精神科治疗药物监测的现状及发展方向课件.ppt

1、234561.v d.HELM HJ,ANDRIESSE D.Clin Chim Acta.1961;6:747-748.2.王见义王见义;吴贞喜吴贞喜;葛志荣葛志荣.神经精神疾病杂志神经精神疾病杂志1980(05):276-278 3.陈刚陈刚;卓海通卓海通.中国医院药学中国医院药学,1983(2):12-144.吴莱文吴莱文.中国临床药理学杂志中国临床药理学杂志,1986 2(3):151-15719611980198389101112131415161718年度年度20092009201020102011201120122012201320132014201420152015氯氮平氯氮平

2、3018301837603760334733472661266126023311331131983198去甲氯氮平去甲氯氮平3018301837603760334733472661266126023311331131983198利培酮利培酮34783478415141514586458639923992418049104910520052009-9-羟利培酮羟利培酮3509350942314231475547554337433746656233623367296729氯丙嗪氯丙嗪269269249249329329246246202224224188188阿米替林阿米替林8 82 21 12

3、200 00 0去甲替林去甲替林8 82 21 13 300 00 0多虑平多虑平1 14 42 22 200 00 0去甲多虑平去甲多虑平1 14 42 21 100 00 0卡马西平卡马西平2121696962627575751151156969丙戊酸丙戊酸3935393554875487696269626970697071398963896398299829血锂全项血锂全项3696369638673867705770575467546757537384738479217921合计（例次）合计（例次）209622096225586255863045130451264172641727218

4、272183445134451363323633219202122国内首家采用生化-磷酸酶法检测血锂浓度试剂盒；液体双试剂，全自动生化分析仪上机即用，操作方法简便；检测结果准确，与原子吸收光谱法和离子选择电极法相关性良好，适合临床实验室常规使用；232425PumpSamplerDetectorComputer Single HPLC SystemMobile PhaseColumn-Waste2627柱切换转载方式柱切换转载方式反向转载反向转载2829303132Amitriptyline+nortriptylineDoxepin+nordoxepinImipramine+desiprami

5、neClomipramine+norclomipramineMaprotilineFluoxetine+norfluoxetineParoxetineFluvoxamineCitalopramEscitalopram33SertralineReboxetineDuloxetineBupropion+hydroxybupropionMianserineTrazodone34Chlorpromazine15 30 h30 300 ng/mL600 ng/mLPerphenazine8 12 h0.6 2.4 ng/mL5 ng/mLFluphenazine16 h1 10 ng/mL15 ng/m

6、LHaloperidol12 36 h1 10 ng/mL15 ng/mLThioridazine30 h100 200 ng/mL400 ng/mLSulpiride8 14 h200 1000 ng/mL1000 ng/mLClozapine12 16 h350 600 ng/mL1000 ng/mLOlanzapine30 60 h20 80 ng/mL150 ng/mLQuetiapine7 h100 500 ng/mL1000 ng/mLRisperidone+9-hydroxy risperidone3 h24 h20 60 ng/mL120 ng/mLAripiprazole60

7、 80 h150 500 ng/mL1000 ng/mL6 h50 200 ng/mL400 ng/mLSertindole55 90 h50 100 ng/mL200 ng/mL13 16 h10 150 ng/mL300 ng/mL35Valproic acidCarbamazepineLamotriginePhenobarbital80 120 h10 40 g/mL50 g/mLPhenytoin20 60 h10 20 g/mL25 g/mLMethadone24 48 h400 600 ng/mL600 ng/mL300 ng/mLBuspirone2 3 h1 4 ng/mL 8

8、 ng/mL36Ratios of metabolite/parent drug(MeanSD)AmitriptylineNortriptyline0.21.8AripiprazoleDehydroaripirazole0.30.5 PM of CYP2D6:0.2BupropionHydroxybupropion547(24h);630(12h)Buspirone6-Hydroxybuspirone2553CarbamazepineCarbamazepine-10,11-epoxide0.070.25CitalopramN-esmethylcitalopram0.310.60Clomipra

