You are on page 1of 22

. .......................................................................

2
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

(1)Ach/N - receptorsfast EPSP


(Ach Nicotinic receptors
)
(2)Ach/M - receptors(SIF cells)DA/2
receptors(ganglion)IPSP
(SIF cells
DA)
(3)Ach/M1 - receptorsslow(late)EPSP
(M1 )
4. Classfication
(1)(Depolarizing blockers)
NN receptors (
)

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

a. Phase I block() Ach


Na+K+
b. Phase II block()
c. AchE -
physostigmineneostigmine
d. Succinylcholine(SCh)

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