[临床医学]镇痛药 蒋国君.pptVIP

Chapter 19 Analgesics Teaching goals 1.定义 Definition 1) with actual or potential tissue damage 2) an essential defensive function 3) a common experience 4) an unpleasant sensory and emotion 一、阿片生物碱类 Alkaloids of opium 1. Pharmacokinetics  First-pass elimination is extensive bioavailability is low. Passes through BBB and placenta（胎盘）barrier. Excretes ： kidney， secretes in milk 2. Pharmacological actions Sedation 镇静 Respiratory depression Cough suppression Others Miosis (缩瞳)： “pinpoint pupils” (针尖样瞳孔) is valuable in the diagnosis of opioid overdosage. Emetic action (催吐): (1) Gastrointestinal tract 胃肠道: (1) Hypotension (低血压): a. Cause peripheral vasodilation. (外周血管舒张) b. Increase histamine（组胺）release. 2. Intracranial pressure（颅内压）? Respiratory depression ? CO2 ? ? Cerebral vasodilation. 脑血管舒张 Inhibit immunoreaction 抑制免疫 (–) lymphopoiesis (淋巴细胞生成), ? secretion of cellular factors, (–) immunoreaction induced by HIV. Mechanism of analgeisia 胆绞痛: with atropine （1）Therapeutic dose Dizziness（眩晕） Nausea（恶心）, vomiting（呕吐） Constipation（便秘） Respiratory depression（呼吸抑制） Orthostatic hypotension（体位性低血压） Addiction therapy 成瘾治疗 2. use ： 1） relief of mild and moderate pain; 2）acute dry cough（剧烈干咳）. 3. side action 1. Effects and addiction all morphine。 2. Onset rapid and duration short。 3. 不引起便秘，不延长产程。 1.Analgesia a Used to trauma(创伤), operation, late stage of cancer. b. Used with atropine to treat visceral colic（内脏绞痛）. c. 2-4h Before delivery （分娩）the pregnant women should not use pethidine（哌替啶）. 2. Cardiogenic asthma（心源性哮喘） 3. Premedication for surgical operation. (麻醉前给药) 4. Artificial hibernation (人工冬眠) dolantin + chlorpromazi