 50 to 800 mg, taken in divided doses. Acute poisoning reactions may occur when a dose reaches 2 to 4 g. The main toxicity is in the cardiovascular system and central nervous system. [1] 5.1 Clinical manifestations
[2]
1. During treatment, the patient initially experiences drowsiness, fatigue, and hypotension; dry mouth occurs after taking large doses , constipation, nasal congestion, blurred vision, increased intraocular pressure or tachycardia and prolonged QT interval, which is a precursor to fatal arrhythmia.
2. Acute poisoning mainly manifests as coma, drop in blood pressure and even shock. The incidence of electrocardiogram abnormalities reaches 70% to 80%, with QT interval prolongation being the most common and QRS widening occasionally seen. Hypothermia may occur.
3. Some patients died suddenly due to cardiac accident, hypotension, shock or pulmonary embolism while taking the medicine. Extrapyramidal reactions (symptoms of paralysis shaking syndrome): akathisia, akinesia, slurred speech, dysphagia, torsional spasms, salivation and other symptoms. This drug can cause drug-induced mental abnormalities such as depression, disturbance of consciousness, agitation, hallucinations and delusions.
4. Eye complications include increased intraocular pressure, cornea and lens opacity. Taking Hibernian may occasionally cause developmental delays in children, enlarged vaginas, galactorrhea and amenorrhea in women.
5. Allergic reaction: leukopenia often occurs 6 to 12 weeks after medication, and aplastic anemia, hemolytic anemia, and thrombocytopenia occur rarely. Fever, rash, asthma, purpura, toxic hepatitis, jaundice, etc. occur.
6. People treated with Chronic Mental Illness may develop symptoms such as high fever, rigidity, and coma, which are often fatal. Human body surface area calculator BMI index calculation and evaluation Female safe period calculator Pregnancy date calculator Normal weight gain during pregnancy Safety classification of medication during pregnancy (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes diet recommendations Common clinical biochemistry units Conversion to basal metabolic rate Calculate sodium supplementation calculator Iron supplementation calculator Commonly used Latin abbreviations for prescription Quick check Common symbols for pharmacokinetics Quick check Effective plasma osmolarity calculator Ethanol intake calculator
Medical encyclopedia, calculate now! 5.2 Diagnosis
The key points for diagnosis of hibernating poisoning are [3]:
1. There is a history of taking or mistakenly taking hibernating, and the above clinical manifestations occur.
2. Exclude the possibility of other drug poisoning. 5.3 Treatment
The key points of treatment for Dongmianling poisoning are [3]:
1. In case of overdose, swallow medicinal charcoal immediately and avoid vomiting.
2. There is no specific antidote for Dongmianling poisoning, and symptomatic and supportive treatment is the main approach.