2015年中央电大《药理学》形考册作业1-4参考答案.docx

中央电大药理学形考册作业1-4参考答案电大药理学(药学专业)作业11、简述不良反应的分类，并举例说明。（1）副反应：如氯苯那敏（扑尔敏）治疗皮肤过敏时可引起中枢抑制。（2）毒性反应：如尼可刹米过量可引起惊厥，甲氨蝶呤可引起畸胎。（3）后遗效应：如苯巴比妥治疗失眠，引起次日的中枢抑制。（4）停药反应：长期应用某些药物，突然停药后原有疾病加剧，如抗癫痫药突然停药可使癫痫复发，甚至可导致癫痫持续状态。（5）变态反应：如青霉素G可引起过敏性休克。（6）特异质反应：少数红细胞缺乏G-6-PD的特异体质病人使用伯氨喹后可以引起溶血性贫血或高铁血红蛋白血症。2、简述血浆蛋白结合率，血浆半衰期的概念及其临床意义答：血浆蛋白结合率：药物与血浆蛋白结合的程度，即血液中与蛋白结合的药物占总药量的百分数。结合率高的药物在结合部位达到饱合后，如继续稍增药量，就能导致血浆中的自由型药物浓度大增，而引起毒性反应。如两种药与同一类蛋白质结合，且结合率高低不同，将他们前后服用或同时服用可发生与蛋白质结合的竞争性排挤现象，导致血浆中某一自由型药物的浓度剧增，而发生毒性反应。药物半衰期（t1/2）是指血浆药物浓度下降一半所需时间，以t1/2来表示，反映血浆药物浓度消除情况。其意义为：临床上可根据药物的t1/2确定给药间隔时间； t1/2代表药物的消除速度，一次给药后，约经5个t1/2，药物被基本消除；估计药物达到稳态浓度需要的时间，以固定剂量固定间隔给药，经5个t1/2，血浆药物浓度达到稳态，以此可了解给药后多少时间可达到稳态治疗浓度。3、简述传出神经药物的分类，每类举一个代表药答：根据传出神经药物作用的性质、作用部位和机制不同进行分类如下：拟胆碱药：M、N受体兴奋药（氨甲酰胆碱）； M受体兴奋药（毛果芸香碱）； 抗胆碱酯酶药（加兰他敏）抗胆碱药：M受体阻断药（阿托品）； NN受体阻断药（美加明）；NM受体阻断药（琥珀胆碱）；胆碱酯酶复活药（碘解磷定）拟肾上腺素药：、受体兴奋药（肾上腺素）；受体兴奋药（去甲肾上腺素）；受体兴奋药（异丙肾上腺素）抗肾上腺素药：受体阻断药（酚妥拉明）；、受体阻断药（拉贝洛尔）4、简述药物排泄的主要途径有哪些？答：药物的排泄途径有：肾脏排泄：一般药物在体内大部分代谢产物通过肾由尿排出，也有的药物以原形由肾清除。胆汁排泄：有些药物可以部分地通过胆汁分泌进入肠道，最后随粪便排出。乳腺排泄。其他途径：挥发性药物如吸入性麻醉剂等可通过呼吸系统排出体外。中央电大药理学形考册参考答案（2）1、简述琥珀胆碱与筒箭毒碱在作用机理、应用及不良反应方面的区别两药肌松作用特点比较如下：筒箭毒碱琥珀胆碱临床用量有神经节阻断作用临床用量无神经节阻断作用抗胆碱酯酶药拮抗其肌松作用抗胆碱酯酶药增强其肌松作用乙醚、氨基苷类抗生素加强其肌松作用连续用药可产生快速耐受肌松前不会引起肌束颤动肌松前出现肌束颤动除极化型：琥珀酰胆碱对N2受体产生持久除极化作用，对Ach的反应减弱或消失【药理作用】1.先出现短时的肌束颤动；肌松作用出现快，持续时间短（28min），易于控制。2.骨骼肌松弛有一定的顺序：颜面部颈部肩胛腹部四肢呼吸肌【临床应用】气管内插管，食道镜等操作。重复给药或静滴用于较长时间的手术；有强烈窒息感（4-5min）禁用于清醒的患者。非除极化型：筒箭毒碱竞争性阻断运动终板上N2受体与Ach结合吸入性麻醉药如乙醚和氨基甙类抗生素如链霉素能加强此药的作用；与抗胆碱酯酶药之间有拮抗作用,过量时可用新斯的明解毒；有神经节阻断作用。因药源有限,临床已少用1、非去极化型肌松药：筒箭毒碱：全麻辅药使肌肉松驰，中毒用新斯的明解救。大剂量血压下降，支气管痉挛。2、去极化型肌松药：琥珀胆碱：口服不吸收，起效快，维持短。2、比较去甲肾上腺素和异丙肾上腺素药理作用的异同去甲肾上腺素（noradrenaline、NA）激动药药理作用收缩血管：激动1受体，收缩小动脉、小静脉。皮肤黏膜肾血管脑、肝、肠系膜血管骨骼肌血管；冠状动脉舒张：1直接作用：心脏兴奋腺苷增多冠脉扩张冠脉流量增加2间接作用：血压上升灌注压升高冠脉流量增加；血压增加：（外周阻力增加）。兴奋心脏：微弱的激动1受体，正性心力作用，整体情况下，心率由于血压升高而反射性降低。异丙肾上腺素(isoprenaline,isoproterenol) 激动药药理作用兴奋心脏: 1受体强大的激动作用,兴奋窦房结可致心率失常。扩张血管：激动骨骼肌血管2受体，血管舒张。血压：收缩压升高，舒张压下降，脉压增大。平滑肌：对支气管平滑肌的舒张作用显著，对黏膜血管无收缩作用。促进代谢3、简述多巴胺及肾上腺素的临床应用多巴胺：临床应用：用于抗休克，与利尿药合用治疗急性肾功能衰竭。肾上腺素：口服无效。一般皮下注射。临床应用：1、心脏停搏2、过敏性休克3、支气管哮喘4、减少局部麻药吸收5、局部止血，鼻黏膜与齿龈出血。4、简述抗肾上腺素药酚妥拉明、普萘洛尔的作用特点和临床应用酚妥拉明：口服生物利用度低。作用特点：1、心血管系统：直接血管舒张作用，心收缩力加强，心率加快。2、其他临床应用：1、治疗外周血管痉挛性疾病和血栓闭塞性及管炎。2、局部浸润注射，拮抗注射NA时药液外漏引起的血管强烈收缩。3、抗休克4、缓解高血压危象5、用于充血性心力衰竭普纳洛尔：治疗心绞痛，心率失常，高血压，甲状腺机能亢进。作用特点：(1)阻滞心脏-受体，使心收缩力减弱，心率减慢，心输出量降低。(2)阻滞肾脏-受体，减少肾素分泌，从而抑制肾素血管紧张素醛固酮降压。(3)可透过血脑屏障，阻滞中枢-受体，外周交感神经降低，血管阻力降低。(4)阻滞突触前膜-受体，减少NE释放。临床应用：治疗室上性心动过速、房颤、房扑、窦性心动过速；治疗高血压心绞痛，心衰早期；治疗甲状腺机能亢进、控制心悸、心律失常、激动不安等；治疗偏头痛、肌震颤、青光眼（噻吗洛尔）、肝硬化引起的上消化道出血。中央电大药理学形考册参考答案（3）1、简述冬眠合剂的药物组成及临床应用 药物组成：氯丙嗪+哌替啶+异丙嗪=冬眠合剂 临床应用：对下丘脑体温调节中枢有很强的抑制作用，可降低正常体温。 2、简述抗精神失常药的分类及临床应用 氯丙嗪 药理作用： 临床运用： 精神分裂症：对型精神分裂症才有效，对型无效甚至加重症状； 治疗呕吐和顽固性呃逆； 低温麻醉与人工冬眠。 氯氮平：为苯二氮卓类，广谱的神经安定剂，对精神分裂症疗效与氯丙嗪相似，目前我国不少地区将其作为治疗精神分裂症的首选药。 抗躁狂症药碳酸锂（安全范围小） 抗抑郁症药米帕明（首选药） 米帕明 临床运用： 治疗抑郁症； 治疗遗尿症；中央电大药理学形考册参考答案（4）1、简述抗高血压药的分类，每类举一个代表药1.利尿药：氢氯噻嗪2.交感神经抑制药（受体阻断药）：可乐定,樟磺味芬,利血平,普萘洛尔3.肾素血管紧张素系统抑制药 : 氯沙坦,卡托普利4.