第17节 治疗中枢神经系统退行性疾病药.ppt

Chater 17 objective 掌握 左旋多巴药动学特点、临床应用与不良反应;苯海索的作用特点等。 熟悉 抗帕金森病药的分类，卡比多巴的作用特点和应用。 了解 其他抗帕金森病药及治疗阿尔茨海默病的药物作用与应用。 classification 1、Parkinson’s disease, PD 帕金森病 2、Alzheimer ’ s disease, AD 阿尔茨海默病 3、Huntington disease, HD 亨廷顿病 4、Amyotrophic lateral sclerosis, ALS 肌萎缩侧索硬化症 Introduction ----§1 anti PD agents Parkinson disease 帕金森病 (paralysis agitans 震颤麻痹 ) 1817 British doctor James Parkinson described and reported; It’s a kind of degenerative disease of CNS, causing tremor(震颤) at rest, muscle rigidity (僵直) and hypokinesia, often with dementia (痴呆). Aetiology(病因学) mostly unknown; toxin induced: MPTP, CO, Mn2+… drug induced: DA-R(-)… rare causes: cerebral ischaemia(脑缺血); encephalitis (脑炎) , stroke (脑卒中)… Pathophysiology theory of Dopamine: in the nigrostriatal pathway (黑质纹状体通路) dopaminergic neurons degeneration. (多巴胺能神经元变性) ? DA concentration? Usual drugs 2、 mostly peripheral decarboxylation (by AADC)? DA ; ? 1% ? CNS . 3、used with AADC inhibitors? effects? ，adverse reactions? Usual drugs Levodopa action and uses Treat PD supply DA first choice characters ： 1) light symptom and young patient ； 2) improvement in rigidity、 bradykinesia； tremor inapplicable. 3) act slowly 、 duration is longer. 4) inefficacy : induced by CPZ； Levodopa adverse reactions 1. Early reactions 1) gastrointestinal ~ (80%)； 2) cardiovascular ~： orthostatic hypotension (30%) 体位性低血压 Levodopa adverse reactions 2. Long term reactions hyperkinesia (运动过多症) on - off response mental confusion (10-15%) Other drugs p.148-150 AADC inhibitors: car