浙江大学医学院：《药理学》课程教学资源（PPT课件）镇痛药 Analgesics

Analgesics 镇痛药 囗 Opioid analgesics 口 Synthetic opioid analgesIcs 囗 Other analgesics 汤慧芳 浙江大学医学院 药理系 2018-11-7

汤慧芳 浙江大学医学院 药理系 2018-11-7 Analgesics 镇痛药 Opioid analgesics Synthetic opioid analgesics Other analgesics

Pain classification An adverse or unpleasant Pain reaction plus the reactions evoked by it Acute Headache Chronic (migraine Postoperative Flare Neuropathic Mixed Nociceptive L躯体痛 Visceral内脏痛 Diabetic neuropathy Cancer pain Osteoarthritis [BS (DN Low back pain Rheumatoid Pancreatitis Post-herpetic arthritis Bladder pain neural lIgia( PHN Fibromyalgiasf Noncardiac chest pain Radiculopathy神经根 维肌痛 Abdominal pain syndrome 痛( RADIC) 满大告学流

Pain Classification Headache (migraine) Acute Chronic Pain Nociceptive 躯体痛 Neuropathic Mixed Visceral 内脏痛 Diabetic neuropathy (DN) Post-herpetic neuralgia (PHN) Radiculopathy 神经根 痛(RADIC) Cancer pain Low back pain Osteoarthritis Rheumatoid arthritis Fibromyalgia纤 维肌痛 IBS Pancreatitis Bladder pain Noncardiac chest pain Abdominal pain syndrome Injury Postoperative Flare An adverse or unpleasant reaction plus the reactions evoked by it

General Considerations a Pain(疼痛) 躯体痛( somatic pain) 快痛,慢痛 内脏痛( visceral pain) 神经性痛 Analgesia(镇痛): 选择性抑制疼痛感觉, 不影响意识和其他感觉 出大皆亭

Pain (疼痛)： 躯体痛(somatic pain) －快痛，慢痛 内脏痛(visceral pain) 神经性痛 Analgesia (镇痛)： 选择性抑制疼痛感觉， 不影响意识和其他感觉 General Considerations

Anterolateral tract axon 誓满大昔流

CGRP 8 Substance P Histamine Dorsal root Bradykinin ganglion neuron Lesion 5HT→ Prostaglandin K °·CGRP Substance P o(Blood vessel Spinal cord Peripheral mechanisms of pain 大亭院

Peripheral mechanisms of pain

中央后回 内囊 Thalamus 脊髓丘脑束一 触觉小体 头面部感觉 球状小体 脑桥 游高神经末相 颈髓后角损伤出现 节段性感觉障碍 环层小体 延髓 颈髓 皮肤的感觉神经末梢 脊髓丘脑侧束 胸倒索 损伤出现 Conduction 脊髓丘脑传导束性 感觉障碍 pathways of 腰髓 aIn 脊髓丘脑束在同侧上升 1-2个节段后交又到对侧 淅昔学院

Thalamus Conduction pathways of pain

General Considerations n Classification of analgesics: n Opioid analgesics (centrally acting) piates Synthetic agents D Antipyretic, analgesic, and anti inflammatory drugs (peripherally acting) aspirin, IndomeThacin n Other drugs(for special types of pain) Carbamazepine, atropine, etc 誓出大昔学流

Classification of analgesics： Opioid analgesics (centrally acting) Opiates Synthetic agents Antipyretic, analgesic, and anti￾inflammatory drugs (peripherally acting) aspirin, indomethacin Other drugs (for special types of pain) Carbamazepine, atropine, etc. General Considerations

Analgesics Non-Opioid pIo Adjuvant Aspirin Opiates Diazepam Indomethacin Synthetic agents Anti-depressents etc Others: Carbamazepine, Atropine, Nitroglycerin, etc. 满大告学流

Non-Opioid Opioid Adjuvant Analgesics Opiates Synthetic agents Aspirin Indomethacin Others：Carbamazepine, Atropine, Nitroglycerin, etc. Diazepam, Anti-depressents, etc

A. Opioid Analgesics Morphine吗啡 HO H3C--OCO0 B CH CH3 HO H3C--OCO Morphine吗啡 Heroin海因

Morphine 吗啡 O N CH3 HO HO O N CH3 H3C OCO H3C OCO Morphine 吗 啡 Heroin 海洛因 A B C D A. Opioid Analgesics

口 Morphine: Morphus, the Greek god of dreams 出大皆亭

Morphine: Morphus, the Greek god of dreams