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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Lin Yuan Ph.D Prof.Cholinergic antagonist 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M胆碱受体 阻断药阿托品Atropine（1）药理作用;（2）临床 应用;（3）不良反应及中 毒期末考试/临床执业医师药理学考试大纲 期末考试/药理学考试大纲 选择题：后马托品，山莨菪碱， 琥珀胆碱，筒箭毒碱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
2、车展策划案lObjective: To understand 1.the classification of cholinergic antagonists;2.pharmacological effects, major clinical uses, and ADR of Atropine3.drug choice in clinical uses: Anisodamine, Homatropine, Succinylcgoline, and Tubocurarine. (relationship between drug lipid solubility and drug selectiv
3、ity) 4.Extended Analysis: (1) how to differentiate NA and Atropine induced mydriasis. (2) explain the phenomenon that low dose of Atropine decreases and the high dose increases cardiac rates. (3) Comments on why both ACh and atropine can dilate vascular smooth muscle. (4) Whether atropine can be use
4、d for the patient with gastric colic also suffered from asthma or angina pectoris (Anaerobic metabolism) or myasthenia gravis.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lQ-1 What is the common feature of M antagonist (Atropine 阿托品)l In therapeutic dosage, antimuscarinic agents antagonize t
5、he muscarinic actions of acetylcholine and related compounds, by selectively and competitively binding to M receptor. lIn higher doses, antimuscarinic agents show anti-nicotinic effects, block N2 receptor at motor nerve endings and N1 receptor in the ganglioninc synapse. 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
6、马M5新车试驾品鉴会活动策划方案海南第一车展策划案lQ-2 Please describe pharmacological effects and clinical uses of M antagonist(1) inhibition of exocrine glands secretions（抑制腺 体分泌） (a) Inhibition of sweating; Clinic uses: e.g., treatment of severe sweating in tuberculosis. (b) Suppression of bronchial and salivary secretio
7、ns. Clinic uses: given before surgery to decrease respiratory tract and salivary secretion. l(c) Decrease of gastric secretion, but the main contribution to peptic ulcer is relief of spasm 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) Mydriasis (扩瞳 ，dilation of the pupil) Clinic uses: (a)
8、 Treatment of iritis by decreasing the activity of ciliary (睫状肌) muscle, which prevent the adhesion between iris and lens and help relieve the inflammation. Cycloplegia (调节麻痹， paralysis of accommodation). Clinic uses: accurate measurement of eye refraction (眼屈光)。Increasing in intraocular pressure （增
9、加眼内压） , especially in eyes with a narrow angle between iris and cornea(角膜) and attack acute glaucoma with potential hazard of ensuing blindness.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(3) Relaxation of smooth muscle in gastrointestina
10、l tract, biliary tract (weak), and bronchi. Clinic uses: （a）gastric colic; (b) weak in the treatment of nephritic colic and biliary colic (肾绞痛，胆绞痛) and should be combined with Pethidine（哌替啶）; (c) bronchial asthma.(4) Effects on heart l小剂量阿托品抑制心率大剂量增加，为什么*l 大剂量阿托品 increases heart rate and cardiac out
11、put by blocking vagal effects on the Sino-Atria pace maker. Clinic uses: acute myocardial infarction, bradycadia caused by excessive vagal tone. 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(5) Effects on blood vessels lACh 与阿托品皆能够舒张血管，是否符合逻辑*lHigh dose of M blocker dilates blood vessel and
12、relief spasm of vessel smooth muscle and improve the micro-circulation, and make a contribution to increase the blood supply to the important organs. The vascular dilation might be a direct effect and is not related to blocking of M receptor. lClinic uses: 感染性休克（Septic shock）. 紫荆电影院成都校园营销策划推广方案海报设计培
13、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l感染性休克的常见致病菌为革兰阴性细菌，如肠杆菌 科细菌；不发酵杆菌；脑膜炎球菌；类杆菌等。l休克发生发展过程中，微血管容积的变化可经历痉挛 、扩张和麻痹三各个阶段。l休克时肾皮质血管痉挛，致皮质血流大减。如休克持 续，则肾小管因缺血缺氧而发生坏死、易并发急性肾 功能衰竭。l阿托品通过阻断M受体、解除支气管痉挛、抑制腺体 分泌、保持呼吸通畅；扩张肾血管，肾功能衰竭；较 大剂量时可解除迷走神经对心脏的抑制，使心率加速 ；抑制血小板和中性粒细胞凝聚等作用。l控制感染，宜联合用药；常用者为一种-内酰胺类加 一种氨基糖甙类抗生素，肾功能减退
14、者后者慎用或勿 用。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l6) treatment of the poisoning caused by 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( 7 ) Central nervous systemlSome M blocker, e.g., Atropine (can cross BBB barrier) in usually dose slightly stimul
15、ates medulla and higher cerebral center(髓质及更高的大脑中枢) . Large doses can produce hallucinations (幻觉) and ultimately, coma. Parkisonian tremor and rigidity resulted from a relative excess of cholinergic activity can be reduced by centrally acting M Blocker.l（M 受体阻断剂的中枢作用，除抗帕金森病外，皆为不良反应）。紫荆电影院成都校园营销策划推广方
16、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lAnisodamine (山莨菪碱)lAnisodamine does not pass readily through the blood brain barrier, and cause less side effect, it is used in relieving gastrointestinal colics and to enhance microcirculation during septic shock, instead of 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Homatropine（后马托品） is about one tenth of the potency of Atropine. It is used solely as a
