治疗中枢神经系统退行性疾病药 ppt课件

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1、Chater17TreatmentofCNSdegenerativediseases治疗中枢神经系统退行性疾病药objective掌握左旋多巴药动学特点、临床应用与不良反应;苯海索的作用特点等。熟悉抗帕金森病药的分类，卡比多巴的作用特点和应用。了解其他抗帕金森病药及治疗阿尔茨海默病的药物作用与应用。classification1、Parkinson’sdisease,PD帕金森病2、Alzheimer’sdisease,AD阿尔茨海默病3、Huntingtondisease,HD亨廷顿病4、Amyotrop

2、hiclateralsclerosis,ALS肌萎缩侧索硬化症Introduction----§1antiPDagentsParkinsondisease帕金森病(paralysisagitans震颤麻痹)1817BritishdoctorJamesParkinsondescribedandreported;It’sakindofdegenerativediseaseofCNS,causingtremor(震颤)atrest,musclerigidity(僵直)andhypokinesia,oftenwit

3、hdementia(痴呆).Aetiology(病因学)mostlyunknown;toxininduced:MPTP,CO,Mn2+…druginduced:DA-R(-)…rarecauses:cerebralischaemia(脑缺血);encephalitis(脑炎),stroke(脑卒中)…PathophysiologytheoryofDopamine:inthenigrostriatalpathway(黑质纹状体通路)dopaminergicneuronsdegeneration.(多巴胺能神经

4、元变性)DAconcentrationAChDAAChnormalParkinson’sdiseasetherapy㈠（+）相对DADAAChSupplyDAAntiAChDopaminemimeticdrug：L-dopaTreatmentofParkinson’sdiseaseCholinoceptorblockingdrug:artaneUsualdrugs（一）Dopaminemimeticdruglevodopa,L-dopa左旋多巴[pharmacokinetics]1、po---abso

5、rbrapidlyfromsmallbowel，influencefactors:1）gastricemptying2）gastricacid3）foodofhighproteinabsorptionFUsualdrugs2、mostlyperipheraldecarboxylation(byAADC)DA;1%CNS.3、usedwithAADCinhibitorseffects，adversereactionsUsualdrugsL-dopapo.brain<1%DCDAcurati

6、veeffect>95%periopheralAADCDAadversereactioncarbidopa（一）liverLevodopaactionandusesTreatPDsupplyDAfirstchoicecharacters：1)lightsymptomandyoungpatient；2)improvementinrigidity、bradykinesia；tremorinapplicable.3)actslowly、durationislonger.4)inefficacy:inducedby

7、CPZ；Levodopaadversereactions1.Earlyreactions1)gastrointestinal~(80%)；2)cardiovascular~：orthostatichypotension(30%)体位性低血压Levodopaadversereactions2.Longtermreactionshyperkinesia(运动过多症)on-offresponsementalconfusion(10-15%)[Druginteraction]p.148notusedwithvita

8、minB6,CPZandreserpine…Otherdrugsp.148-150AADCinhibitors:carbidopa(卡比多巴);MAO-Binhibitors：selegiline(司来吉兰)COMTinhibitors：nitecapone(硝替卡朋)DAreceptoragonist：lisuride(利修来得)Drugsthatreleasedopamine：amantadine(金刚烷胺)