钙拮抗药: 硝苯地平，维拉帕米5.血管扩张药:硝普钠2、简述钙拮抗剂的药理作用钙拮抗药维拉帕米、地尔硫卓【药理作用】1.降低心肌耗氧：通过对心肌钙通道阻滞作用，抑制心肌收缩性，减慢心率而降低心肌作功，减少耗氧量；通过扩张外周血管，降低外周阻力，降低心脏负荷。2.舒张冠脉，增加冠脉流量而改善缺血区的供血供氧；对痉挛的动脉血管舒张明显。3.防止缺血心肌的钙超负荷【临床应用】变异性及稳定性心绞痛最为适合。3、简述氟喹诺酮类药物药理作用的主要特点作用机制：抑制DNA回旋酶，是氟喹诺酮类抗G-的重要靶点，使细菌的DNA无法保持高度的卷紧和螺旋状态，从而抑制了细菌DNA的复制。抑制拓扑异构酶IV是氟喹诺酮类抗G+重要靶点。(2)药物特点 抗菌谱广，抗菌活性强，尤其对G-杆菌的抗菌活性 高，包括对许多耐药菌株如MRSA(耐甲氧西林金葡菌)具有良好抗菌作用； 耐药发生率低，无质粒介导的耐药性发生； 体内分布广，组织浓度高，可达有效抑菌或杀菌浓度； 大多数系口服制剂，亦有注射剂，半衰期较长，用药次数少，使用方便； 为全化学合成药，价格比疗效相当的抗生素低廉，性能稳定，不良反应较少。因而本类药成为化学合成抗感染药物中发展最为迅速，已成为临床治疗细菌感染性疾病的主要化疗药物。4、简述红霉素、链霉素、庆大霉素的不良反应红霉素：不良反应1. 直接刺激反应：口服胃肠道反应是主要不良反应； 静滴血栓性静脉炎；2. 肝损害：无味红霉素。转氨酶升高、白细胞升高、发热、黄疸等，停药数日可恢复正常；3. 耳毒性：大剂量4. 心脏毒性：静注过快5. 伪膜性肠炎：口服红霉素偶可致肠道菌株失调引起伪膜性肠炎 。链霉素:不良反应：1、第八对脑神经损害。2、肾脏损害3、神经肌肉阻滞作用4、过过敏反应庆大霉素:不良反应：第八对脑神经损害，肾毒性最大。不易与利尿酸及呋喃苯胺酸等利尿药合用。请您务必删除一下内容，O(_)O万分谢谢！2015年中央电大期末复习考试小抄大全，电大期末考试必备小抄，电大考试必过小抄Indonesia has emerged as a top vacation destination for Chinese this summer, along with Thailands Phuket island and the Maldives archipelago. Encouraged by growth in Chinese travelers to Indonesia, the government in Jakarta has recently relaxed its visa policy. Since June 10, Chinese tourists can enter Indonesia through nine appointed locations, including the Soekarno Hatta International Airport in Jakarta, the Ngurah Rai International Airport in Bali and the Kuala Namu International Airport in Medan, by just getting their passports stamped on arrival. Officially, it is called the free-visa scheme. The new policy also means Chinese tourists can save $35 on visa fees, which will likely make trips to Indonesia more alluring. While such an arrangement allows Chinese visitors to stay up to 30 days for the purpose of traveling, those seeking extensions will need to get paid visas from that countrys missions inBeijing,Shanghai,GuangzhouorHong Kong, according to an official at the Indonesia embassy in Beijing. Santo Darmosumarto, head of the embassys information, social and cultural section, says the new policy is aimed at strengthening people-to-people contacts between the two countries. Dai Yu, marketing director of Ctrip, a major Chinese online travel agency, says: Weve seen a nearly 50 percent growth over the previous month in the number of Chinese tourists to Bali since the policy was announced. During his trip to China in March, Indonesian President Joko Widodo proposed that his country and China aim to increase two-way visits to a maximum of 10 million people in the next few years. The Indonesian government has set their sights on greeting 2 million Chinese tourists by the end of this year, according to the official. The Indonesian government hopes that Indonesian nationals would also be given preferential treatment while visiting China, says Darmosumarto. In 2013, the number of Chinese tourists who visited Indonesia stood around 807,000. Last year, it increased to 959,000, he adds. Bali