Transcript 人體免疫與藥物應用 Human Immunology and Application in Medicine

Human Immunology and
Application in Medicine
人體免疫與藥物應用
Immunology
Self-defense
Pathogens:
Bacteria
Virus
Parasites
(1) The Mechanism for How to Defense
(2) How to Strengthen Immune System
Edward Jenner and Cowpox Vaccine
Edward Jenner,M.D.(British)
1789 將取自擠奶女工痘痂之牛痘病毒
(Cowpox Virus)，給一位八歲男孩子接
種，使他得到抵抗天花病毒(Smallpox
Virus)感染之免疫力
—Active Immunisation.
1900 Germany Chemist
Paul Ehrlich and Ab
Phytotoxin免疫老鼠後得到之血清
(Antitoxin)具有中和植物毒素的作用
---Antibody
Side Chain Theory
1908 Nobel Prize
Elie Metchnikoff and Phagocytes
1885 Biologist(Russia)
Elie metchnikoff發現以玫瑰刺進
Invetebrates體內其周圍會出現
Macrophagocytes後來在哺乳動物發現也
有此類Cell
1908 shared Nobel Prize with Paul Ehrlich
Basic Components of
the Immune System
Medicine, Drug
Chemical Molecule
Drug + Receptor-------Drug-Receptor Complex-----Pharmacologic Response
Adverse Reaction
Side Effect
Routes of Drug Administration
1. Oral Administration
2. Sublingual
3. Rectal
4. Intravenous
5. Intramuscular
6. Subcutaneous
7. Inhalation
Classification
1. Chemical Classification
2. Pharmacological Classification
Licenc(s)e System
1. Viagra
(Sildenafil)
2. Amphetamine
(1) Caffeine
(2) Morphine
(3) Heroine
(4) Codeine
Adverse Drug Reaction
(Side Effect)
Aspirin-----Acidic
Natural products
Purity
Standardization
1. Garlic
Garlic is a bulb.It may be used As dried,
powdered,and compressed into a tablet.
Key Component—Alliin
Sulfur Content
Alliin--------Allicin(odor)
Cholesterol-Lowering Effect
2.Chamomile
Bisabolol
Anti-Inflammatory Effect
Anti-Allergenic Activity
3.Cranberry
Citric,Malic,Benzoic and Qunic Acids
Cranberry Juice has been used as a
UrinaryTract Disinfectant.
Cranberry makes urine become more acidic.
Inhibition of bacterial growth.
4.Ginkgo biloba
Vasodilation on both arterial
And venous circulation.
Increase cerebral blood flow.
It might be useful for disorder of
memory(Alzheimer’s Disease).
5. Ginseng
The root of the species Panax ginseng,
also called Asian or Korean ginseng
Ginsenoside stimulates the
CNS,combats fatigue.
Pharmacological Classification
1. Acting on the GI Tract
(1) Peptic Ulcer
No Acid,No Ulcer
Antacids:
NaHCO3, Mg(OH)2,
Al(OH)3
1.Lederscon:
Al(OH)3 +Mg(OH)2
2.Ulsanic:
(Sucralfate)
Insoluble in water
Not absorbed from GI
It binds to the ulcer site to form a
protective barrier that prevents exposure
of the lesion to acid.
Side Effect:Constipation
3. Motility and Secretion
Metoclopramide:
Dopamine Antagonist
刺激胃腸之運動
4. Laxatives
加速糞便通過腸道
2. Drugs used in Hypertension
3. Anxiolytics,Sedatives and Hypnotics
CNS Inhibitor:Anxiolytics
輕微之中樞神經系統抑制可使激動或焦
慮的人平靜下來
Benzodiazepines(BDZs)
Sleep Disorder
Acute Anxiety States
At night large dose:Hypnotics
Day time small dose:
Anxiolytic,Sedative
Sublingual,IM,IV
Dependence of BDZs:
Physical Withdrawal
Syndrome
Drug Interactions of BDZs:
With Alcohol-----------Additive or Synergistic
Effect
Triazolam(Halcion)
小白板
has all of the characteristic benzodiazepine
pharmacological actions.It is
marked as a sedative-hypnotic drug.
