文档介绍：Chapter 7 cholinesterase inhibiting drugs & cholinesterase reactivators 第七章 抗胆碱酯酶药和胆碱酯酶复活药
TAISHAN medical university
zhangfeng
Cholinesterase(胆碱酯酶,AChE)
acetylcholinesterase(乙酰胆碱酯酶)也称真性胆碱酯酶:主要存在于胆碱能神经末梢突触间隙。
Pseudocholinesterase(假性胆碱酯
酶):主要存在于血液及肝脏中。
新斯的明抑制胆碱酯酶过程示意图
Neostigmine(新斯的明)
1. Pharmacological effects
①cholinesterase inhibitor
②very strong effect on skeletal muscle
--direct activating N2 receptors
--release ACh at the motor nerve endings(运动神经)
③strong stimulating effect on gastrointestinal tract(胃肠道平滑肌) and gallbladder smooth muscle(胆囊平滑肌)
2. Clinical Uses
①myasthenia gravis (重症肌无力)
②Postoperative ileus(术后肠梗阻) and urinary retention(尿潴留)
③ Paroxysmal supraventricular tachycardia(阵发性室上性心动过速)
④Overdosage of muscle relaxants
⑤Atropine intoxication
3. Side Effects
large dosage----nausea(恶心), vomiting(呕吐), abdominal pain(腹痛),HR , fibrillation of muscle fibers(肌束颤动), “cholinergic crisis”(胆碱能危机)
4. Contraindications
①Mechanical intestinal obstruction (ileus) (机械性肠梗阻)
②urinary obstruction(尿路阻塞)
③bronchial asthma(支气管哮喘)
Pyridostigmine(吡斯的明)
and weaker than neostigmine
is longer
Uses
①myasthenia gravis
②postoperative intestinal distention and urinary retention
③less side effects
Physostigmine(毒扁豆碱,又称Eserine)
Clinical Uses
①a(青光眼)
②awakening of traditional Chinese herb anesthesia (中药麻醉的催醒)
③atropine intoxication
病例讨论