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홍차넷
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티타임
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- 다양한 주제에 대해 자유롭게 글을 작성하는 게시판입니다.
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전체기타일상/생각꿀팁/강좌방송/연예도서/문학영화의료/건강문화/예술경제생활체육과학/기술철학/종교정치요리/음식역사여행육아/가정IT/컴퓨터음악창작게임스포츠사회오프모임
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| Date |
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| Name | 모모스 |
| Subject | 조현병, 정신분열증, Schizophrenia 에 사용되는 약물 |
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우리의 뇌와 마음을 지배하는 약물들을 아래와 같이 분류할 수 있습니다.  항정신병약 (Antipsychotics) 은 요즘 말이 많은 조현병 (정신분열증, Schizophrenia) 에 사용되는 약물들입니다. 위 그림 상단을 차지하고 있네요. 실제 전체 작용기전이 모두 알려져있지 않습니다. 일부 알려진 사실을 바탕으로 간략하게 써보겠습니다. 정형항정신병약 (Typical antipsychotics) 오래 전부터 정형항정신병약(Typical antipsychotics) 인 Chlorpromazine, Haloperidol 등이 쓰여왔습니다. 지금도 제한적으로 사용되고 있습니다.  Haloperidol 만 우선 알아보면 주로 뇌에 존재하는 신경전달물질인 도파민 (Dopamine) 매개로 하는 신경말단의 시스템에 작용합니다. 도파민 Receptor를 block하여 도파민의 작용을 억제하여 신경 흥분을 막습니다. (Dopamine Receptor Antagonist) 반면 이들과 반대로 지난 번 "코카인과 코카콜라" 글에 나와있는 거처럼 코카인은 도파민의 재흡수를 막아 도파민의 작용시간을 늘려 뇌신경들의 흥분상태를 유지시키고 도파민과 비슷한 구조의 암페타민 (필로폰) 은 도파민과 같은 작용을 나타내서 신경흥분제로 작용합니다. (Dopamine Receptor Agonist) 세부적으로 들어가면 Haloperidol은 Dopamine-1, Dopamine-2 뿐만 아니라 Histamine-H1, 5-HT(Serotonine)-2 Receptor Antagonist로도 작용합니다. Haloperidol 같은 정형항정신병약 (Typical antipsychotics) 은 EPS ( Extral Pyramidal Syndrome) 라는 부작용 빈도가 높습니다. Dopamine Receptor를 저해함으로서 나타난다고 알려져있습니다. EPS ( Extral Pyramidal Syndrome, 추체외로부작용)  본인의 의지와 관계 없이 혀가 끊임 없이 나왔다가 들어갔다 하는 사람들을 보신 적이 있으실 겁니다. 대표적인 EPS 증상입니다. 정형항정신병약의 주된 부작용인 EPS는 파킨슨병의 증상 (Pseudoparkinsonism) 과 비슷하게 나타나기도 하고 안면이나 사지의 근육 운동이 곤란하거나 제멋대로 움직이기도 하고 (Dystonia) 하며 안절부절하며 끊임없이 다리를 움직이기도 합니다. (Akathisia) 비정형항정신병약 (Atypical antipsychotics) 비정형항정신병약으로는 Clozapine (클로자릴), Risperidone (리스페달), Olanzapine (자이프렉사), Sulpiride (솔리안), Quetiapine (쎄로켈), Ziprasidone (젤독스), Zotepine (로도핀), Aripiprazole (아빌리파이) 등이 있습니다.  Risperidone만 우선 알아보면 정형항정신병약(Typical antipsychotics)의 작용기전과 비슷합니다. Risperidone은 Dopamine-2, 5-HT(serotonine)-2, α-adrenergic receptor antagonist 로 작용합니다. 비정형항정신병약 (Atypical antipsychotics) 은 Dopamine Receptor에 영향이 적어서 정형적항정신병약물 (Typical Antipsychotics) 에 비해 EPS ( Extral Pyramidal Syndrome) 부작용이 많이 감소했습니다. 그래서 현재는 비정형항정신병약들이 주로 사용되고 있습니다. Clozapine 는 좀 특이합니다. 일반적으로 항정신병약들이 양성 정신분열증에만 사용되는데 Clozapine는 음성 정신분열증에도 효과가 있습니다. 그만큼 항정신병약은 작용기전에 대해서 모르는 부분이 많습니다. 다만 Clozapine는 백혈구감소증이라는 치명적인 부작용이 나타날 수도 있어서 정기적인 혈액검사를 통해 모니터링이 필요한 약입니다. 정형항정신병약과 비정형항정신병약도 모두 세부적으로 들어가면 약물이 속한 세대별로 그리고 각각 약물마다 효과와 부작용이 조금씩 다릅니다. 비정형항정신병약이 정형항정신병약 (Typical Antipsychotics) 에 비해 EPS ( Extral Pyramidal Syndrome) 부작용은 감소했지만 약물에 따라 백혈구감소증이나 체증 증가, 당뇨, 고지혈증의 부작용 등이 동반되는 경우가 많습니다. 기전 자체도 불분명한 것이 많은 약물로 임상 경험이 많은 정신과전문의가 환자의 상태에 따라 약물을 선택하고 조절하는 것이 매우 중요한 약물입니다. 따라서 정기적인 관리가 중요하고 약물치료뿐만 아니라 다른 치료도 병행해야합니다. Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 133 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 146 Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 161 2
이 게시판에 등록된 모모스님의 최근 게시물
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40734 class="iamcmt" style="display:none;"> Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 66
40734 class='vcm '>
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40734'> damianhwang
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16/05/21 10:37
40734>삭제 주소복사
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 150
2세대 약으로 분류한것중에 Abilify는 partial agonist라 별도로 분류하는 편입니다.
