【正文】 P 87 21 擬膽堿藥 MR 激動藥 抗 ChE藥 抗膽堿藥 MR 阻斷藥 NR 阻斷藥 pilocarpine neostigmine atropine 筒箭毒堿 擬腎上腺素藥 ?R激動藥 NA ? 、 ?R激動藥 Adr, DA ?R激動藥 異丙腎上腺素 抗腎上腺素藥 ?R阻斷藥 phentolamine ?R阻斷藥 propranolol 22 23 Questions 1. 簡述酚妥拉明的作用、用途、不良反應。 3. 比較常用全麻藥的特點。 26 Definition （ 定義 ） Local anesthetics (LAs) are drugs that block both the generation (產(chǎn)生 ) and the conduction （ 傳導 ） of the nerve impulse（ 沖動 ） when applied locally to nerve tissue in appropriate （ 適當?shù)?） concentrations. 27 Local anesthetics produce the reversible（ 可逆的 ） loss of sensation without the loss of consciousness. The first local anesthetic to be discovered is cocaine (可卡因 ). Owing to addiction (成癮 ), its clinical uses was limited. 28 A chemical search for synthetic (合成的 ) substitutes (代用品 ) for cocaine started in 1892. This resulted in 1905 in the synthesis of procaine (普魯卡因 ), which is still useful local anesthetic. 29 【 structure activity relationship】 (構效關系 ) The molecule（ 分子 ） of LA can be divided into three main portions(部分 ): 芳香族環(huán) ：疏水性 (hydrophobicity)（ 親脂性 ） 中間鏈 ： 酯： procaine 酰胺： lidocaine 胺基團 ： 親水性 (hydrophilism) （ 與 H+結合后 ） 30 NH 2 COO CH 2 CH 2 NC 2 H 5C 2 H 5NH COO CH 2 CH 2 NCH 3CH 3C 4 H 9C H 3C H 3N H COCH 2 NC 2 H 5C 2 H 5普魯卡因procaine 丁卡因tetracaine 利多卡因lidocaine 31 【 mechanism of local anesthesia】