影响药物效应的因素跟合理用药原则.ppt

第 4 章 影响药物效应的因素及合理用药原则Chapter 4 Influence factors of drug effect and principle for reasonable medication 第四章 影响药物效应的因素及合理用药原则Chapter 4 Influence factors of drug effect and principle for reasonable medication 药物与机体之间相互作用及其引起的任何变化都可以成为影响药物效应的因素。因而，掌握包括药物剂型、药动学、药效学等众多因素对理解药物效应的影响是非常重要的。从患者方面看,应认真考虑用药个体化，进行合理用药使患者得到最佳疗效和最少不良反应。 In general, an understanding of the factors influencing drug effects and rational medication includes the pharmacokinetic and pharmacodynamic considerations and the individualiza-tion of drug therapy for a particular patient. 影响药物作用的因素 第一节 药物方面的因素 药物剂型 药物可制成溶液剂、糖浆剂、片剂、胶囊、颗粒剂、注射液、气雾剂、栓剂等各种不同给药途径的剂型。相同药物剂型有多种药物剂量规格，适用于不同治疗目的。给药途径不同时剂量可相差很大。 给药途径 可影响药物吸收、产生和维持效应的速度和时间。产生效应由快到慢通常是静脉注射吸人肌内注射皮下注射口服直肠贴皮。 常用的给药途径及其重要性 常用的给药途径：门诊 口服；急救 注射。 药物产生效应的速度通常是:静脉注射吸入肌内注射皮下注射口服直肠贴皮。 The routes by which a therapeutic agent may be given and knowledge about the advantages and disadvantages of these different routes are of primary importance. The general routes of drug administration include intravenous, subcutaneous, and intramuscular injection or infusion, and oral ingestion. 药典(pharmacopeia)与药量 处方用药应按照药典规定的剂量使用 药物剂量与效应有密切的关系（量效关系）。注意处方用药不可超过每日或每单位时间最大用量(极量，maximum dose)。 生物类药剂所含的药量常用生物活性IU为单位。此类药物容易导致过敏反应。使用前需常规做皮肤过敏试验。 The intensity of a biological response produced by a drug is related to concentration of the drug at the site of action, which is directly related to plasma drug concentration. 临床新的长效剂型 缓释剂(slow release formulation) 延迟释放剂(extended release formulation) 持续释放剂(sustained release formulation) 控释剂(controlled release formulation) 使用这些长效剂型可方便患者和维持长期疗效。 The formulations (pharmaceutical preparations) of a drug, like the route of administration, also influences pharmacokinetic processes. Besides the conventional dosage forms (“immediate-release” dosage forms), newly developed ones include controlled-release, extended-release, sustained-release or prolonged-action preparations (formulations). 联合用药及药物相互作用 临床合并用药和