哈尔滨医科大学药理学8.pptVIP

* * 解热镇痛抗炎药 Antipyretic-analgesic and Anti-inflammatory Drugs Pain Treatment Analgesics Antipyretic-analgesic and anti-inflammatory drugs* An unpleasant experience associated with actual or potential tissue damage. Pain Pain Physiology Ion Fluxes (H+/ K+) Neurochemistry Tissue Injury Mast Cell Sensitized Nociceptor Aspartate, Neurotensin, Glutamate, Substance P To brain Histamine Bradykinin Leukotrienes Dorsal horn Prostaglandins Pain Transmission Pain perception Spinal cord Enkephalin inter-neuron Nociceptor Descendingpathway Ascendingpathway Descending Pain Control Pathways Descending impulse Enkephalin Opioid receptor Opportunities for Pain Treatment At the receptor Along the nerve At receptors in spinal column and brain Acute vs chronic Nociceptive vs Neuropathic Pain Acute vs. Chronic Pain C fibers: dull, aching, burning pain Dorsal root ganglion To brain A-delta fibers: sharp,shooting pain Ascending pain pathway Tissue injury Spinal cord Nociceptive Pain Ascending pain pathway Nerve injury Spinal cord Neuropathic Pain Principles of Pain Management Gold standard: patient determines severity Tradition: pain has been undertreated Prevention or early treatment best Pain kills Pain is real Balance pain relief with side effects of drugs Antipyretic-analgesic and Anti-inflammatory Drugs Non-steroidal anti-inflammatory drugs, NSAIDs. Aspirin-like drugs. Mechanism of NSAIDs Arachidonic acid, AA Prostaglandin, PG Leukotrienes, LTs PGE2 PGF2? PGI2 TXA2 PLA2 phospholipid COX NSAIDs Salicylates Aspirin and NSAIDs Anti-inflammatory Inhibits cyclooxygenase pathway for breakdown of arachidonic acid to prostaglandins and thromboxane Ibuprofen, Naprosyn naproxen COX-2 inhibitors Acetaminophen Inhibits synthesis of prostaglandin in CNS but not in periphery. No anti-inflammatory or anti-platelet effects but good for mild pain and to reduce fever Adverse reactions rare. Overdose may cause liver disease esp in persons who regularly consume alcohol. *