9、mineNorclomipramine0.82.6ClozapineNorclozapineNonsmokers 0.50.6;Smokers 0.40.7DoxepinNordoxepin0.6.1.6 PM CYP2C19:1.8 PM CYP2D6:0.8EscitalopramN-Demethylescitalopram0.31.037Ratios of metabolite/parent drug(MeanSD)Fluoxetine Norfluoxetine0.71.9FluvoxamineFluvoxamino acid01.2HaloperidolReduced haloper

10、idolmean 0.6ImipramineDesipramine0.63.2 PM CYP2D6 4.1MaprotilineDesmethylmaprotiline1.13.7 PM CYP2D6 4.9MianserinN-Desmethylmianserin0.50.8MirtazapineN-Desmethylmirtazapine0.21.2MoclobemideMoclobemide N-oxide0.8.2.5OlanzapineN-Demethylolanzapinenonsmokers:0.10.3smokers:0.20.4PerphenazineN-Dealkylper

11、phenazine0.6.2.838Ratios of metabolite/parent drug(MeanSD)QuetiapineNorquetiapine0.13.8ReboxetineO-Desethylreboxetine 5.2N-Desmethylvenlafaxine0.461.4839Drugs Drugs nClt-SD-Clt+SD mL/minFhC/Dlow ng/mL/mgC/D high ng/mL/mgAntidepressantdrugsAntidepressantdrugsAmitriptyline8 1983730.5241.031.68Bupropio

12、n17 2500113001240.060.28Citalopram8 3675450.8241.021.51Clomipramine9 5839330.5240.370.6Doxepin85 76926441240.180.27Duloxetine12 61017330.5240.20.57Escitalopram 243609600.8240.581.54Fluoxetine n.r.6008330.7240.60.83Fluvoxamine6 80719601240.350.86Maprotiline6 50317470.8240.321.1Mianserin n.r.84319480.

13、3240.110.25Mirtazapine10 4559450.5240.370.85Paroxetine 30 1561108561240.060.44Reboxetine n.r.225112412.5531.1Trazodone873103 1246.729.47Venlafaxine 18 74715401240.450.9340Drugs Drugs nClt-SD-Clt+SD mL/minFhC/Dlow ng/mL/mgC/D high ng/mL/mgAntipsychotic drugsAmisulpride78 5206930.5240.50.67Aripiprazol

14、e647700.9248.6312.85Chlorpromazine11 104315100.1240.050.07Clozapine16 2587280.5240.40.8Flupentixol3 4404900.6240.780.87Fluphenazine decanoate12 238039401240.180.29Haloperidol6 4206800.6240.610.99Olanzapine491 2336370.8240.872.38Paliperidone n.r.31980.3241.996.31Perphenazine 8 100925660.4240.110.28Pi

15、mozide721553 0.5240.6416.53Quetiapine10 114624211240.130.21Risperidone8 911710.7243.514Sertindole6 133600 1241.165.22Supiride6 3314990.25240.350.52Thiordazine11 4049820.6240.421.03Zotepine14 467102671240.071.49Ziprasidone12 3033970.6241.051.3641Drugs Drugs nClt-SD-Clt+SD mL/minFhC/Dlow ng/mL/mgC/D h

16、igh ng/mL/mgAnticonvulsant drugs Mood stabilizersCarbamazepine n.r.5874 1249.411.93Lamotrigine 129224912414.0931.28Lithium n.r.1040 12417.3669.44Oxcarbazepine 717035063 1240.140.41Primidone 83047 12414.7823.15Topiramate 6213112422.4733.55Valproic acid 94.59.8 12471.23154.32Anxiolytic and hypnotic dr

17、ugsAlprazolam634830.8246.7316.53Bromazepam1050911247.6713.95Buspirone41126027020.04240.010.02Clonazepam963900.8245.437.69Diazepam4810430.92413.0152.91Lorazepam15361090.8245.9817.93Triazolam133265840.9241.011.81Zaleplon1086813300.3240.160.25Zolpidem102663640.67241.022.14Zopiclone102508831240.792.784243既往检测搜集的数据及文献资料既往检测搜集的数据及文献资料PPK模型模型测定个体测定个体12点血药浓度作为反馈点血药浓度作为反馈个体药动学参数个体药动学参数个体化给药方案个体化给药方案444546474849谢谢！谢谢！