神经系统药理—魏尔清(镇痛药VIP免费

Part12Part12AnalgesicsAnalgesicsOpioidanalgesicsOpioidanalgesicsSyntheticopioidanalgesicsSyntheticopioidanalgesicsOtheranalgesicsOtheranalgesicsGeneralConsiderationsGeneralConsiderationsPainPain((疼痛疼痛))：：躯体痛－快痛，慢痛躯体痛－快痛，慢痛内脏痛内脏痛情绪反应情绪反应AnalgesiaAnalgesia((镇痛镇痛))：：选择性抑制疼痛感觉，选择性抑制疼痛感觉，不影响意识和其他感不影响意识和其他感觉觉PainClassificationPainClassificationHeadacheHeadache(migraine)(migraine)AcuteAcuteChronicChronicPainPainNociceptiveNociceptiveMixedMixedNeuropathicNeuropathicVisceralVisceralDiabeticneuropathy(DN)Post-herpeticneuralgia(PHN)Radiculopathy(RADIC)CancerpainLowbackpainOsteoarthritisRheumatoidarthritisFibromyalgiaIBSPancreatitisBladderpainNoncardiacchestpainAbdominalpainsyndromeInjuryInjuryPostoperativePostoperativeFlareFlareAnadverseorunpleasantreactionplusthereactionsevokedbyitPaingenerationandreactionsPaingenerationandreactionsStimulationanddepolarizationofsensorynerveendingsStimulationanddepolarizationofsensorynerveendingsPain:Pain:peripheralsensoryreflexperipheralsensoryreflexPeripheralmechanismsofpainPeripheralmechanismsofpainPeripheralmechanismsofpainPeripheralmechanismsofpainPrimary&secondaryhyperalgesiaPrimary&secondaryhyperalgesiaTheperceptionofsomaticpainTheperceptionofsomaticpainTheperceptionTheperceptionandconductionofandconductionofsomaticpainsomaticpainConductionConductionpathwaysofpainpathwaysofpainCorticalCorticallocationsoflocationsofpainpainThefMRIimagingofpainThefMRIimagingofpainClassificationofanalgesicsClassificationofanalgesics：：OpioidanalgesicsOpioidanalgesics(centrallyacting)(centrallyacting)opiatesopiatessyntheticagentssyntheticagentsAntipyretic,analgesic,andanti-inflammatoryAntipyretic,analgesic,andanti-inflammatorydrugsdrugs(peripherallyacting)(peripherallyacting)aspirin,indomethacinaspirin,indomethacinOtherdrugsOtherdrugs(forspecialtypesofpain)(forspecialtypesofpain)carbamazepine,atropine,nitroglycerin,carbamazepine,atropine,nitroglycerin,etc.etc.GeneralConsiderationsGeneralConsiderationsMorphineMorphine吗啡吗啡ONCH3HOHOONCH3OCOH3CH3COCOMorphineMorphine吗啡吗啡HeroinHeroin海洛因海洛因A.A.OpioidAnalgesicsOpioidAnalgesicsOpiumOpiumMorphine:Morphine:Morphus,Morphus,theGreektheGreekgodofdreamsgodofdreams1.1.PharmacologicaleffectsPharmacologicaleffects(1)Mechanismsofactions(1)MechanismsofactionsActingoncentralopioidreceptorsActingoncentralopioidreceptorsreceptorsreceptorsreceptorsreceptorsδδreceptorsreceptorsA.A.OpioidAnalgesicsOpioidAnalgesicsATPcAMPGiACOpioidReceptorsandEndogenousLigandsOpioidReceptorsandEndogenousLigandsδδEndorphinEndorphinEnkephalinEnkephalinDynorphinDynorphinK+Gi=MechanismsofMechanismsofmorphineactionsmorphineactionsPeripheralmechanismsofmorphineactionsPeripheralmechanismsofmorphineactionsCentralmechanismsofmorphineactions:Centralmechanismsofmorphineactions:PaininhibitorysystemPaininhibitorysystem(2)Centralnervoussystemeffects(2)CentralnervoussystemeffectsA.A.AnalgesiaAnalgesia：：maximalanalgesicefficacymaximalanalgesicefficacy；；relievingunpleasantsensation;relievingunpleasantsensation;euphoniaeuphoniaandpotentialofdependenceandpotentialofdependenceB.B.DepressionofrespirationDepressionofrespiration::reducingthesensitivityofrespiratorycentertoCOreducin...