1、影响药物作用的因素(Factors of Influencing Drug Effect)彭 青作用与效应作用与效应量效关系量效关系靶点靶点药效学药效学吸收、分布吸收、分布代谢、排泄代谢、排泄药动学药动学生理生理精神精神遗传遗传疾病疾病生物节律生物节律习惯习惯环境环境机体因素机体因素联合用药联合用药长期用药长期用药给药方法给药方法药物因素药物因素理化性质理化性质药物剂型药物剂型配伍用药配伍用药药学药学学习目标 在本次课结束时，每位同学能 列举影响药物作用的各个因素。General View Pharmaceutical factors:zPhysical and chemical proper
2、ty of drugzDrug preparation(药物制剂)zMethods of drug administrationzDrug interaction Biological factors:Physiological factorsPsychological factorsGenetic factorsPathological factorsBody response changes induced by long-term medicationBiorhythm(生物节律)living habit and environmentPharmaceutical FactorsSect
3、ion 11.Physical and Chemical Property of Drug Soluble Exposure decompose(见光分解)2.Drug Preparation Oral administration:tablet,capsule,oral liquor Injection:aqua(水剂),oils(油剂),emulsion(乳剂)New praparation:Slow release formulation(SLF):extended release formulatuion(延迟释放剂),sustained release formulatuion(持续
4、释放剂)Controlled release formulation(CLF):transdermal patch(透皮贴剂)bioequivalence3.Methods of Drug Administration Dose:gtt,ml,Route:p.o.,i.m.,i.v.,p.r.(直肠给药)Time:a.c.(饭前),p.c.(饭后)Interval:q.d.,b.i.d.,post antibiotic effect(PAE,抗菌后效应)Period of treatment:4.Drug Interaction Pharmacokinetics:absorption,dist
5、ribution,metabolism,excretion Pharmacodynamics:Synergism(协同作用):addition(相加作用):=1+1 potentiation(增强作用):1+1 Antagonism(拮抗作用):subtraction(相减作用):1 counteraction(抵消作用):0 Incompatibility(配伍禁忌配伍禁忌)Biological FactorsSection 21.Physiological Factors Age:Children:The aged:Gender:Body weight(BW):Interindividua
6、l variation:hypersensitivity&hyposensitivity anaphylaxis(allergy)idiosyncrasy(特异质反应)Age 小儿的药物代谢清除率较高 小儿对药物较敏感 发育阶段，易受药物影响老年的器官功能降老年的器官功能降低低对药物敏感性增高对药物敏感性增高肾小球滤过率肾小球滤过率心脏指数心脏指数生活能力生活能力肾血流量肾血流量最大呼吸能力最大呼吸能力功功 能能（%）年年 龄（岁）龄（岁）10010080806060404020203030505070709090Gender 药物反应和药物代谢酶活性有性别差异。酒精在女性代谢较男性慢（女性更
7、易发生中毒反应 女性对特非那定（terfenadine，抗组胺药）的心脏毒性更敏感 激素作用：雌、孕激素抑制药物代谢女性对药物的清除能力多比男性弱，如女性利眠宁T1/2为男性的2倍Size/Obesity 影响分布容积影响分布容积 影响清除率影响清除率2.Psychological Factors placebo placebo effects3.Genetic Factors Genetic polymorphism Racial differences in drug response Idiocyncrasy种族种族(ETHNICITY)GenesSocialCulturalEnviro
8、nmentINTRINSICEXTRINSICIn the age of the Genome，Why do people respond differently to drugs?Variability in:-Drug metabolism genotypeDrug transporter genotypeDrug receptor genotypeDrug/drug/environment/genotype interactionsGeneChip Analysis S M A R T C A R DFen-Fei GaoGENOME(Confidential)Personalized
9、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 based on knowledge of your specific genetic makeup!XenobioGeneChipEnd of 3rd session 4.Pathological Factors Liver disease:Kidney disease:Dystrophia(营养不良):acid
10、-base disturbance(酸碱平衡失调)5.Body Response Changes Induced by Long-term Medication1.Tolerance:body drug,pharmacodynamic tolerance and metabolic tolerance(肝药酶活性被诱导增强所致)Acute tolerance(tachyphylaxis)Brady-phylaxisCross tolerance2.Drug resistance:pathogen(病原体),tumor cells drug3.Dependence:Physiological d
11、ependence(physical dependence)Psychological dependence4.Withdrawal symptoms(withdrawal syndrome)Rebound phenomenon(反跳现象)6.Biorhythm Chronopharmacology(时间药理学)时间药物效应时间毒理时间药物代谢7.Living Habit and Environment Diet:component,quantity,time;Smoking:hepatic drug enzyme activity Drinking wine or liquor:Alcoho
12、l 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(茶碱)excites the central nervous system and heart,promotes diuresis(利尿).Environment:医生就是药 医生每用一次药，就可能：产生副作
13、用；维持药物作用相当时期；引起毒性反应；给以正确的病症；给以应当禁忌的病人；剂量过大；剂量过小；给药间隔时间正确；给药间隔时间不当；仅产生安慰剂效应。后面内容直接删除就行后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料可以编辑修改使用资料可以编辑修改使用资料仅供参考，实际情况实际分析资料仅供参考，实际情况实际分析主要经营：主要经营：课件设计，文档制作，课件设计，文档制作，网络软件设计、网络软件设计、图文设计制作、发布广告等图文设计制作、发布广告等秉着以优质的服务对待每一位客户，做到让客户秉着以优质的服务对待每一位客户，做到让客户满意！满意！致力于数据挖掘，合同简历、论文写作、致
14、力于数据挖掘，合同简历、论文写作、PPTPPT设计、设计、计划书、策划案、学习课件、各类模板等方方面计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求面，打造全网一站式需求The user can demonstrate on a projector or computer,or print the The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider fieldpresentation and make it into a film to be used in a wider field
