藥理學總論課件：影響藥物作用的因素

1、影響藥物作用的因素(Factors of Influencing Drug Effect)作用與效應量效關系靶點藥效學吸收、分布代謝、排泄藥動學生理精神遺傳疾病生物節(jié)律習慣環(huán)境機體因素聯(lián)合用藥長期用藥給藥方法藥物因素理化性質藥物劑型配伍用藥藥學學習目標在本次課結束時，每位同學能列舉影響藥物作用的各個因素。General ViewPharmaceutical factors:Physical and chemical property of drugDrug preparation(藥物制劑)Methods of drug administrationDrug interaction Biolo

2、gical factors:Physiological factorsPsychological factorsGenetic factorsPathological factorsBody response changes induced by long-term medicationBiorhythm(生物節(jié)律)living habit and environmentPharmaceutical FactorsSection 11. Physical and Chemical Property of DrugSolubleExposure decompose (見光分解)2. Drug P

3、reparationOral administration: tablet, capsule, oral liquorInjection: aqua(水劑), oils(油劑), emulsion(乳劑)New praparation:Slow release formulation (SLF): extended release formulatuion(延遲釋放劑), sustained release formulatuion(持續(xù)釋放劑)Controlled release formulation (CLF): transdermal patch(透皮貼劑)bioequivalence

4、3. Methods of Drug AdministrationDose: gtt, ml, Route: p.o., i.m., i.v., p.r.(直腸給藥) Time: a.c.(飯前), p.c.(飯后)Interval: q.d., b.i.d., post antibiotic effect (PAE, 抗菌后效應)Period of treatment:4. Drug InteractionPharmacokinetics: absorption, distribution, metabolism, excretionPharmacodynamics:Synergism(協(xié)同

5、作用): addition(相加作用): =1+1potentiation(增強作用): 1+1Antagonism(拮抗作用): subtraction(相減作用): 1counteraction(抵消作用): 0Incompatibility(配伍禁忌)Biological FactorsSection 21. Physiological FactorsAge:Children:The aged:Gender:Body weight (BW):Interindividual variation:hypersensitivity & hyposensitivityanaphylaxis (a

6、llergy)idiosyncrasy(特異質反應)Age小兒的藥物代謝清除率較高小兒對藥物較敏感發(fā)育階段，易受藥物影響老年的器官功能降低對藥物敏感性增高腎小球濾過率心臟指數(shù)生活能力腎血流量最大呼吸能力功 能 （%）年 齡（歲）1008060402030507090Gender藥物反應和藥物代謝酶活性有性別差異。酒精在女性代謝較男性慢（女性更易發(fā)生中毒反應女性對特非那定（terfenadine，抗組胺藥）的心臟毒性更敏感激素作用： 雌、孕激素抑制藥物代謝女性對藥物的清除能力多比男性弱，如女性利眠寧T1/2為男性的2倍Size / Obesity影響分布容積影響清除率2. Psychologic

7、al Factorsplaceboplacebo effects3. Genetic FactorsGenetic polymorphismRacial differences in drug responseIdiocyncrasy種族(ETHNICITY)GenesSocialCulturalEnvironmentINTRINSICEXTRINSICIn the age of the Genome，Why do people respond differently to drugs?Variability in:-Drug metabolism genotypeDrug transport

8、er genotypeDrug receptor genotypeDrug/drug/environment /genotype interactionsGeneChip Analysis S M A R T C A R DFen-Fei GaoGENOME(Confidential)Personalized Medication in the FutureIn the future (? years), your doctor will be able to select the best drug to treat your disease and the appropriate dose

9、 based on knowledge of your specific genetic makeup!XenobioGeneChipEnd of 3rd session 4. Pathological FactorsLiver disease:Kidney disease:Dystrophia(營養(yǎng)不良):acid-base disturbance(酸堿平衡失調)5. Body Response Changes Induced by Long-term MedicationTolerance: body drug, pharmacodynamic tolerance and metaboli

10、c tolerance (肝藥酶活性被誘導增強所致)Acute tolerance (tachyphylaxis)Brady-phylaxisCross toleranceDrug resistance: pathogen(病原體), tumor cells drugDependence:Physiological dependence (physical dependence)Psychological dependenceWithdrawal symptoms (withdrawal syndrome)Rebound phenomenon(反跳現(xiàn)象)6. BiorhythmChronoph

11、armacology(時間藥理學)時間藥物效應時間毒理時間藥物代謝7. Living Habit and EnvironmentDiet: component, quantity, time;Smoking: hepatic drug enzyme activityDrinking wine or liquor: Alcohol enhances hepatic drug enzyme activity; when acute and large amount administration, it makes the hepatic drug enzyme saturation.Drinking tea: Tannic acid(鞣酸) influences drug absorption. Elixophylline(茶堿)