Lom anticholinesterase agents. Yuav ua li cas yog anticholinesterases?

rau neurons kis tau tus mob pulses yog muab los ntawm tshwj xeeb tshuaj - kev sib kho. Ib tug ntawm cov neurotransmitter yog acetylcholine. Cov kab mob, thaum nyob rau hauv lub synapses, kev cuam tshuam rau lub cell week yuav ua lawv inhibition los yog stimulation thiab ua ntau yam teebmeem. Lub tshaj neurotransmitter cleaved los ntawm kev enzymes.

Anticholinesterase tshuaj: nta thiab lub hom phiaj

Los ntawm anticholinesterase tshuaj no yog cov uas inhibit qhov kev enzyme cholinesterase. Qhov no enzyme cleaves los ntawm lub hydrolysis ntawm lub neurotransmitter acetylcholine, uas hau pulses nyob rau hauv raug thereto synapses parasympathetic qab haus huv, ganglia, thiab nyob rau hauv tag nrho cov Somatic fibers. anticholinesterases tau tsim lug txhim khu situational kev txiav txim ntawm acetylcholine neurons, thiab stimulation ntawm tej qhov chaw ntawm lub paj hlwb. Cov kev siv ntawm cov tshuaj muaj ib cov nyhuv rau tag nrho cov kab mob.

Action anticholinesterases yog zoo li cov nyhuv ntawm stimulation ntawm cholinergic qab haus huv. Cov tshuaj nrog rau hauv tib lub qhov chaw nyob rau hauv lub receptor nto kev ua si raws li acetylcholine, li no tsim ib txoj kev ua tej zaum ntawm lub paj xaus. Cholinomimetics thiab anticholinesterase agents yog, nyob rau hauv qhov tseeb, tib pab pawg neeg ntawm pharmacological tshuaj. Muaj ob peb hom ntawm cov tshuaj uas txawv nyob rau hauv lawv cov tshuaj qauv thiab reversibility ntawm kev txiav txim. Cholinesterase blockers raug muab faib ua reversible thiab irreversible.

Txhais tau hais tias ib tug reversible txiav txim

Anticholinesterases - npaj reversible txiav txim yog li ntawm cov tshuaj qauv ntawm carbamic acid esters thiab ntau yam aminoalcohols. Cov tshuaj tiv thaiv kev tivthaiv thaiv cov hlab cholinesterase, nws yuav acidic xaus, uas tsim lub enzyme nrog ib tug qauv ntau npaum li cas ruaj khov kev sib txuas lus dua uas yog tsim los ntawm lub sis raug zoo nrog acetylcholine. Sau kom tiav kev puas tsuaj ntawm no compound tshwm sim los ntawm hydrolysis rau 3-4 teev.

Los ntawm txhais tau tias ntawm ib tug reversible anticholinesterase nyhuv yog "galantamine", "physostigmine", "Neostigmine" (los yog "Neostigmine"), "pyridostigmine," "oksazil", "rivastigmine", "edrophonium."

Nyob rau hauv phosphorous - ib yam khoom uas irreversible txiav txim

Formulations irreversible kev txiav txim ntawm pab pawg neeg no yog cov organophosphorus tebchaw. Cov tshuaj inhibit acetylcholinesterase rau ib ntev lub sij hawm. Phosphorus, uas yog nyob rau hauv nyob tus yeees ntawm cov molecules ntaub ntawv ib tug ruaj khov compound nrog lub enzyme, uas muaj peev xwm ciaj sia nyob rau hauv lub cev rau ob peb hnub los yog txawm lub lis piam. Rov qab yuav tsum tau npaum li cas acetylcholinesterase tshwm sim los ntawm lub tsim ntawm tshiab molecules. Qhov no pab pawg neeg ntawm tebchaw muaj xws li "phosphacol", "Armin", "trichlorfon", "Malathion", "dichlorvos" tej yam tshuaj lom, siv nyob rau hauv lub chav kawm ntawm cov tub rog ua hauj lwm - sarin thiab soman.

Organophosphate tshuaj yog heev tshuaj lom. Lawv feem ntau siv nyob rau hauv lub neej txhua hnub raws li tshuaj tua kab; lom tau los ntawm lawv cov tsis yog kev siv thiab uas tsis yog-observance ntawm kev ruaj ntseg ntsuas.

Los anticholinesterase tshuaj

Thaum ib tug zoo sib thooj ntawm cov teebmeem uas tsim lub cev anticholinesterases, indications rau txhua ntawm lawv yog cov tshwj xeeb. Yuav kom xav txog ib cov tswv yim nyhuv thaum muab mus rau hauv lub cev yuav piv txwv li, "neostigmine".

