33章B-内酰胺类抗生素-Jun Peng-4.ppt

延长青霉素有效血浓度的措施 （1）减慢吸收（改进剂型） 普鲁卡因青霉素油剂（溶解度小-24h 苄星青霉素（长效西林） 1次/15d Slow down the absorption procaine penicillin oil (low solubility) (modify the dosage form) benzathine penicillin 1 time/per 15d （2）减慢排泄：合用丙磺舒 Slow down the excretion: combined medication with probenecid －－－不用于急性或重症感染（血浓度低） [肾上腺素救治过敏性休克]Remedy allergic shock by adrenaline ①升压:α → 外阻↑ BP ↑ (boost pressure) ②改善呼吸困难 (improve dyspnea) → 粘膜水肿↓ 支气管分泌↓ ③ 抑制肥大细胞释放组胺、白三烯等过敏介质 Inhibiting the release of histamine, leukotriene et al allergic substances from mast cell. β-内酰胺类复方制剂组方的基本规律 2. G+菌：作用不及第一代和第二代 G-菌：强于第一代和第二代 铜绿假单胞菌及厌氧菌：有较强作用 for G+ bacteria, not strong as the 1st and 2nd generation; for G- bacteria, stronger than the 1st and 2nd generation; for pseudomonas aeruginosa and anaerobe, strong activity. 对多种?_内酰胺酶高度稳定 Highly stable against ?-lactamase 4. 对肾脏基本无毒性: almost no renal toxicity 第四代头孢菌素- The 4th generation 　1. 对G+ 、 G-作用均强 Strong effective to both G+ and G- bacteria 2. 对β_内酰胺酶尤其是超广谱质粒、染色体介导 的酶稳定 Stable against ?-lactamase, particularly for superspectrum plasmid and chromosome – mediated enzyme. 3. 无肾脏毒性: no renal toxicity ② 皮试： A .15-20min出现红晕、丘肿1cm（＋） B. 停药1d以上重作皮试 C .不同厂家、不同批号重作皮试 Skin test: A. produce a red, raised spot within 15-20min, the size of wheal1 cm (+) . B. Redo the skin test after stopping medication more than a day. C. Redo the skin test if the drugs are from different producers or different lot number. ③ 专用注射器，药物新鲜配制 Use special syringe and make solution of drug freshly ④ 避免饥饿时注射 Avoid injection of drugs when the patient is hungry or local medication ⑤ 必备急