胆碱受体阻断药课件

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1、CholinoceptorBlockingDrugsClassificationBaseonspecificreceptoraffinitiesAntimuscarinicagentsAntinicotinicagents(consistofganglion-blockersandneuromuscularjunctionblockers)AtropineanditsalkaloidsAtropineAnisodamineAcopolaminechemistryandpharmacokineticsTertiaryaminealkaloidestersoftropicacidWel

2、labsorbedfromthegutandacrosstheconjunctivalmembraneWidelydistributedMetabolismandexcretionPharmacologicalEffectsGlandsSweat,salivaryglandsecretionaregreatlyreducedBronchialsecretiondecreasedReductioningastricsecretionandtotalacidcontent,especiallyatdosesgreaterthan1mgPharmacologicalEffectsEyeMy

3、driasisocularpressureincreasecycloplegia动眼神经的副交感神经支配毛果芸香碱激动瞳孔括约肌M受体缩瞳阿托品阻断瞳孔开大肌扩瞳去甲状腺素能神经支配虹膜(包括瞳孔括约肌和瞳孔开大肌)毛果芸香碱的缩瞳作用激动占优狭窄时眼内压增高，闭角型青光眼（急，慢型充血性青光眼）变性或硬化时眼内压增高开角性青光眼（慢性单纯性青光眼）睫状体上皮细胞分泌血管渗出房水瞳孔前房前房角间隙小梁网巩膜静脉窦血流毛果芸香碱的降低眼内压作用间隙扩大,房水入循环毛果芸香碱收缩瞳孔括约肌缩瞳虹膜拉紧虹膜根部变薄毛果芸香碱收缩睫状肌扩张小血管阿托品扩瞳，虹膜退向四周，前房角间隙变窄，房水

4、回流受阻，眼内压升高降低眼内压正常时晶体较扁平受睫状肌控制环状肌辐射状肌(瞳孔括约肌)动眼神经兴奋或毛果芸香碱动眼神经胆碱能神经阿托品向瞳孔中心收缩悬韧带，睫状小带放松睫状肌松弛而退向外缘，悬韧带拉紧(瞳孔开大肌)去甲肾上腺素能神经支配对眼调节无重要意义只视近物(调节痉挛)只视远物(调节麻痹)晶状体变扁屈光度降低晶状体变凸屈光度增加毛果芸香碱的调节痉挛作用外界睫状肌起点悬韧带PharmacologicalEffectsSmoothmuscleGastrointestinaltract:relaxGenitourinarytract:relax,voidslowlyPharmacolo

5、gicalEffectsCardiovascularsystem:Heartrate:Lowerdoses:PresynapticreceptorblockedbradycardiaAtmoderatetohightherapeuticdoses:tachycardiaAtrioventricularconductionIntoxicconcentrations:intraventricularconductionblockPharmacologicalEffectsbloodvesselandpressureVasodilationandhypopiesiscausedbychol

6、innergicnervecanbeblockedAttoxicdoses,cutaneousvasodilationPharmacologicalEffectsCNSAtnormaldoses,minimalstimulanteffectIntoxicdoses,excitement,agitation,hallucinationsandcomaClinicalusesRelievehyperkinesiaInhibitsecretionOphthalmology:iritis,optometryArrhythmiashockCholinergicpoisoningClinical

7、uses2001年1月11日羊城晚报（成都消息）37岁男性，因家庭纠纷喝乐果中毒。昏迷，每30分钟用5支阿托品，无效每10分钟用5支，无效每5分钟用10支，连续使用72小时，总共用了1700支，850mg病人清醒，生命体征趋向平稳。（阿托品的最低致死量为成人80-130mg，儿童10mg）。AdverseeffectsDrymouth,mydriasis,tachycardia,hotandflushedskin,agitationanddeliriumH