"Neostigmine" yog muaj nyob rau hauv ampoules nyob rau hauv daim ntawv ntawm 0.05% cov kua thiab txhaj subcutaneously los yog intravenously. Thaum txhaj mus rau hauv cov ntshav nws tswj cov zaj uas lub pulses nyob rau hauv neuromuscular kis tau tus mob thiab lub ganglia ntawm lub autonomic lub paj hlwb. Tus neeg mob tus mob yog manifested raws li nram no:

• vim rau ncig nqaij contraction ntawm lub iris menyuam kawm ntawv yog roj;
• tshwm sim spasm ntawm kev pab, lub lens assumes ib convex zoo vim so Zinn bundles ntawm ua kom pom tseeb yog teem rau lub nyob ze ze, cov muaj peev xwm kom paub qhov txawv deb khoom yog ruaj txo;
• poob lub plawv dhia;
• tsub kom lub suab nrov ntawm tus nqaij ntshiv ntawm hauv nruab nrog cev - ua pa ib ntsuj av tau, mob plab thiab cov hnyuv, lub tsev me nyuam, zais zis;
• kho kom zoo skeletal nqaij vim tus paub tso cai ntawm lub impulses ntawm synapses;
• nce secretion ntawm exocrine qog - hws, muaj qaub, bronchial, pais plab.

daim ntawv thov

Cov teebmeem yog lub luag hauj lwm rau kev siv ntawm no pab pawg neeg ntawm cov tshuaj nyob rau hauv lub tshuaj nyob rau hauv txawv tus neeg mob. Indications anticholinesterase agents yuav tsis tag rau tej kab mob, vim lawv muaj ib cov nyhuv rau lub hauv paus thiab peripheral lub paj hlwb, ua rau cov zuag qhia tag nrho cov ntxim rau lub tag nrho kab mob. Feem ntau cov feem ntau lawv yog tsa nyob rau hauv yuam cai ntawm lub innervation thiab lub suab nrov ntawm skeletal los yog tus mob.

Xav txog cov tau ntawm kev kho mob nrog anticholinesterase agents yuav ua tau cov piv txwv ntawm "neostigmine". Cov tshuaj no yog ib tug reversible txiav txim thov nyob rau hauv myasthenia - ib tug kab mob autoimmune, uas yog reflected nyob rau hauv cov tsis muaj zog ntawm lub skeletal leeg. Tus kab mob manifests nws tus kheej thaum xub thawj tsis laus lub ntsej muag nqaij, ces cov weakening ntawm cov leeg nyob rau hauv lub caj dab, sab sauv thiab sab extremities; nyob rau hauv loj heev zaum, ua pa tsis ua hauj lwm vim tsis txaus lag luam ntawm lub diaphragm. "Neostigmine" symptomatic ua rau lub cev, es ua kom cov kis tau tus mob ntawm impulses mus rau lub neuromuscular kis tau tus mob, kev txhim kho cov nqaij cov laus thiab cov tsav kev ua si yog thawm.

Tsis tas li ntawd, qhov no tshuaj yog muab nyob rau hauv lub postoperative lub sij hawm thaum cov hnyuv los yog atony ntawm lub urinary zis. Nyob rau hauv Ophthalmology nws yog tsis tshua muaj qhia rau glaucoma los txo intraocular siab. Raws li ib tug antagonist yog siv nyob rau hauv ib tug overdose ntawm nqaij hnaiv thiab tshuaj antidepolyarizuyuschego kev txiav txim. Qee zaus "Neostigmine" yog siv los tsim kho nqaij nrog tsis muaj zog ua hauj lwm rau.

Alzheimer tus kab mob

Npaj reversible txiav txim tau tau muab siv rau cov kab mob ntawm lub hauv paus poob siab system, nws yog ib qhov nyuaj rau kho. Alzheimer tus kab mob no yog tsa "galantamine" - ib tug alkaloid tau los ntawm lub tubers ntawm snowdrops zoo Galantus ( "Rivastigmine", aka "Exelon"), tiam sis feem ntau therapeutically zoo los ua "donepezil", uas xaiv blocks lub acetylcholinesterase nyob rau hauv lub hlwb synapses thiab yuav luag tsis cuam tshuam rau nws cov peripheral lub paj hlwb.

