2021年护理药理学考试重点.pdf

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1、序论药理学的研究任务：研究药物与机体相互作用规律与作用机制的科学。护理人员掌握药理学的知识，有助于协助医生诊治疾病和合理用药，使药物治疗达到最佳效果，对提高医疗和护理水平具有重要意义。要求：药理学、药效动力学、药代动力学的概念第一章药物效应动力学一、药物作用的基本规律1药物的基本作用兴奋和抑制是药物作用的两种基本类型。兴奋：使机体器官组织原有机能活动水平增强。肾上腺素使心率加快、血压升高。抑制：使机体器官组织原有机能活动水平减弱。吗啡产生镇痛和呼吸抑制。一种药物对不同的器官或组织，可分别产生兴奋或抑制作用，肾上腺素收缩皮肤粘膜的血管（兴奋），而舒张骨骼肌血管和冠脉血管（抑制）。兴奋和抑制作用，

2、在一定的条件下可以相互转化。过渡的兴奋如惊厥不止，可导致中枢衰竭甚至死亡。2药物的选择作用在治疗剂量范围内，药物对某一、两种器官或组织产生明显的药理作用，而对其它的器官和组织，作用很小甚至无作用。临床意义：选择性高的药物针对性强，如：洋地黄对心肌的兴奋作用，利尿剂对肾小管的作用；选择性低的药物，作用范围广，不良反应多。比如阿托品。临床精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 1 页，共 46 页根据药物选择性的作用规律，对不同疾病选择不同的药物，药物的适应症取决于药物作用的选择性。3药物作用的临床效果（药物作用于机体，基本的临床表现是）（1）治疗作用：凡能达到防治疾病目

3、的的作用。（2）不良反应：用药后产生与治疗目的无关的其他作用。副作用、毒性反应、后遗效应、变态反应（青霉素过敏）二、药物的量效关系1几个基本概念（5 页图）（1）量效关系：药物剂量与效应之间规律性变化。（2）最小有效量：出现疗效的最小剂量。（3）治疗量：临床用药的剂量。（4）最小中毒量：引起中毒反应的最小剂量。（5）极量：比治疗量大，比最小中毒量小。三、药物和受体学说近代分子生物学和生物化学的研究认为，大多数药物是通过与细胞上某些大分子蛋白质相结合而产生作用，故以受体学说来阐明药物作用原理。药物与受体结合引起效应的两个条件：亲和力：药物与受体相结合的能力；内在活性：药物能产生效应的能力。（1）

4、激动药：药物与受体有较强的亲和力，也有较强的内在活性，能兴奋受体产生明显效应。如吗啡激动阿片受体引起镇痛作用。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 2 页，共 46 页文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3

5、E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8

6、J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码

7、:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L

8、8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5

9、W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1

10、O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5

11、K4 ZL3E8S2O8J3（2）拮抗药：药物与受体亲和力较强，但无内在活性，不引起效应，但能阻断激动剂和受体的结合。如纳络酮本身没有明显的药理效应，但在体内和吗啡竞争同一受体，具有对抗吗啡的药理作用。（3）部分激动药：本类药物与受体的亲和力较强，但只有弱的内在活性。要求：名词解释：不良反应、治疗量、极量、安全范围、受体激动剂、受体拮抗剂、后遗效应思考题：药物作用的选择性及其临床意义第二章药物代谢动力学这一章主要介绍机体对药物的处置过程及体内血药浓度随时间变化的规律，包括药物的吸收、分布，代谢和排泄等过程。一、药物的转运药物进入体内要经过转运（吸收，分布，排泄）和代谢（转化）过程。药物的转运是

12、通过体内各种生物膜进行的，这一过程又称为跨膜转运，分为主动转运和被动转运两种。多数药物属被动转运。1被动转运又称下山转运、顺梯度转运。特点是：依赖膜两侧浓度差。从高浓度一侧向低浓度侧扩散，达平衡时为止；不消耗能量；不需载体参与。脂溶性大，分子量小，极性小及非解离型药物易转运。常用的药物多属弱酸性或弱碱性化合物，在体液内只部分解离，因而存在解离型与非解离型两种互变形式，解离型药物难以通过细胞膜，而非解离型药物易于通过细胞膜。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 3 页，共 46 页文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档

13、编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA1

14、0L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10

15、I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 H

16、I1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2

17、C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 Z

18、L3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2

19、O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3药物解离的多少与药物所在溶液的pH值有关，弱酸性药物在pH高的碱性环境中，易解离，而在pH低的酸性环境中不易解离，易于通过生物膜弱碱性药物在pH低的酸性环境中易解离，而在pH高的碱性环境中不易解离，易于通过生物膜。临床意义：改变生物膜两侧的PH，可以影响药

20、物的转运。（弱酸性药物巴比妥类中毒后，应以弱碱性药物洗胃，使胃内残留药物不易继续吸收，同时应碱化尿液，使肾小管中的药物不易被重吸收，促进其排泄）。2主动转运又称上山转运。特点是：逆浓度梯度进行；需要消耗能量；需特异载体。二、药物的体内过程首关消除口服某些药物，在胃肠道吸收后，经门静脉进入肝脏，在进入体循环前被肠粘膜及肝脏代谢灭活或结合贮存，使进入体循环的药量明显减少。药物与血浆蛋白结合药物吸收入血后，多数与血浆蛋白结合，成为结合型药物。结合型药物特点：暂时失去药理活性；不易透过毛细血管壁、血脑屏障及肾小球，减少了代谢、排泄，使作用维持时间延长；与蛋白质的结合是疏松和可逆的，当游离型药物浓度下降

21、时，结合型药物即可释放药物，成为游离型，恢复其原有的药理活性。游离型药物才能进行转运。治疗剂量下药物与血浆蛋白结合的百分率称为血浆蛋白结合率。药物的代谢代谢是指药物在体内发生化学结构的变化。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 4 页，共 46 页文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8

22、S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3

23、文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:C

24、A10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K

25、10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5

26、 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6

27、N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4

28、 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3药物在体内的代谢依赖于酶的催化，一类代谢酶为专一性药酶，如乙酰胆碱酯酶，只代谢乙酰胆碱；另一类为非专一性酶，主要存在于细胞内，所以称肝药酶，主要是细胞色素P-450，这类酶能代谢数百种药物。凡是能增强肝药酶活性的药物，称肝药酶诱导剂。如苯巴比妥、苯妥因钠、利福平等能增强肝药酶活性。凡是能抑制或减弱肝药酶活性的药物，称肝药酶抑制剂，如氯霉素、西米替丁、异烟肼等能减弱肝药酶活性。其临床意义是如酶促剂或酶抑剂与可被肝药酶代谢的药物合用时，剂量应适当的加减。（12 页表）药物的排泄：肝肠循环：某

29、些药物，自胆汁排入十二指肠，在肠内水解后，经小肠粘膜再吸收，经肝重入体循环，延长了药物作用时间。如洋地黄毒苷。血浆半衰期：指血浆药物浓度下降一半时所需时间。是表达药物消除速度的参数，对制定给药方案、间隔时间提供重要依据。一般情况下，一次给药后，经5 个半衰期，约 96以上药物被消除。每隔一个半衰期给药，约经5个半衰期可达稳态血浓度。掌握基本概念：首过效应、生物利用度、药物血浆蛋白结合率、血浆半衰期、稳态浓度、耐受性和依赖性。思考题：体液pH值改变对药物转运的影响；被动转运和主动转运的特点；血浆半衰期的临床意义；第四章影响药物作用的因素影响药物作用的因素药物方面包括剂型、剂量、给药途径、药物理化

30、性质及药物相互作用等。机体方面包括年龄、性别、营养状态、精神状态、遗传因素、个体差异及病理情况等，可对药效产生影响。药物依赖性：分为身体依赖性和精神依赖性。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 5 页，共 46 页文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8

31、K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W

32、5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O

33、6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K

34、4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E

35、8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J

36、3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:

37、CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3耐受性：反复用药后，机体对该药的反应性减弱，药效降低，这种现象成为耐受性。耐受性是可逆的，停止用药后，耐受性将逐渐消失。耐药性：又称抗药性，是在长期应用化疗药物后，病原体对药物产生的耐受性。第六章传出神经药物概论传出神经的分类、受体的主要类型、分布及效应；一、传出神经的分类大家可以看书上的图，传出神经包括植物神经系统和运动神经系统。运动神经自中枢发出后，直接到达骨骼肌，支配骨骼肌运动，中间不更换神经元，受人的主观意识支配。植物神经又分为交感和副交感神经，主要支配心脏、平滑肌、腺体及眼等器官。交感神经与副交感神经对同一器官

38、的作用基本相反，其功能不受主观意识支配。植物神经从中枢发出后在神经节更换神经元，故植物神经有节前纤维和节后纤维之分。二、神经递质能够传递神经冲动的化学物质成为递质。传出神经末梢所释放的神经递质，称外周神经递质，主要有乙酰胆碱（Ach）、去甲肾上腺素（NA）和肽类递质根据末梢释放递质的不同，将传出神经分为两大类：胆碱能神经和去甲肾上腺素能神经两大类。1胆碱能神经：兴奋时其末梢释放乙酰胆碱包括全部交感和副交感神经节前纤维；全部副交感节后纤维；支配汗腺和骨骼肌血管的交感神经节后纤维；运动神经；支配肾上腺髓质的内脏大神经5 种。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 6 页，

39、共 46 页文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3

40、文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:C

41、A10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K

42、10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5

43、 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6

44、N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4

45、 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J32去甲肾上腺素能神经:兴奋时其末梢释放去甲肾上腺素,大多数交感神经节后纤维属本类。支配平滑肌和心脏。三、受体与效应位于突出后膜或效应器上，能与神经递质结合。

46、受体也分为两类：1胆碱受体与兴奋后效应：M胆碱受体：主要分布心血管、胃肠、支气管、眼及腺体等。M 效应：心脏抑制、血管扩张、腺体分泌、胃肠和支气管平滑肌收缩、缩瞳等N胆碱受体：N1受体：分布神经节和肾上腺髓质。N2受体：分布骨骼肌N效应：骨骼肌收缩、神经节兴奋、肾上腺髓质分泌增加2去甲肾上腺素受体与兴奋后效应：受体效应：皮肤、粘膜、腹腔内脏血管、瞳孔扩大肌等 受体效应：1 受体：主要分布于心脏 2受体：主要分布骼肌血管、冠状血管、腹腔内脏血管、支气管及胃肠平滑肌心脏兴奋、骨骼肌血管和冠脉扩张，支气管及胃肠平滑肌松弛四、乙酰胆碱的合成与消除胆碱乙酰化酶合成：胆碱+乙酰辅酶 A 乙酰胆碱胆碱酯酶消

47、除：胆碱+乙酸五、传出神经药物的分类分类精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 7 页，共 46 页文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C

48、5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL

49、3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O

50、8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编码:CA10L8K10I5W5 HI1O6N2C5K4 ZL3E8S2O8J3文档编