3.Glaucoma（毒扁豆碱、地美溴铵、新斯的明）4.Intoxicationof.ppt

Reversible Anticholinesterase agents Neostigmine (新斯的明） (Not into CNS) [Clinical Uses] po, sc, im 1. Myasthenia gravis: direct and indirect effects 2. Postoperative abdominal distension; Urinary retention 3. Intoxication of d-tubocurarine and atropine 4. Supraventricular tachyarrhythmias 5. glaucoma Cautions: Cholinergic Crisis (atropine, d-tubocurarine) Skelatal muscle GI、bladder smooth muscle CV, glands, eyes, brachial smooth muscle Physostigmine (毒扁豆碱 ) Eyes: similar to pilocarpine (more rapid, stronger and longer) Peripheral effects: similar to neostigmine but stronger Central effects: excitation → inhibition Clinical use: 1. Glaucoma 2. Intoxication of central anticholinergics (tricyclic antidepressant, antihistaminics, anti-emetic, antiparkinson agents, phenothiazines antipsychotic agents) 毒性大，除解毒外一般不全身应用 Other Reversible Anticholinesterase agents 1.Myasthenia gravis : neostigmine Pyridostigmine（吡斯的明） Ambenonium chloride（安贝氯铵 ） Galanthamine（加兰他敏 ） 2.Glaucoma: Physostigmine (1~2d) Demecarium bromide (地美溴铵, 9d ) Neostigmine 3.Alzheimer’s disease :Donepezil(多奈哌齐), Rivastigmine, Tacrine 4.Diagnostic test for myasthenia gravis : Edrophonium chloride (依酚氯铵，腾喜龙) Edrophonium chloride 用于诊断重症肌无力和鉴别肌无力危象及胆碱能危象。也用作筒箭毒碱等非去极化肌松剂的拮抗剂。 【用法及用量】 ①腾喜龙试验: iv 10mg，注射后重症肌无力症状明显缓解，10分钟后恢复原状，可确定诊断。 ②肌无力危象和胆碱能危象的鉴别:先注射2mg，若症状好转，再将其余8mg注射完，诊断为肌无力危象；若注射2mg后症状加重，应立即停注，诊断为胆碱能危象。 ③筒箭毒碱等非去极化肌松弛剂的拮抗剂:静脉注射5～10mg/次，总剂量可达40mg。 Irreversible Anticholinesterase Agents—Organophosphates（有机磷酸酯类） 1）弱：敌百虫、乐果、马拉硫磷 2）强：敌敌畏 3）剧：内吸磷、甲拌磷、对硫磷 4）强剧：沙林、塔朋、梭曼 （战争化学毒气） 东京地铁毒气案1995年奥姆真理教 Pathway of intoxication aging Mechanisms of intoxication Signs of intoxication 1. Acute intoxication: acute cholinergic crisis (1) M manifestation (muscarinic effects ) (2) N manifestation (nicotinic effects) (3) CNS effects 2. Chronic intoxication 心率减慢、血压下降、缩瞳可不明显 复杂的自主神经综合效应 呼吸中枢抑制，血管运动中枢抑制 尿失禁 呼吸困难 肌阵挛 肌纤维自发性收缩