Chapter19Chapter19AnalgesicsAnalgesicsobjectiveobjective1.1.掌握掌握吗啡吗啡、、哌替啶哌替啶的药理作用与作用的药理作用与作用机制、临床应用机制、临床应用,,不良反应和禁忌不良反应和禁忌症。症。2.2.熟悉熟悉阿片生物碱类镇痛药的概念、分类阿片生物碱类镇痛药的概念、分类可待因、喷他佐辛、曲马朵、可待因、喷他佐辛、曲马朵、罗通定、纳洛酮的药理作用和临床罗通定、纳洛酮的药理作用和临床用途用途..3.3.了解了解其他镇痛药的概念与应用特点其他镇痛药的概念与应用特点IntroductionIntroductionpainpain【【definitiondefinition】】1)acommonexperience;1)acommonexperience;2)anessentialdefensivefunction,2)anessentialdefensivefunction,3)anunpleasantsensoryandemotion3)anunpleasantsensoryandemotion4)withactualorpotentialtissue4)withactualorpotentialtissuedamage.damage.Painfunctiondisordersshock;Achingfeature、part、paroxysmDiagnosticgist(诊断依据)AdvantageDisadvantagePainAcutepain锐痛Chronicpain钝痛烧伤、战伤、割伤头痛、牙痛、关节痛、神经肌肉痛等传导慢、定位不明确、伴情绪反应刺激强、传导快,定位明确【【ClassificationofpainClassificationofpain】】HasaneffectonCNS,removesorlessensthesensationofpain.ClassificationofdrugsClassificationofdrugsAnalgesics镇痛药RelievepainAntipyreticAntipyretic((解热)、、AnalgesicAnalgesic((镇痛)AntiinflammatoryAntiinflammatory((抗炎)NSAIDsNSAIDsOpioidanalgesicsOpioidanalgesicsSection1Section1阿片生物碱类镇痛药阿片生物碱类镇痛药麻醉麻醉药品药品阿片类:鸦片、海洛因、吗啡阿片类:鸦片、海洛因、吗啡古柯类:可卡因、古柯叶古柯类:可卡因、古柯叶大麻类:大麻、大麻酚大麻类:大麻、大麻酚精神精神药品药品镇静催眠药:巴比妥类镇静催眠药:巴比妥类中枢兴奋剂:冰毒、摇头丸中枢兴奋剂:冰毒、摇头丸致幻剂:麦角酰二乙胺致幻剂:麦角酰二乙胺其他其他烟草:烟草:酒精:酒精:挥发性有机溶剂:汽油挥发性有机溶剂:汽油毒品的分类名称名称主要成分主要成分鸦片鸦片罂粟罂粟海洛因海洛因二乙酰吗啡二乙酰吗啡冰毒冰毒甲基苯丙胺甲基苯丙胺摇头丸摇头丸二亚甲基双氧苯丙胺二亚甲基双氧苯丙胺KK粉粉氯胺酮氯胺酮常见毒品的主要成分Beautifulpoppy(罂粟)Blessingordisaster?NOTICE!———全世界有10%的人口卷入了毒品的生产和消费;———全世界每年约有10万人因吸毒死亡;———全世界每年约有1000万人因吸毒丧失正常智力和工作能力;———世界毒品贸易已经占到世界贸易的13%,仅次于军火贸易;poppyopiumheroinmorphinemorphinemorphine吗啡吗啡(梦神)(梦神)PharmacokineticsPharmacokineticsFirst-passeliminationisextensiveFirst-passeliminationisextensivebioavailabilityislow.bioavailabilityislow.PassesthroughBBBandplacentaPassesthroughBBBandplacenta((胎盘胎盘))barrier.barrier.ExcretesExcretes::kidneykidney,,secretesinmilksecretesinmilkPharmacologicalEffectsPharmacologicalEffects一、CNS1、Analgesia镇痛2、Sedation镇静3、Coughsuppression镇咳4、Respiratorydepression抑制呼吸AnalgesiaAnalgesia镇痛镇痛Stronger:5-10mgExtensive:variouspainchronicpain>acutepainLonger:4-6hours镇痛时,意识清醒,其他感觉不受影响SedationSedation镇静镇静消除焦虑、紧张、恐惧等欣快感Decreaseanxiety、tensionanddread.Euphoria:contentment(满足)well-being(飘飘欲仙)(欣快)•RespiratorydepressionRespiratorydepressiontherapydosage:respiratoryrateandtidvolume.toxicdosage:1)respiratoryfailure.2)SensitivityofrespiratorycentertoCO2.3)(--)respiratorycenterInhibitionofcoughreflexInhibitionofcoughreflexOthersOthersMiosisMiosis((缩瞳缩瞳))::““pinpointpupils”pinpointpupils”isisvaluableinthediagnosisvaluableinthediagnosisofopioidoverdosage.ofopioidoverdosage....