镇静催眠药中毒课件

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1、Toxicity,Sedative-HypnoticsBackgroundSedative-hypnoticsareagroupofdrugsthatcauseCNSdepression.Benzodiazepines(BZD)barbituratesnonbarbituratenonbenzodiazepinesedative-hypnotics(NBNB)themostcommonlyusedagentsBackgroundacutesedative-hypnoticspoisoningwith

2、drawalsyndromeEtiologyBenzodiazepines(BZD)Longacting(halflife>30h):chlordiazepoxide(利眠宁)diazepam（地西泮、安定）flurazepam（氟安定）Shortacting(halflife6-30h):alprazolam(阿普唑仑)Ultrashortacting:triazolam(三唑仑)EtiologyBarbituratesUltrashortactingMethohexital(Brevital甲己

3、炔巴比妥)thiopental(Pentothal硫喷妥那)Shortactingpentobarbital(Nembutal戊巴比妥)secobarbital(Seconal司可巴比妥)IntermediateactingAmobarbital(Amytal异戊巴比妥)butalbital(Fioricet,Fiorinal异丁巴比妥)LongactingPhenobarbital(Luminal鲁米那)Nonbarbiturate,nonbenzodiazepinesedative-hypnot

4、ics(NBNB)Chloralhydrate(水合氯醛)Ethchlorvynol(乙氯维诺)Glutethimide(导眠能)Methyprylon(甲乙哌酮)Meprobamate(眠尔通)Etiology一、Pharmacokinetics：1、PharmacokineticsoftheBZDMostBZDareextensivelymetabolizedbytheliver.Somearemetabolizedtoproductswhichareactiveandmayhaveamuchl

5、ongerhalflifethantheparentdrug.ThemajorrouteofmetabolismisN-demethylation.intheelderlyCimetidinePathogenesisPathogenesis2、PharmacokineticsofBarbituratesBarbiturateswithlowlipidsolubilityareexcretedintheunchangedformbythekidneys.iephenobarbital（苯巴比妥）.Ba

6、rbiturateswithhighlipidsolubilityaremetabolizedtomorepolarcompoundsintheliverbeforebeingexcretedviathekidneys.iethiopental（硫喷妥）.3、PharmacokineticsofNBNBMostNBNBareextensivelymetabolizedbytheliverPathogenesisBZDIntheCNS,benzodiazepinesexerttheirclinical

7、effectbyenhancingtheactivityoftheinhibitoryneurotransmitterGABA.(TheclinicaleffectsofGABAreleaseandGABA-gatedchloridechannelsincludesleepinductionandexcitementinhibition)BarbituratesinprolongationofthedurationofopeningofGABA-gatedchloridechannels,leadi

8、ngtohyperpolarizationofthemembraneandsuppressionofneurotransmission.。NBNBsimilartotheactionofBarbiturates二、ThemechanismofactionPathogenesisBZDGABAchloridechannelCl-Cl-＋＋＋＋＋－－－－－hyperpolarizationClinicalBenzodiazepineblurredvision,dizzin