啡药理作用and作用机制研究PPT课件

.,1,吗,啡,?,.,2,？,.,3,为,什,么,?,.,4,吗啡的药理作用And作用机制,全科班第二小组,morphine,汇报人：曹群群,.,5,Pharmacokinetics,First-passeliminationisextensivebioavailabilityislow.PassesthroughBBBandplacenta（胎盘）barrier.Excretes：kidney，secretesinmilk,.,6,药理作用,中枢神经系统,平滑肌,心血管系统,免疫系统,.,7,PharmacologicalEffects,一、CNS,1、Analgesia镇痛,2、Sedation镇静,3、Coughsuppression镇咳,4、Respiratorydepression抑制呼吸,消除焦虑、紧张、恐惧等欣快感,直接抑制咳嗽中枢，使咳嗽反射减轻或消失,.,8,Respiratorydepression,therapydosage:respiratoryrateandtidvolume.toxicdosage:1）respiratoryfailure.,2）SensitivityofrespiratorycentertoCO2.3）(-)respiratorycenter,.,9,Analgesia镇痛,Stronger:510mg,Extensive:variouspainchronicpain(钝痛)acutepain（锐痛）,Longer：46hours,镇痛时,意识清醒,其他感觉不受影响,.,10,Morphine（）Opioidreceptors模拟内源性阿片肽作用增强内源性镇痛系统的功能analgesia镇痛,Mechanismofaction,.,11,内源性镇痛系统,脑啡肽神经元,脑啡肽,阿片受体,结合,20%,.,12,Mechanismofaction,morphine,阿片-R,脑啡肽,.,13,Others,兴奋支配瞳孔的副交感神经瞳孔缩小。急性中毒时：针尖样瞳孔,Miosis(缩瞳)：,兴奋延髓CTZ恶心、呕吐,抑制丘脑下部释放：,促性腺释放激素,促肾上腺皮质激素释放因子,.,14,二.Smoothmuscle,(1)Constipation(便秘):,（-）CNS便意迟钝(+)gastroenteric（胃肠道）smoothmuscle,propulsiveperistalticwaves(推进性蠕动),PharmacologicalEffects,.,15,(2)biliarypressure:constrictsbiliarysmoothmusclebiliarycolic(胆绞痛),(3)Urinaryretention(尿潴留),(4)bronchialSM(+)-inducedasthma(诱发哮喘),.,16,三.Cardiovascularsystem,(1)Hypotension(低血压):a.Causeperipheralvasodilation.(外周血管舒张)b.Increasehistamine（组胺）release.c.RespiratorydepressionCO2vasodilation,.,17,2.Intracranialpressure（颅内压）respiratorydepressionCO2Cerebralvasodilation.3.Protectionsofmyocardiacischemiasimulateischemicpreconditioning(模拟缺血性预适应),.,18,()lymphopoiesis(淋巴细胞增殖)secretionofcellularfactors,（细胞因子的分泌）()immunoreactioninducedbyHIV.,四Inhibitimmunoreaction,.,19,ClinicalUses,1.Analgesia镇痛：其它镇痛药无效的急性锐痛心梗剧痛：前提：BP正常机理：镇痛、镇静、扩血管biliarycolic(胆绞痛):withatropine,一个前提三个机理,.,20,2.Cardiogenicasthma,强心甙类加强心肌收缩力速尿减轻心脏负荷氨茶碱强心，松弛支气管平滑肌吗啡,治疗,心源性哮喘,.,21,吗啡,扩张外周血管外阻心负荷,镇静消除焦虑恐惧心负荷,呼吸中枢对CO2的敏感性缓解浅快呼吸,.,22,Diarrheafromalmostanycause