Contraindications

Raws li cov los ntawm cholinesterase tshuaj reversible txiav txim, contraindications rau lawv lo lus uas peb yog qaug dab peg, mob hawb pob, angina pectoris, Parkinson tus kab mob thiab ntau yam mob ntawm lub plawv conduction system.

Cov tsos mob ntawm overdose thiab lom mob

Lom anticholinesterases muab cov tsos mob ncaj qha txuam nrog ntev stimulation ntawm receptors rhiab rau acetylcholine. Pupillary cai, tseg lub plawv dhia (bradycardia), bronchial spasm thiab - thiaj li - dyspnea cov tsos mob hyperperistalsis mob huam mus txog rau thaum ntuav thiab raws plab, nquag tso zis. Maj mam txo cov ntshav siab raws li ib tug rau txim ntawm lub braking nyhuv uas cov vagal paj. Tshwm sim chaotic lus thiab twitch skeletal leeg thiab tus nplaig vim conduction mob nyob rau hauv neuromuscular kis tau tus mob.

lom FOS

Haus ntawm Organophosphorus tebchaw ua ib tug soj ntsuam daim duab zoo xws li cov lom cov neeg ua hauj reversible anticholinesterase kev txiav txim. Cov tsos mob tej zaum yuav tshwm sim zog vim yog lub siab toxicity ntawm cov tshuaj. Rau cov tsos mob ntawm lom nyob rau Somatic theem no ntxiv rau cov teebmeem nyob ntawm lub hauv paus poob siab system theem - tsis meej pem, tsis meej pem, ua pa nyuaj siab.

Organophosphorus tebchaw ua ib tug ntse tu-sauv, qhov muag plooj tsis pom kev, dyspnea, tawm hws, mob ntuav, ntxhov siab - tus neeg mob pib ntshai, nws yuav unmanageable. Vim hais tias ntawm cov smooth nqaij spasm muaj ib tug ntse mob nyob rau hauv nws lub plab. Thaum deterioration tshwm sim tu-sauv, ntshav siab ntog, coma tsim. Tuag yuav tshwm sim vim tuag tes tuag taw ntawm lub pa chaw.

Zoo ib yam li cov tsos mob muaj cai nyob rau hauv tus neeg mob ntawm lom amanita muscaria. Qhov no yog vim lawv cov ntsiab lus ntawm muscarinic - tshuaj lom nrog cholinomimetic kev txiav txim.

Kev nqis tes ua nyob rau hauv cov ntaub ntawv ntawm kev qaug tshuaj lom

Kev kho mob nyob rau hauv cov ntaub ntawv ntawm kev qaug tshuaj lom nrog anticholinesterase agents yuav muaj tsuas ib tug kws. Nyob rau hauv cov neeg mob, cov tshuaj yog tswvcuab "Atropine" subcutaneous txhaj yog yuav ua tau npe "Metacin" los yog lwm yam anticholinergics. Nws yog tsim nyog los tswj ua tsis taus pa ntawm qhov kev tsim nyog qib. Yuav siv tracheotomy, cov neeg kho tshuab cua thiab oxygenation.

Thaum tsev neeg lom FOS qhia qhov uas tshuaj lom nkag mus rau hauv lub cev. Yog hais tias lub tshuaj tau penetrated los ntawm daim tawv nqaij, nws yog rinsed 3-5% dej qab zib tov los yog nrog dej thiab xab npum. Nyob rau hauv lub rooj plaub uas cov tshuaj tau noj, nqa tawm pais plab lavage, ntau yam enemas, muab adsorbents los yog cov tshuaj ntaus cev. Yog hais tias lub organophosphorus compound tau muaj lub sij hawm rau lub caij nplooj zeeg mus rau ib tug ntau dua raws li mus rau hauv cov hlab ntsha, yog muab diurez siv diuretic tshuaj. Nyob rau hauv tej rooj plaub, chaw uasi mus rau txoj kev lim cov ntshav los ntawm hemodialysis thiab hemosorption.

Tsis tas li ntawd, nyob rau hauv cov ntaub ntawv ntawm lom FOS tsa Reaktivatory cholinesterase, uas thaum muab nyob rau hauv thawj ob peb teev tom qab intoxication yuav restore sim enzymes. Tej zaum nws yuav "Izonitrozin", "Trimedoksim", "Dipiroksim". Yog hais tias cov ntshav siab yog siab, symptomatically tshuaj antihypertensive tshuaj. Preference yog muab rau cov neeg uas tsis muaj feem xyuam rau lub hauv paus poob siab system. Nrog lub weakening ntawm txawj ua tsis taus pa yog ib tug cov neeg kho tshuab cua thiab muab cov pa.