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1、紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案Cholinergic mimic agents Lin Yuan Lin Yuan PhD, ProfPhD, Prof Dept. PharmacologyDept. Pharmacology紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案胆碱受体 激动药乙酰胆碱药理作用毛果芸香碱（1）药理作用 （2）临床应用抗胆碱酯 酶药和 胆碱酯 酶复活 药易逆性抗胆碱 酯酶药（1）作用机制（2）药理作 用 （3）新斯的明的临床应用难逆性抗
2、胆碱 酯酶药（1）毒理作用机制 （2）急性中毒胆碱酯酶复活 药碘解磷定碘解磷定的药理作用及临床 应用期末考试/临床执业医师药理学考试大纲 紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 知识整合 乙酰胆碱小剂量与大剂量效应的不同；外源性与内 源性乙酰胆碱产生的效应一样吗？乙酰胆碱长时间 与短时间产生的效应一样吗？ 如何区分肌无力危象（Myasthenic Crisis ）和胆 碱能危象（Cholinergic Crisis ）紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 O
3、bjective: To understand 1. the classification of Cholinergic mimic agents; 2. pharmacologic effects of Acetylcholine (ACh); Extended Analysis: endogenous and exogenous ACh; ACh in low and high dose (specially in organophosphate intoxication) , Short time/long time exposure. 3. pharmacological effect
4、s and major clinical uses of pilocarpine, neostigmine. Extended Analysis: identification of Myasthenic Crisis and Cholinergic Crisis 4. treatment of organophosphate intoxication. 紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 Extended Analysis: for the treatment of glaucoma, which of the foll
5、owing drugs has less ADR, pilocarpine or physostigmine.紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 Q-1 How are Cholinergic mimic agents classified (1) Direct-acting agents: directly bind to and activate the muscarinic or nicotinic cholinergic receptors. Direct-acting agents can be further
6、sub-classified into M receptor agonist, e.g., pilocarpine (毛果芸香碱， 代表药物） ; M and N receptor agonist, e.g., Acetylcholine and Carbachol.紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 (2) Indirect-acting agents: produce their cholinergic effects by inhibiting the action of acetylcholinesterase.
7、Reversible: e.g., neostigmine (新斯的明） Irriversible: organophosphate , e.g., Insecticides （杀虫剂，乐果，敌敌畏等）.紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 Acetylcholine (ACh) 1. Classification (M receptor agonist, M/N receptor agonist) 2. Compare endogenous/exogenous ACh 3. ACh low dose/high dose (
8、specially in organophosphate intoxication) , 4. Short time/long time.紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案ACh 5g 500g ACh 5g Atropine 紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案(Adrenergic fibers)： (Cholinergic fibers)：N1N2MN1N1紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南
9、第一车展策划案 Q-2 Describe pharmacological effects, clinical application and major adverse effects of M receptor agonist, e.g., pilocarpine. Pharmacological effects(1) Stimulates the secretion of sweat and saliva . (2) Decrease of cardiac function (rate, conduction) (3) Contraction of the smooth muscle of
10、 the iris sphincter ciliary muscle (睫状肌) , result in(a) miosis ; (b) Accommodation spasm*（调节痉挛）(c ) Decrease of ocular pressure紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 *A spasm of accommodation is a condition in which the ciliary muscle of the eye remains in a constant state of contract
11、ion. Normally, this contraction bends the lens to allow the eye to “accommodate“ for near-vision. Opposite: cycloplegia = paralysis of the ciliary muscle resulting in a loss of accommodation紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 Clinical application(1) Antimuscarinic drugs intoxicatio
12、n (2) glaucoma Glaucoma is a disease of the nerve that sends the information from the eye to the brain characterized by increased intraocular pressure. “chronic open angle glaucoma“, occurs as a result of too much fluid being pumped into the eye. “acute narrow angle glaucoma“, in which the drainage
13、site (the angle) is restricted and the fluid outflow is cut off. 紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案Redial muscle of iris stimulation causesdilation of pupilCircular (sphincter) muscle of iris stimulation causescontraction of pupil紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策
14、划案Iris (虹膜）The direction of ContractionLens晶体Aqueous humor房水Canal Schlemn巩膜静脉窦Cilliary body睫状体滤帘滤帘Pupil contractionPupil contractionPosterior chamber(后房)A AAnterior chamber(前房)The contraction of iris sphincter and ciliary muscle will broaden the angle of anterior chamber and facilitate the outflow o
15、f aqueous humor from anterior chamber into venous blood via the Schlemms canal, resulting in reduced intraocular pressure.anterior Chamberangle前房角紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案 调节于近视：毛果芸香碱激动睫状肌环形纤维上M受体，使 睫状肌向虹膜中心方向收缩，悬韧带松弛，晶状体变凸，屈光度增加 ，使远物不能聚焦成像于视网膜上，因此模糊不清, 此时，只适合于 观测特定近距离的物体
16、，这种作用称为调节痉挛。 紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案Nearsightedness, an abnormal lengthening of the eyeNearsightedness紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案紫荆电影院成都校园营销策划推广方案海报设计培训精品教程海马M5新车试驾品鉴会活动策划方案海南第一车展策划案Flat lensconvex len
