第17章 治疗中枢神经系统退行性疾病药剖析.ppt

Chater 17 objective 掌握 左旋多巴药动学特点、临床应用与不良反应;苯海索的作用特点等。 熟悉 抗帕金森病药的分类，卡比多巴的作用特点和应用。 了解 其他抗帕金森病药及治疗阿尔茨海默病的药物作用与应用。 classification 1、Parkinson’s disease, PD 帕金森病 2、Alzheimer ’ s disease, AD 阿尔茨海默病 3、Huntington disease, HD 亨廷顿病 4、Amyotrophic lateral sclerosis, ALS 肌萎缩侧索硬化症 Introduction Parkinson disease 1817 British doctor James Parkinson described and reported: “It’s a kind of degenerative disease of CNS, causing tremor at rest, muscle rigidity and hypokinesia, often with dementia ” Aetiology mostly unknown; toxin induced: MPTP, CO, Mn2+… drug induced: DA-R(-)… rare causes: cerebral ischaemia; encephalitis , stroke…… Description and Causes Most cases of idiopathic Parkinson’s are believed to be due to a combination of genetic and environmental factors. At both ends of the spectrum are rare cases that appear to be due solely to one or the other. Environmental risk factors associated with the development of PD include: use of pesticides, living in a rural environment, consumption of well water, exposure to herbicides, and proximity to industrial plants or quarries. Pathophysiology theory of Dopamine: in the nigrostriatal pathway dopaminergic neurons degeneration. DA concentration? Why is balance significant? Usual drugs 2、 mostly peripheral decarboxylation (by AADC)? DA ; ? 1% ? CNS . 3、used with AADC inhibitors? effects? ，adverse reactions? Usual drugs Pharmacological effects supply DA first choice 1) light symptom and young patient ； 2) improvement in rigidity、 bradykinesia； 3) act slowly 、 duration is longer. 4) inefficacy : induced by CPZ； adverse reactions 1. Early reactions 1) gastrointestinal ~ (80%): anorexia, nausea and vomitting 2) cardiovascular ~： orthostatic h