人体结构与功能 10-Parasympathomimetics学习资料.ppt

OtherReversibleAnticholinesteraseagents1.Myastheniagravis:neostigminePyridostigmine（吡斯的明）Ambenoniumchloride（安贝氯铵）Galanthamine（加兰他敏）2.Glaucoma:Physostigmine(1~2d)Demecariumbromide(地美溴铵,9d)3.Alzheimer’sdisease:Donepezil(多奈哌齐),Rivastigmine,Tacrine4.Diagnostictestformyastheniagravis:Edrophoniumchloride（依酚氯铵，腾喜龙）Edrophoniumchloride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:iv10mg，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。IrreversibleAnticholinesteraseAgents—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）PathwayofintoxicationagingMechanismsofintoxicationSignsofintoxication1.Acuteintoxication:acutecholinergiccrisis(1)Mmanifestation(muscariniceffects)(2)Nmanifestation(nicotiniceffects)(3)CNSeffects2.Chronicintoxication心率减慢、血压下降、缩瞳可不明显[signsofacuteintoxication]1.Mildintoxication:Msigns2.Moderateintoxication:M+Nsigns3.Severeintoxication:M+N+CNSsignPreventionandtreatmentofintoxicationDiagnosis:exposure,symptoms,AChEactivityPrevention:importantTreatmentofacuteintoxication1.Decontamination:topreventfurtherabsorption(gasmask,removalofclothing,gastriclavage)2.Symptomatictreatmentandantidotes(1)Atropine:atropinization(阿托品化)(2)CholinesteraseReactivators3.Maintenanceofvitalsignsgastriclavage2%NaHCO3,or1%brine→MgSO4!!Dipterex―――――→DDVP(敌百虫)(敌敌畏)×NaHCO3Pralidoximechloride(PAM-Cl):氯解磷定Mechanismsofaction磷酰化AChE氯解磷定复合物磷酰化氯解磷定AChECholinesteraseReactivatorsDirectbindingwithfreeorganophosphatestherapeuticeffect1.inhibitNmmanifestation——strong2.inhibitMmanifestation——weak3.CNS1.2.PAM-Clalsohavethefollowings: