抗胆碱酯酶药和胆碱酯酶复活药泰山医学院.pptxVIP

抗胆碱酯酶药和胆碱酯酶复活药泰山医学院;第2页/共25页;新斯的明抑制胆碱酯酶过程示意图;Neostigmine（新斯的明）;2. Clinical Uses ①myasthenia gravis （重症肌无力） ②Postoperative ileus（术后肠梗阻） and urinary retention（尿潴留） ③ Paroxysmal supraventricular tachycardia（阵发性室上性心动过速） ④Overdosage of muscle relaxants ⑤Atropine intoxication ;3. Side Effects large dosage----nausea（恶心）, vomiting（呕吐）, abdominal pain（腹痛）,HR , fibrillation of muscle fibers（肌束颤动）, “cholinergic crisis”（胆碱能危机） 4. Contraindications ①Mechanical intestinal obstruction (ileus) （机械性肠梗阻） ②urinary obstruction（尿路阻塞） ③bronchial asthma（支气管哮喘）;Pyridostigmine（吡斯的明）;Physostigmine(毒扁豆碱，又称Eserine）;;;;Ⅱ.难逆性抗胆碱酯酶药 ;有机磷酸酯类抑制胆碱酯酶过程示意图;2. Mechanism of Organophosphate Intoxication ①With exposure to Ops anticholinesterase agents, the enzyme (AChE) is phosphorylated（使磷酸化）and becomes unable to function. ②Acetylcholine build-up,which causes interfer-ence with nerve impulse transmission at nerve endings.;3. Acute intoxication ①Muscarinic receptors --pupil,vision,gland,respiration,gastrointestinal tract, bladder,etc. ②Nicotinic receptors --heart rate,blood pressure --neuromuscular junction ③central nervous system --excitement→inhibition Cholinesterase Aging (Once aging occurs, re-activation of the enzyme is virtually impossible.) ;4.Chronic Intoxication Reduction of AChE, headache, dizziness, fatigue （疲劳）, sometimes muscle fasciculation, miosis （瞳孔缩小）. 5.Treatment of Acute Intoxication ①Terminate exposure ②Maintain airway ③Atropine ④cholinesterase reactivator ⑤other treatment;Atropine (阿托品 ）;Ⅲ. Cholinesterase Reactivator（胆碱酯酶复活药） ;第19页/共25页;Pralidoxime iodide (碘解磷定，派姆，PAM ）;2.Improve the symptoms? ①stop muscle fasciculation（肌束颤动） ? ②improve CNS symptoms --awake the patients --stop convulsion（躁动不安） 3.Side Effects General malaise（不适）,blurred vision（视力模糊）,dizziness,nausea（恶心）,Vomiting, tachycardia（心动过速）;Pralidoxime chloride,PAM-Cl (氯解磷定）;;讨论： （1）对口服有机磷中毒的病人洗胃时应注意哪些问题？如果该患者为敌百虫口服中毒是否仍可用碱性溶液洗胃？ （2）如何