remains the most popular site among Chinese tourists. In February, more than 92,200 Chinese tourists made trips to Bali, ranking first among overseas visitors, the Bali Times reported. Last year, the island witnessed more than 586,000 arrivals from China, an increase of 51 percent over 2013. Bali isnt just for sightseeing, but also for weddings, honeymoons, golf and many outdoor activities, says Fan Wenqing, a marketing executive at Garuda, Indonesias national airliner. Garuda offers three nonstop flights between Beijing and Bali, and four each week between Beijing and Jakarta. There are daily flights from Guangzhou, inGuangdongprovince, and Shanghai to Jakarta as well. It takes from six to eight hours on a nonstop flight to reach Indonesia from China. Indonesia is home to more than 17,000 islands. Tourists can tour Yogyakarta to see Prambanam and Borobudur, two historical and religious sites, and explore the local handicraft markets. The base of a volcano, Bandung, which is also known as the Paris of Java, is ideal for adventure-seekers. Many ecotourism destinations, such as Toba Lake in Sumatra, Tanjung Puting National Park in Kalimantan and Bunaken in Manado, are places the embassy official recommends for tourists. Indonesia boasts world-class surfing facilities along the shores of Sumatra down to Nusa Tenggara Islands. Recently, Lombok, a sister island east of Bali has gotten so much attention from Chinese travelers that some travel agencies are offering twin packages for Bali and Lombok. The best time to visit Bali is from May to October, when it doesntrainmuch and the weather is cool. At press time, a weeklong package from Shanghai or Guangzhou to Bali was a little more than 3,000 yuan ($480) on Ctrips website. Chinese tourists have taken a shine to rafting in Ubud, sightseeing in Tanah Lot, and surfing and diving in Nusa Lembongan, says Dai. Civet coffee, essential oil and woodcarvings are among the most popular products for Chinese tourists in Indonesia, she says. Indonesian food is also something that visitors shouldnt miss. Local cuisines feature many spices, including peppers and cloves, and coconut pulp. Fried rice, dirty duck and roast suckling pig are recommended. Childrens illustration books first appeared in the 1600s in Europe. Their passage to China, however, took much longer, roughly 300 years. In China, childrens illustration books have a history of just 100 years and their development can be divided into four stages. From early 1900s to mid 1900s, a large number of books and magazines with illustrations appeared with the fast development of the modern publishing industry. The illustrationarts at that time were a mixed genre of Chinese traditionalpaintings and the westernstyle, and most of the stories originate from the fundamental changes that China experienced after the collapse of Qing Dynasty (1644-1911), the warlord struggles and the war against the Japanese invasion. The second stage was from mid 1900s to late 1970s, when the cultural revolution (1966-76) ended. The fast development of some special publishing houses for children gave birth to a large number of illustration-story books, which made a good use of folk art techniques, such as wood board carving, frescoes, and ink and wash painting, etc. Many of the popular stories are from Chinese history and wars after 1900s. The third stage is from early 1980s to late 1990s, a golden period for the development of childrens illustration books. The reform and opening-up brought in new concepts and ideas from the West to China, a country that had been closed to the West for nearly three decades. Fast development of economy, society and culture provided the writers and painters with a lot of inspiration to create new literature works and draw illustrations. China also imported large amounts of childrens illustration books from the West and Japan. Many young parents in China have a strong nostalgia about childrens illustration books they read in the 1980s and 1990s. This is also the last era in Chinas artistic innovation before the advent of the Internet period. The fourth stage is featured with the spread of the Internet and the other computerized means of art innovation. The hand-drawn childrens illustration books are gradually replaced by cartoons drawn and copied by software and machines, and shown on tablets, computers, television and smart phones, instead of books. Hainan Tropical Wildlife Park and Botanical Garden is natures haven, with no less than 4,000 rare birds and animals representing 200 species. With tropical forest covering over 90 percent of its area, the garden offers beautiful views of a wide range of tropical plants, flowers and fruit trees. The scenic spot about 25 kilometers from the center of Haikou offers a drive-thru safari tour where you can get up close with elephants, lions and bears. The Safari on Foot area features walking trails where visitors can see the rest of the animals, including hippos and monkeys, and feed them for a small fee. Visitors also can see what happens when you breed a lion and a tiger. Two unique attractions are rare hybrids: a liger, the offspring of a mallion and a female tiger and a tigon, which is created by a female lion and a male tiger. As ateaching center of the National Popular Science Education program, the park also serves as a second classroom for students to learn about wildlife and plants. Since it was established in 1995, it has received more than one million student visitors. At a crucial moment when pessimism has brought the Greek crisis to such a head that the country is closer to a default on its debt repayments than ever, Li offered a spark of enthusiasm to restart the stalled talks by calling