肾上腺素能药物及局麻药.pptxVIP

第八章 肾上腺素受体激动药 儿茶酚胺儿茶酚胺代谢过程/main/ntquery;jsessionid=271acy6bg1xt0?method=4dsname=Wikipedia+Imagesdekey=Epinephrine.pnggwp=8sbid=lc05a ??epinephrineNorepinephrine （美）Noradrenaline （英）酒石酸去甲肾上腺素注射液Adrenoceptor agonistsBasic actions:Excitation of smooth muscles (skin vessel and mucosal vessel)Inhibition of smooth muscles (intestine, bronchia and skeletal muscle vessel)Excitation of heartMetabolism (glycogenolysis and lipolysis)Endocrine effects (insulin↓, renin↑, etc.)CNS excitatory effectsα adrenoceptor agonists α受体激动剂 第二节α1 andα2 adrenoceptor agonists (non-selective)Noradrenaline 去甲肾上腺素 blood vessel: contraction heart: HR ↓(by baroreflex) cardiac output: no change or decrease (by peripheral resistance ↑) BP: ↑(net effect) Clinical uses: 1, Allergic and neurogenic shock 2, upper digestive bleeding (local action)Adverse drug reactions: 1, local tissue necrosis 2，acute renal failure 3, BP decrease after sudden withdrawal α1 adrenoceptor agonistPhenylephrine去氧肾上腺素 vasoconstriction→BP↑maintain BP at anesthesiasupra-ventricular tachycardiaα2 adrenoceptor agonistclonidine可乐定CNS selective: hypertension, neuropathic pain, insomnia, opioid detoxication, … α，β adrenoceptor agonistsEpinephrine 肾上腺素 (Greek, nephros, kidney )Adrenaline in action. A cheetah running to catch its prey. epinephrine1, cardiovascular system Heart（β1）: HR↑, contraction↑, conductance↑, cardiac output↑, oxygen consumption↑ arrhythmia (large dose) Blood vessel（? receptors）: contraction in skin, mucus, abdominal viscera dilation in coronary and skeletal muscle vessels BP: systolic↑，diastolic, － or ↓2，respiratory and digestive smooth muscle (β2): relaxation3, metabolism（β1）: glycogenolysis→blood sugar↑ lipolysis→blood fatty acid↑epinephrineClinical uses:cardiac arrest caused by anesthesia operation drowning drug intoxication electric attack atrio-ventricular blockallergic shockClinical uses of epinephrine3, asthma4, inhibition of absorption of local anesthetics5，local hemostasisADR: arrhythmia; stroke