후에 비슷한 약들이 점점 더 나오면서, 이것만 아예 따로 떼서 3세대로 분류하려고 하는 움직임도 있긴 합니다만..아직은...
정형 비정형으로 분류한건, 원래 할로페리돌 쓰다가. 후에 개발한 약이 우리가 원래 알던 약이랑 뭔가 달라..비정형적이야 라고
임상의들이 불러 그런것이라..요즘은 정형 비정형이라는 말대신 FGA, SGA (1세대, 2세대)로 분류하고 있긴 합니다.
1세대 약에서 대표적인 부작용으로 보는것중에 EP... 더 보기
후에 비슷한 약들이 점점 더 나오면서, 이것만 아예 따로 떼서 3세대로 분류하려고 하는 움직임도 있긴 합니다만..아직은...
정형 비정형으로 분류한건, 원래 할로페리돌 쓰다가. 후에 개발한 약이 우리가 원래 알던 약이랑 뭔가 달라..비정형적이야 라고
임상의들이 불러 그런것이라..요즘은 정형 비정형이라는 말대신 FGA, SGA (1세대, 2세대)로 분류하고 있긴 합니다.
1세대 약에서 대표적인 부작용으로 보는것중에 EP... 더 보기
2세대 약으로 분류한것중에 Abilify는 partial agonist라 별도로 분류하는 편입니다.
후에 비슷한 약들이 점점 더 나오면서, 이것만 아예 따로 떼서 3세대로 분류하려고 하는 움직임도 있긴 합니다만..아직은...
정형 비정형으로 분류한건, 원래 할로페리돌 쓰다가. 후에 개발한 약이 우리가 원래 알던 약이랑 뭔가 달라..비정형적이야 라고
임상의들이 불러 그런것이라..요즘은 정형 비정형이라는 말대신 FGA, SGA (1세대, 2세대)로 분류하고 있긴 합니다.
1세대 약에서 대표적인 부작용으로 보는것중에 EPS말고도 고프로락틴 혈증이 있긴 헌데,
이건 2세대로 개발된 대표약물인 리스페달 (할로페리돌(할돌)과 같은 개발사 -> 얀센)에서 만든 약에도 그대로 승계되긴 합니다만.
다른 약에는 별로 안나타납니다..
얘들은 어떻게든 대응치료가 되니까 차라리 덜한데.
만성장기 부작용으로 tardive dyskinaesia나 NMS같은 것들이 심각한 것이고, 이게 덜하면서 EPS는 예방된다는게 SGA의 selling point이긴 합니다.
음성증상의 경우도 설명하자면 몇단계 돌아가긴 하지만, 결국 SGA로 치료해~~가 지침이 되겠구요.
양성증상, 음성증상이라고 하는것은..
원래 사람이 하는 행위에서 +로 더 하면 양성증상이고, (본다->이상한것도 보인다 (환각), 생각한다 -> 잘못된 생각을 하고 신념을 가진다(망상))
원래 사람이 하는 행위를 덜하게 되면 음성증상으로 분류하고요; (논리 -> 무논리, 욕망 -> 무욕망)
2세대약중에서 metabolic effect 부작용이 문제가 특히 되는건 자이프렉사 (올란자핀)인데 문제는 얘가 SGA중 최고 히트작이고
임상사용의 기준이 되는 약인지라;;;; 약에 따라 다르다고 보기보다는 거의 자이프렉사 저놈이 문제야~ 라고 말하는 편인데.