on Greece and its creditors to reach a last-minute deal that will allow Greece to remain in the eurozone. Given the escalation of the countrys crisis over the weekend sent a shock wave through the global stock markets on Monday, there are ample reasons to worry about the uncertainties surrounding the events in Greece and the effect a default would have on Europe, relations between China and the EU, global financial stability and the nascent global economic recovery. Greece has announced that it will hold a referendum on a bailout plan proposed last week by the countrys creditors. In response, Greeces eurozone partners have refused to extend the countrys bailout program and the European Central Bank capped its emergency support for the countrys banks. A real danger now looms of Greece exiting the euro, which might derail the global economic recovery and damage the long-term viability of the euro as a currency. However, such a tragedy is neither certain nor unavoidable. The EU should shoulder its responsibility to prevent the Greek crisis from overshadowing the fragile global recovery. As a major customer and supplier of the 28-nation EU, and a responsible long-term holder of Eurobonds, Chinas confidence in and commitment to a strong eurozone offers EU leaders the necessary support to look at the Greek crisis from a broader and longer perspective. When Li said that China will not only consider a China-EU investment platform to back European Commission President Jean-Claude Junckers plan to revive the European economy, but also buy more bonds issued by the European Investment Bank, EU leaders should be clear that China wants to see the EU maintain its integrity and a forward trajectory. Such a confidence-building effort is particularly valuable, especially from such a large country as China which already has a huge stake and seeks to further expand it in a strong eurozone. It will be a tragedy to allow inaction over the Greek crisis to stand in the way of growth-boosting Sino-EU cooperation. Like a shining pearl, West Lake is the symbol of Hangzhou city. From ancient times, many poems have praised the amazing scenery of the lake. At the very beginning, the West Lake was a part of the Qiantang River. In the year 822, Bai Juyi, a famous poet and an officer of the Tang Dynasty (AD 618-907), suggested to build a stronger causeway to store water so that the lake was doubled in size. And during the Song Dynasty (AD 960-1279), many temples and pagodas were built due to a Buddhist revival, and the look of West Lake was formed at that time.The West Lake is quite big and features different classic views from different locations. Technically, there are ten scenes which were marked by Emperor Qianlong with four-character inscriptions 200 years ago, such as the Melting Snow on the Broken Bridge and Sunset Glow over Leifeng Pagoda.