20章解热抗炎药110329

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1、解热镇痛抗炎药Chapter20Antipyretic-analgesicandanti-inflammatorydrugs1Teachinggoals1、简述阿司匹林的作用、用途、不良反应。2、简述对乙酰氨基酚的作用特点。3、比较解热镇痛药与氯丙嗪在降温方面的作用和应用。4、比较解热镇痛药与镇痛药在镇痛方面的作用和应用。2§1Introduction【Definition】1.-havestrongantipyreticeffects2.-haveanalgesiceffects3.-somehaveanti-inflammatorya

2、ndanti-rheumaticeffects.(一类具有解热、镇痛，且大多数还有抗炎、抗风湿作用的药物)3膜磷脂PLA2花生四烯酸白三烯等环内过氧化物环氧化酶糖皮质激素(-)解热镇痛抗炎药(-)甾体抗炎药SAIDs非甾体抗炎药NSAIDs【mechanism】vessalPGI2PGF,PGE等plateletTXA2non-steroidalanti-inflammatorydrugs4PG:agroupofautacoids-leadtoinflammation,painandfever.NSAIDs→㈠环氧化酶（COX）→前列腺素

3、（PG）合成→解热、镇痛、抗炎(是自体活性物质，可致炎、致痛、致热)5细菌毒素病毒等粒细胞吞噬、处理产生释放内热原CNSPG合成与释放体温调定点>370C发热NSAIDs㈠COX→(-)PG合成【commonpharmacologicalactions】一.Antipyreticaction(解热作用)6Properties:1.temperatureofpatientswithfever(只降发热者体温)2.independentofenvironmenttemperature(降温作用与环境温度无关)3.increasehea

4、tdissipationmainly.(主要增加散热)7Meaningofpyretic(发热利弊):Advantages:1.-enhancethedefensefunction.(提高机体防御功能)2.diagnosisofdiseases(热型是诊断的依据).80400c370c12345day低热稽留热弛张热T9disadvantages：highfeverCNSfunctiondisorderse.g.convulsion(惊厥)durativefeverconsumephysicalenergy(持续发热，消耗体能)10U

5、ses＆notes1.T>39ºc(especiallyforchildren)2.durativefeverthathasbeendiagnosedclearly.(诊断明确的持久发热)3.feverwithobviouspain.(发热伴明显疼痛者)4.symptomatictreatmentonly(仅为对症治疗)11组织损伤局部炎症局部释放致痛物质BK、PG等（+）痛觉感受器疼痛痛觉增敏NSAIDs㈠NSAIDs→㈠COX→PGsynthesis↓→PG致痛及痛觉增敏↓→analgesia(镇痛)二.Analgesicaction

6、(镇痛作用)12Properties:1）moderateanalgesics(镇痛作用中等)2）-bewellforchronicpainandinflammatorypain（炎性疼痛及慢性钝痛效佳）3）noaddictionandnorespiratorydepression(不成瘾，不抑制呼吸)13三.Anti-inflammatoryaction(抗炎作用)Prostaglandins(PG)：1.-dilatebloodvessels.(扩血管)2.↑vascularpermeability(血管的通透性↑)e.g.tissu

7、eedema3.synergywithotherinflammatorymediators.(协同其它炎症介质的作用)NSAIDs→㈠COX→PG↓→antiinflammation14Properties:1.symptomatictreatmentonlye.g.relieveredness,swelling,heatandpain(对症治疗，可明显改善红、肿、热、痛)2.-donotarresttheprogressionofpathologicalinjurytotissueandoccurrenceofcomplications

8、.(不能阻止病程进展及合并症的发生)3.Acetaminophenhasnoanti-inflammatoryaction.(苯胺类药无抗炎作用)15COX：COXCOX-1：COX-2：结构