(다른 약들..이를테면, 아세나핀이나 클로자핀은 거의 같은 수준으로 나타나지만, 아세나핀은 듣보고...클로자핀은 원래 마지막에 마지막에 마지막에나 쓰는 약이다 보니..
리스퍼달이나 아빌리파이는 조금 덜하지만, 판매량 자체가 차이가 나서..
뭐 아빌리파이야 요새는 많이 팔리는 약이긴 하겠지만..SGA라고 보기에도 뭔가 좀 다른놈인지라..)
이걸 타겟으로 노리고 나온 약이 아빌리파이입니다만, 아빌리파이는 sedation effect(진정효과)가 없다시피해서
초창기에 임상의사들이 이거 뭐 약 맞어? 밀가루 아냐 소리하고 그러기도 했;;
(agiation시키는거 아니냐는 소리까지 했죠)
요새는 얘들을 특히 2세대들은 조현병뿐 아니라 양극성 장애에도 널리 써서..조현병약물이라 부르기도 뭣해진 감도 있고 뭐 그렇습니다.
후에 비슷한 약들이 점점 더 나오면서, 이것만 아예 따로 떼서 3세대로 분류하려고 하는 움직임도 있긴 합니다만..아직은...
정형 비정형으로 분류한건, 원래 할로페리돌 쓰다가. 후에 개발한 약이 우리가 원래 알던 약이랑 뭔가 달라..비정형적이야 라고
임상의들이 불러 그런것이라..요즘은 정형 비정형이라는 말대신 FGA, SGA (1세대, 2세대)로 분류하고 있긴 합니다.
1세대 약에서 대표적인 부작용으로 보는것중에 EPS말고도 고프로락틴 혈증이 있긴 헌데,
이건 2세대로 개발된 대표약물인 리스페달 (할로페리돌(할돌)과 같은 개발사 -> 얀센)에서 만든 약에도 그대로 승계되긴 합니다만.
다른 약에는 별로 안나타납니다..
얘들은 어떻게든 대응치료가 되니까 차라리 덜한데.
만성장기 부작용으로 tardive dyskinaesia나 NMS같은 것들이 심각한 것이고, 이게 덜하면서 EPS는 예방된다는게 SGA의 selling point이긴 합니다.
음성증상의 경우도 설명하자면 몇단계 돌아가긴 하지만, 결국 SGA로 치료해~~가 지침이 되겠구요.
양성증상, 음성증상이라고 하는것은..
원래 사람이 하는 행위에서 +로 더 하면 양성증상이고, (본다->이상한것도 보인다 (환각), 생각한다 -> 잘못된 생각을 하고 신념을 가진다(망상))
원래 사람이 하는 행위를 덜하게 되면 음성증상으로 분류하고요; (논리 -> 무논리, 욕망 -> 무욕망)
2세대약중에서 metabolic effect 부작용이 문제가 특히 되는건 자이프렉사 (올란자핀)인데 문제는 얘가 SGA중 최고 히트작이고
임상사용의 기준이 되는 약인지라;;;; 약에 따라 다르다고 보기보다는 거의 자이프렉사 저놈이 문제야~ 라고 말하는 편인데.
(다른 약들..이를테면, 아세나핀이나 클로자핀은 거의 같은 수준으로 나타나지만, 아세나핀은 듣보고...클로자핀은 원래 마지막에 마지막에 마지막에나 쓰는 약이다 보니..
리스퍼달이나 아빌리파이는 조금 덜하지만, 판매량 자체가 차이가 나서..
뭐 아빌리파이야 요새는 많이 팔리는 약이긴 하겠지만..SGA라고 보기에도 뭔가 좀 다른놈인지라..)
이걸 타겟으로 노리고 나온 약이 아빌리파이입니다만, 아빌리파이는 sedation effect(진정효과)가 없다시피해서
초창기에 임상의사들이 이거 뭐 약 맞어? 밀가루 아냐 소리하고 그러기도 했;;
(agiation시키는거 아니냐는 소리까지 했죠)
요새는 얘들을 특히 2세대들은 조현병뿐 아니라 양극성 장애에도 널리 써서..조현병약물이라 부르기도 뭣해진 감도 있고 뭐 그렇습니다.
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