第二十八章-作用于呼吸系统的药物-课件

28 第二十八章 作用于呼吸系统的药物 ppt课件28 第二十八章 作用于呼吸系统的药物 ppt课件1objectivel掌掌握握 平平喘喘药的的概概念念、分分类，沙沙丁丁胺胺醇醇、氨氨茶茶碱碱、色色甘甘酸酸钠的的药理理作作用用、临床床应用、不良反用、不良反应。l熟熟悉悉 呼呼吸吸系系统药物物分分类，异异丙丙托托溴溴铵、糖糖皮皮质激激素素的的作作用用特特点点，平平喘喘药的的临床床应用用。可可待待因因、右右美美沙沙芬芬、喷托托维林林等等药理作用特点。理作用特点。l了了解解 镇咳咳药和和祛祛痰痰药的的概概念念；苯苯佐佐那那酯、溴己新的溴己新的药理作用及理作用及临床床应用。用。objective掌握 平喘药的概念、分类，沙丁胺醇、氨茶碱21 introductionlRespiratorydiseaseisafamiliar,repetitiousdisease.lThecommonsymptomsare:cough,sputum(痰痰);asthma(哮喘哮喘).1 introduction Respira31 introduction呼吸系统炎症呼吸系统炎症病原生物感染病原生物感染过敏反应过敏反应痰痰咳咳喘喘支气管痉挛支气管痉挛antitussivesexpectorantsAntiasthmatics1 introduction呼吸系统炎症病原生物感染过敏42 usual drugs-AntiasthmaticsAntiasthmaticslI.AntiasthmaticslAsthmapathologicfeatures:lSoakage（浸润）浸润）ofinflammatorycells,lcontractionofairwaysmoothmuscle,lmucosalthickeningfromedemaandcellularinfiltration,ltheplugofmucusintheairwaylumen.2 usual drugs-Antiasthma52 usual drugs-AntiasthmaticsAntiasthmaticslresponsivenessofthetracheaandbronchitovariousstimuli.lAsthmaticstimuliinclude:inhaledallergens(吸入性过敏原吸入性过敏原);drugs;non-specificstimulisuchascoldair,exercise,stress,andpollution.2 usual drugs-Antiasthma62 usual drugs-AntiasthmaticsAntiasthmaticslBronchialinflammatorymediators:LTs,PGs,TXA2,PAFlcellfactorsILs,TNF-,GM-CSF.2 usual drugs-Antiasthma72 usual drugs-AntiasthmaticsAntiasthmaticslClassificationsofantiasthmatics.Bronchodilators1.-Ragonists;2.Theophylline;3.M-Rantagonists;.Antiinflamatorydrugs.Mast-cellstabilizers2 usual drugs-Antiasthma82 usual drugs-AntiasthmaticsAntiasthmatics一一.Bronchodilators1.-Ragonistsadrenerling;Ephedrine;isoprenaline;selective2-RagonistsSalbutamol;TerbutalineClenbuterolFormoterol;Salmeterol2 usual drugs-Antiasthma92 usual drugs-AntiasthmaticsAntiasthmaticslBasicactions(+)ACintracellularcAMP:brochodilation;releaseofinflammatorymediators;microvascularleakage;mucociliary（粘膜纤毛）粘膜纤毛）transport.2 usual drugs-Antiasthma102 usual drugs-AntiasthmaticsAntiasthmaticsl2selectiveagonistslfirstlinedrugsforasthmaatpresentbronchodilationisoprenaline,butcardiovasculareffects;po.absorbedwell,longduration;adversereactionsnotcommon.2 usual drugs-Antiasthma112 usual drugs-AntiasthmaticsAntiasthmaticsl2.Theophyllines 氨茶碱氨茶碱aminophylline,胆茶碱胆茶碱cholinetheophyllinerelaxthesmoothmusclesofthebronchi;po.chronicasthmaiv.acuteasthma2 usual drugs-Antiasthma122 usual drugs-AntiasthmaticsAntiasthmaticslmechanismofactionunclear,possiblyinclude:1)InhibitPDEintracellularcAMP;2)endogenicCAsrelease;3)Inhibitadenosine(腺苷腺苷)receptors;4)anti-inflammationinflammatoryresponseeosinophilsmediatedbyILs.2 usual drugs-Antiasthma132 usual drugs-AntiasthmaticsAntiasthmaticsl【Adverseeffects】nausea,vomiting,tremor(颤抖颤抖),insomnia(失眠失眠),tachycardia.Note:concentrations20g/mltoxiceffectsmayoccur;Rapidiv.aminophyllinesuddendeath,(probablyduetocardiacarrhythmias)2 usual drugs-Antiasthma142 