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      當前位置: 首頁 > 執業藥師 > 執業藥師備考資料 > 2019執業藥師《藥學專業知識二》講義及例題:第一章

      2019執業藥師《藥學專業知識二》講義及例題:第一章

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      發布時間:2019年06月10日 10:20:42 來源:環球網校 點擊量:

      【摘要】《藥學專業知識二》是2019年執業藥師資格考試的考試科目之一,目前2019執業藥師藥學專業知識二考試大綱及教材都已公布,環球網校執業藥師頻道為大家帶來2019執業藥師《藥學專業知識二》講義及例題:第一章,幫助大家學習掌握該科目。

      相關推薦:2019執業藥師《藥學專業知識二》講義及例題匯總

      第一章 精神與中樞神經系統疾病用藥

      一、藥理作用與臨床評價

      (一)作用特點

      1.巴比妥類——抑制中樞神經系統。

      小劑量——鎮靜、催眠;

      中劑量——麻醉;

      大劑量——昏迷,甚至死亡。

      脂溶性高,作用快——異戊巴比妥;

      脂溶性低,作用慢——苯巴比妥。

      2.苯二氮(艸卓)類

      ——激動苯二氮(艸卓)受體——抑制中樞神經系統。

      ①地西泮——吸收最快;

      氟西泮、氯硝西泮、勞拉西泮

      ②阿普唑侖

      【地西泮】——用于:

      1.焦慮\鎮靜催眠

      2.抗癲癇——補充TANG:癲癇持續狀態——首選。

      3.抗驚厥,并緩解炎癥所引起的反射性肌肉痙攣、肌緊張性頭痛;家族性、老年性和特發性震顫;

      4.手術麻醉前給藥。

      地西泮口訣—TANG

      鎮靜焦慮助睡眠,

      癲癇持續是首選;

      對抗驚厥效果好,

      中樞肌松解痙攣。

      【注意事項】

      (1)不要驟然停藥——反跳現象。

      (2)原則上不應作連續靜脈滴注,但在癲癇持續狀態時例外。

      (3)治療癲癇時,可能增加癲癇大發作的頻度和嚴重度,需要增加其他抗癲癇藥用量。

      3.其他類——特異性更好、安全性更高。

      (1)環吡咯酮類——佐匹克隆、艾司佐匹克隆

      ——鎮靜催眠、抗焦慮、肌肉松弛和抗驚厥。

      (2)含咪唑并吡啶結構——唑吡坦——僅具有鎮靜催眠作用。

      【怎么選?——最重要內容,提前講TANG】

      (1)原發性失眠——首選非苯二氮(艸卓)類。

      為改善起始睡眠(難以入睡)和維持睡眠質量(夜間覺醒或早間覺醒過早),可選服:唑吡坦、艾司佐匹克隆(不良反應少,尤其無鎮靜和宿醉現象)。

      (2)入睡困難者——首選:艾司唑侖或扎來普隆。

      (3)焦慮型、夜間醒來次數較多或早醒者

      ——氟西泮;或三唑侖(“迷魂藥”) 。

      憂郁型的早醒失眠者——在常用催眠藥無效時,可配合抗抑郁藥(阿米替林和多塞平)。

      (4)由精神緊張、情緒恐懼或肌肉疼痛所致

      ——氯美扎酮。

      (5)自主神經功能紊亂,內分泌平衡障礙及精神神經失調所致——谷維素,需連續服用數日至數月。

      (二)典型不良反應

      1.巴比妥類

      常見:“宿醉”現象——嗜睡、步履蹣跚、肌無力。

      依賴性——強烈要求繼續應用或增加劑量,或出現心因性依賴、戒斷綜合征。

      過敏——皮疹,嚴重者剝脫性皮疹、史蒂文斯-約翰綜合征(可能致死)——立即停藥!

      靜脈注射——呼吸抑制、暫停,支氣管痙攣,瞳孔縮小、心律失常、體溫降低甚至昏迷。

      2.苯二氮(艸卓)類

      耐藥性;

      突然停藥——反跳現象、依賴性、殘余(后遺)效應。

      精神運動損害——嗜睡、步履蹣跚、共濟失調。

      靜脈注射——更易呼吸抑制、低血壓、心動過緩甚至心跳停止。

      老年人較敏感——過度鎮靜、肌肉松弛作用;覺醒后可發生震顫、顫抖、思維遲緩、運動障礙、步履蹣跚、肌無力等“宿醉”現象,極易跌倒和受傷——必須告知患者晨起時宜小心。

      3.其他類

      唑吡坦:共濟失調、精神紊亂。

      佐匹克隆:嗜睡、精神錯亂、酒醉感、戒斷現象。

      (三)禁忌證

      1.巴比妥類——嚴重呼吸功能不全、肝硬化、血卟啉病、貧血、未被控制的糖尿病。

      2.苯二氮(艸卓)類——顯著的神經肌肉呼吸無力、呼吸抑制、嚴重肝損害者、妊娠期、新生兒。

      3.佐匹克隆——嚴重睡眠呼吸暫停綜合征、失代償呼吸功能不全、重癥肌無力。

      (四)藥物相互作用

      主要強調——巴比妥類——肝藥酶誘導劑——加速自身代謝,還可加速其他藥物代謝——降低療效。

      ①合用乙酰氨基酚類藥——降低乙酰氨基酚類藥療效,增加肝中毒危險。

      ②與糖皮質激素、洋地黃類、環孢素、奎尼丁、三環類抗抑郁藥合用——降低藥效。

      ③與抗凝血藥合用——抗凝作用減弱。

      二、用藥監護

      (1)耐藥性及依賴性——應交替使用。

      (2)服用后應注意避免駕車、操縱機器和高空作業。

      (3)服用期間不宜飲酒——增強睡眠程度,加重頭痛、頭暈。

      下一頁為例題

      1 2

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