吗啡的药理作用And作用机制吗啡的药理作用And作用机制全科班第二小组汇报人:曹群群Pharmacokinetics•First-passeliminationisextensivebioavailabilityislow.•PassesthroughBBBandplacenta(胎盘)barrier.•Excretes:kidney,secretesinmilk药理作用药理作用中枢神经系统平滑肌心血管系统免疫系统PharmacologicalEffects一、CNS1、Analgesia镇痛2、Sedation镇静3、Coughsuppression镇咳4、Respiratorydepression抑制呼吸消除焦虑、紧张、恐惧等欣快感直接抑制咳嗽中枢,使咳嗽反射减轻或消失Respiratorydepressiontherapydosage:respiratoryrateandtidvolume.toxicdosage:1)respiratoryfailure.2)SensitivityofrespiratorycentertoCO2.3)(--)respiratorycenter•Analgesia镇痛Stronger:5-10mgExtensive:variouspainchronicpain(钝痛)>acutepain(锐痛)Longer:4-6hours镇痛时,意识清醒,其他感觉不受影响Morphine(+)Opioidreceptors模拟内源性阿片肽作用增强内源性镇痛系统的功能analgesia镇痛Mechanismofaction内源性镇痛系统内源性镇痛系统脑啡肽神经元脑啡肽阿片受体结合<20%Others兴奋支配瞳孔的副交感神经瞳孔缩小。急性中毒时:针尖样瞳孔Miosis(缩瞳):•兴奋延髓CTZ→恶心、呕吐•抑制丘脑下部释放:促性腺释放激素促肾上腺皮质激素释放因子二.Smoothmuscle(1)Constipation(便秘):(--)CNS便意迟钝(+)gastroenteric(胃肠道)smoothmuscle,→propulsiveperistalticwaves(推进性蠕动)PharmacologicalEffects(2)biliarypressure:constrictsbiliarysmoothmusclebiliarycolic(胆绞痛)(3)Urinaryretention(尿潴留)(4)bronchialSM(+)----inducedasthma(诱发哮喘)三.Cardiovascularsystem(1)Hypotension(低血压):a.Causeperipheralvasodilation.(外周血管舒张)b.Increasehistamine(组胺)release.c.RespiratorydepressionCO2vasodilation2.Intracranialpressure(颅内压)respiratorydepressionCO2Cerebralvasodilation.3.Protectionsofmyocardiacischemiasimulateischemicpreconditioning(模拟缺血性预适应)(–)lymphopoiesis(淋巴细胞增殖)secretionofcellularfactors,(细胞因子的分泌)(–)immunoreactioninducedbyHIV.四Inhibitimmunoreaction[ClinicalUses]1.Analgesia镇痛:其它镇痛药无效的急性锐痛心梗剧痛:前提:BP正常机理:镇痛、镇静、扩血管biliarycolic(胆绞痛):withatropine一个前提三个机理2.Cardiogenicasthma强心甙类—加强心肌收缩力速尿—减轻心脏负荷氨茶碱—强心,松弛支气管平滑肌吗啡治疗心源性哮喘心源性哮喘吗啡扩张外周血管外阻心负荷镇静消除焦虑恐惧心负荷呼吸中枢对CO2的敏感性缓解浅快呼吸Diarrheafromalmostanycausecanbecontrolled.3.Diarrhea(止泻)全体成员:赵丹柏小三、曹群群、陈利、鞠建龙、刘迎辉、卢国庆、祁义民、任少男、宋兰兰、王干彪、张成玉、张亚琴、赵一奇、邹创创