usual drugs-AntiasthmaticsAntiasthmatics3.M-receptorantagonists 异丙阿托品异丙阿托品Ipratropine 氧托品氧托品oxitropium泰泰乌托品托品tiotropiumsecond-linedrugsforasthma.aerosolinhalant（气雾吸入剂）气雾吸入剂）2 usual drugs-Antiasthma152 usual drugs-AntiasthmaticsAntiasthmatics【characteristics】1.selectiveM-RcGMPbronchodilation；2.aerosoladministration poorlyabsorbed；3.usedforchronicbronchitis(Ach-mediatedbronchospasm支气管痉挛支气管痉挛）.2 usual drugs-Antiasthma162 usual drugs-AntiasthmaticsAntiasthmatics二二.AntiinflamatorydrugsCorticosteroidsTheglucocorticoids（糖皮糖皮质激素）激素）usedintreatmentofasthmainclude:二丙酸倍二丙酸倍氯米松米松Beclomethasone；氟尼氟尼缩松松Flunisolide；布地奈德布地奈德Budesonide2 usual drugs-Antiasthma172 usual drugs-AntiasthmaticsAntiasthmatics【MechanismsofAction】1.Anti-inflammatoryaction；2.Anti-allergicreaction 3.lipocortin1（脂皮素脂皮素1）PLA2LTsandPGs.4.prevent2Rdown-regulation.2 usual drugs-Antiasthma182 usual drugs-AntiasthmaticsAntiasthmatics【Clinicaluses】Inhalation(themostcommonway);Usuallypo.iv.reservedfor:severeacuteexacerbationsofasthma,（严重的哮喘急重的哮喘急剧发作）作）severestatusasthmaticus.（严重的哮喘持重的哮喘持续状状态）2 usual drugs-Antiasthma192 usual drugs-AntiasthmaticsAntiasthmatics三三.Mast-cellstabilizers色甘酸色甘酸钠Sodiumcromoglicatelstabilizeantigen-sensitizedmastcellsCa2+influx;releaseofinflammatorymediators.lInhalation,slowly(after2-3d)mainusedinpreventingasthmaticattacks,otherallergicdiseases.2 usual drugs-Antiasthma20第二十八章-作用于呼吸系统的药物-课件212 usual drugs-AntiasthmaticsAntiasthmatics四四.Others1.5-lipoxygenaseinhibitor齐留通留通zileuton2.LT-recepterantagonists扎扎鲁司特司特zafirlukast孟孟鲁司特司特montelukast3.Anti-IgEmonoclonalantibodies2 usual drugs-Antiasthma222 usual drugs-antitussivesantitussivesII.AntitussiveslinhibitthecoughreflexCentralantitussivesCodeine;Pentoxyverine;Benproperine;PeripheralantitussivesBenzonatate 2 usual drugs-antitussi232 usual drugs-antitussivesantitussivesl可待因可待因Codeine(+)opioidreceptor(morphine)analgesicactions,antitussiveactions.usedforirritativedrycoughing.Addiction（成瘾性）成瘾性）(long-termuse)2 usual drugs-antitussi242 usual drugs-antitussivesantitussives苯佐那苯佐那酯benzonatatethederivativeoftertracaine1.Localanestheticeffectslthepulmonarystretchreflex；（肺牵张反射）肺牵张反射）lsensorynervousterminals；2.usedtopreventcoughduringbronchoscopy（支气管镜检查）支气管镜检查）.2 usual drugs-antitussi252 usual drugs-expectorantsexpectorantsIII.Expectorants乙乙酰半胱氨酸半胱氨酸N-acetylcysteineMucolytics（粘痰溶解剂）粘痰溶解剂）breakdisulfidebondsofmucussputumviscosity（粘性）粘性）.Useinchronicobstructivepneumopathia.（慢性阻塞性肺病）慢性阻塞性肺病）2 usual drugs-expectoran262 usual drugs-expectorantsexpectorants 溴己新溴己新Bromhexinelbreaksthemucoitin（粘多糖）粘多糖）ofthesputum；lusedinthechronicbronchitis（支气管炎）支气管炎）,asthmaandbronchiectasis（支气管扩张支气管扩张症）症）.2 usual drugs-expectora27have a think:lForeachdrugcategoryofantiasthmatics,lgiveexamples,ldescribetheirmechanismsofactionandmajorclinicaluses.have a think:For each dru28