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Skeletal Muscle Relaxant (!!!)..........................8
...........................................................................15
....................................................................................15
...........................................................................15
...........................................................................19
............................................................................................20
p.37~43
p.43 ~49
p.49 ~55
~ ~
Ach Ach Ach Ach
2
.
1.
(1)
A. Ach Cholinergic neurons
a.
b.
c. (sweat glands)
B. nicotinic receptormuscarnic
receptors
(2)
A. NE Adrenergic neurons
2.
(1)
A. Nicotinic NM
a.
b. NM
3
B. Nicotinic NN
a.
b. NN
c. NN NG (ganglion)
inactivation
Ach binding
Open channel
(2)
A. 5
B. Ach
Na K
4
3. Ach
Ach
5
A.
a.
() (
)
b.
I.
() ()
II.
()(
)
III. ()
()()
c.
d.
(2)(Nondepolarizing blockers)
(competitive inhibition) Ach NNreceptor
()
A. Hexamethonium(C6)
B. (Mecamylamine)
C. Trimethaphan
D.
6
(3)
(4)
A. ()
B.
C.
D. ......
(5)......
Skeletal Muscle Relaxant (!!!)
7
(1)
(GA)
(2)(Spasmolytics)(muscle
spasm)(spasticity)
(3)
A. NMJ( end plate)
NAP
VOC Ca2+
Ach
Ach NM receptors Na+K+
muscle active potential
(transverse tubule system)
(sarcoplasmic reticulum) rynaodine
8
receptors(RYR) Ca2+
B.
TTX
HC-
3
d-TC
SC
h
dantroli
ne
a. TTX
b. HC-3 Ach
c. d-TCdecamethonium , SCh
decamethonium
d. dantrolene
(2) 2 Ach
9
Ach
d-TC( NM ) Ach
Sch( NM ) Ach
10
A. Nondepolarizing blockers
a. Ach
b. AchE (antiAChE agents )
physostigmine,neostigmine,
c.
I. d-Tubocurarine(d-TC)
i.
ii. (ex.
()
iii.
(i) histimine()
(ii) (NG block)
II. Gallamine(d-TC )
i. histimine NG block
ii. (M2)
iii. d-TC 5~10
III.Pancuronium
i. histimine
ii. (M2)
iii. d-TC 5
d. Pharmakinetic
plasma ChE2
11
12
B. Nondepolarizing blockers
I. 1 5
pseudoChE
II.
i. atypical pseudoChE p't
ii. / halothane Ca2+
SR RYR (dantrolene)
III.
e. (NMJ)
13
f.
I. ( GA )
II. (ECT)
III.
IV. (tetanus)/glycine
C. (d-TC)(SCh)
()(!)
d-TC
a. tubocurarine rocuronium
b. neostigmine AchEI()
Succinylcholine Phase I()
neostigmine
14
1 ():Ether, Halothane, Isoflurane(
) :
1.
2. (),
3.
2 Aminoglycoside():Streptomycin,
Kanamycin, Gentamicin():
1. P
1
2 (SCH )
3 (d-TC)
4 ()
5 (d-TC)
6 ()
15
1 Spasticity(): cerebral palsy(), multiple
sclerosis (ALS) ()and stroke()
tonic strech reflex() flexor (arms) and extensor
(legs) muscle spasm ()()
)together with pain, rigidity(), muscle
weakness.Spinal cord or brain damage
inhibitory neuron dysfunction()
tonic stretch reflex()
motor neurons hyperactivity( )
spasticity()
2 Baclofen()
1.
glutamate
Motor neuron
2. :(:)
16
3. :(15 -1000mg /),70-85%/
4. :,,,(
,)
5. Baclofen diazepam GABA ( Baclofen
benzodiazepines )
3 Diazepam
1. : GABA
2. :(,,/):
,,,,
17
3. :,...
4 Dantrolene( RYR)(!!)
1. :,( RYR)
18
2. :(25 /-100 /,),
/(halothane + SCh 42 C,
)
3. :drowsiness ,dizziness ,weakness ,GI
upset ,hepatic damage (
),seizures ,pericarditis
1 ,,~hyperreflex ~
2 :(NSAID/)
3
2. Clonidine
1. :(),
2.
:methocarbamolcarisoprodolchlorozoxazone
cyclobenaprine
3. :,,,
4 Diazepam: GABA
5 Botulinum toxin type A A (BOTOX) :,
19
:
104
28.?
(A)
(B)
(C)
(D)
(B)
p.3
Ach
31.Diazapam ?
(A)GABA
(B)Muscarinic
(C)Glycine
(D)Nicotinic
(A)
p.17 Benzodiazepines(diazapam) GABA
101
33.
?
(A) Succinylcholine
(B) Neostigmine
(C) Bethanechol
(D) Atropine
(A)
P14
20
34.?
(A) valium
(B) Succinylcholine
(C) d-tubocurrarine
(D) gallamine
: (C)
: P11.12 d-TC= d-tubocurrarine,
37.Baclofen ?
(A) GABAa
(B) GABAb
(C)
(D) 5-HT2A
(B)
P17
39.?
(A) Atracurium
(B) Succinylcholine
(C) Neostigmine
(D) Dantrolene Succinylcholine
(D)
P18
21
40.(muscle pain)?
(A) Diazepam
(B) Tubocurarine
(C) Succinylcholine
(D) Baclofen
(C)
p.14 Succinylcholine
22