神经系统药理—魏尔清(镇痛药.ppt

Part 12Analgesics Opioid analgesics Synthetic opioid analgesics Other analgesics General Considerations Pain (疼痛)： 躯体痛－快痛，慢痛 内脏痛 情绪反应 Analgesia (镇痛)： 选择性抑制疼痛感觉， 不影响意识和其他感觉 Pain Classification Headache (migraine) Acute Chronic Pain Nociceptive Mixed Neuropathic Visceral Diabetic neuropathy (DN) Post-herpetic neuralgia (PHN) Radiculopathy (RADIC) Cancer pain Low back pain Osteoarthritis Rheumatoid arthritis Fibromyalgia IBS Pancreatitis Bladder pain Noncardiac chest pain Abdominal pain syndrome Injury Postoperative Flare An adverse or unpleasant reaction plus the reactions evoked by it Pain generation and reactions Stimulation and depolarization of sensory nerve endings Pain: peripheral sensory reflex Peripheral mechanisms of pain Peripheral mechanisms of pain Primary secondary hyperalgesia The perception of somatic pain The perception and conduction of somatic pain Conduction pathways of pain Cortical locations of pain The fMRI imaging of pain Classification of analgesics： Opioid analgesics (centrally acting) opiates synthetic agents Antipyretic, analgesic, and anti-inflammatory drugs (peripherally acting) aspirin, indomethacin Other drugs (for special types of pain) carbamazepine, atropine, nitroglycerin, etc. General Considerations Morphine 吗啡 Morphine 吗 啡 Heroin 海洛因 A. Opioid Analgesics Opium Morphine: Morphus, the Greek god of dreams 1. Pharmacological effects (1) Mechanisms of actions Acting on central opioid receptors  receptors  receptors δ receptors A. Opioid Analgesics ATP cAMP Opioid Receptors and Endogenous Ligands  δ  Endorphin Enkephalin Dynorphin K+ a b g a b g = Mechanisms of morphine actions Peripheral mechanisms of morphine actions Central mechanisms of morphine actions: Pain inhibitory system (2) Central nervous system effects A. Analgesia：maximal analgesic efficacy； relieving unplea