(1) Anxiolytic
(2) Sedative-Hypnotic
(3) Anti-Convulsant
(4) Muscle Relaxant
Withdrawal Syndrome of DZs
焦慮 失眠 頭痛 厭食
嘔吐 發抖 全身虛弱
停藥後5-6 days later
4. Antipsychotics Drugs
Also known as Neuroleptics(鎮神藥)
Or Major Tranquilizers
Schizophrenia(精神分裂)
Treatment:
Hyperactivity of Dopamine
Positive Symptoms:
Paranoia(偏執),Hallucination,
Delusion(錯覺)
Negative Symptoms:
Thought Disorder,Behavioural Disturbances,
Flat or Inappropriate Affect
(單調或不合宜的情感),
Social Withdrawal
Pharmacological action:
Sedation,Disinterest(冷漠),
Limited Range of Emotion
Dysphoria(不快)
Improve positive Symptom
Side Effect:
Orthostatic Hypotension,
Xerostomia(口乾),
Akathysia(不能靜坐)
Agitation(情緒激昂)
Delirium(譫妄)
Gynecomastia (男性女乳化)
Tolerance
長期使用
臉部變形
口周圍震顫
顆粒性白血球缺乏
Classification of Antipsychotics
1. Phenothiazine
Chlorpromazine
(Thorazine)
Strong Sedation
治療具暴力傾向病人
Side Effect:
顆粒性白血球缺乏
Photosensitization
More than 3weeks
IM or IV
2. Lithium
Manic-Depressive Illness
治療狂燥型憂鬱症
It might prevent excessive
Release of Dopamine
Side Effect:
Polydipsia劇渴
Polyuria多尿
Edema
Tetratogenic
Antidepressants
(1)Endogenous Depression
內生性憂鬱症
Profound Sadness深悲
Passimism悲觀
Loss of Interest
Sleep Disturbances
Change in Appetite
Diminished Libido性慾降低
Difficulty in Concentration
15% Suicide
(2) Reactive Depression反應性憂鬱症
與Life Events有關如
個人失敗或生理疾病
(3) Manicdepressive Disorder
躁鬱症
Pharmacological Action:
Antidepressants can block
Reuptake of Norepinephrine
5. Anti-Inflammatory Drug
發炎是細胞受破壞與感染時正常之反應
可能引發疼痛與發燒
Nonsteroidal Antiinflammatory Drugs
(NSAIDs)
(1) Aspirin
Acetylsalicylic Acid(ASA)
Low cost & Effective
Dose:4g/day
具有止痛抗發炎與解熱作用
(2) Acetaminophen
Tylenol,Panado
(3) Morphine
Classification of Pain
A. Physiological
Most common
Ex.Getting a cut
B. Inflammatory
Infection
Tissue Injury
C. Neuropathic
Injury to CNS or PNS
Pain Manegement
Morphine—Pain Relieving
Opium
Papaver somniferum
Depression of CNS
Treatment of Severe Pain
急性劇烈及持續性內臟疼痛有效
Increased Tolerance to Pain
Lower Perception of External Stimuli
Feeling of Well-Being(Euphoria)
Addiction
Withdrawal Symptom
Physical Dependence
CNS Hyperactivity:
憂慮 顫抖 頭痛 易怒
心跳加速 肌肉Spasticity
Vomiting Anorexia
Action Mechanism:
提高Threshold of Pain
Analgesia ,Euphoria
Sedation, Respiratory Depression
Abuse:
Decrease Anxiety
Produce Euphoria
Side Effect:
Constipation
Mental Clouding
6. Drugs used in Nausea and
Vertigo(Anti-Emetics)
7. Sex Hormones and Drugs
Male:Testosterone
Female:Estrogen(動情素)
Progesterone(黃體素)
Play Profound roles in
Reproduction & in the
Menstrual Cycle
Testosterone:
Androgenic(Promoting male physical
Characteristics)
Anabolic(Muscle Building)
Estrogen:
Development of secondary sex Characteristics
in women at Puberty
Development of Lipid & Other Tissues that
contribute
To Breast Shape and Function.
Fluid Retention in the Breast.
Development of Vagina,Uterus.
Pigmentation of the nipples.
DES:
Diethylstilbestrol
Same Activity of Estrogen
Phytoestrogens:
Several Natural Plant Substance
That have General Structural
Features Similar to Those of
Estrogen
Genistein:from soybean
Daidzein:from soybean
Coumestrol:from legumes
Therapeutic Action
1. Treating Cardiovascular Disease
2. Reducing Postmenopausal
Symptoms
3. Preventing Osteoporosis
Birth Control
1. Inhibition of Ovulation
Estrogen + Progestrone
2. Abortifacient(墮胎藥)
Mifepristone(RU486)
1980 France
Roussell Uclaf Synthesized
38486---RU486
(1) Antagonizing the Effect of
Progesterone at Receptor
(2) Decrease in Progesterone
Secretion
(3) Softening of the Cervix,
Which aids in expulsion
Of the Fertilized Ovum
High Dose of Estrogen
Cigarette Smoking increase
The risk of
(1) Thromboembolic Disease
Blood Clots
(2) Cancer Cell Spreading
降低Estrogen Content
1.Progestin Minipill
Progesterone only
Suppress Ovulation
2.Depo(Provera)
IM Injection
Medroxyprogesterone
3.Transdermal
Contraceptives
FDA approved the 1st transdermal
contraceptive
Patch in 2001
Norelgestromin+Estradiol
Once a week for 3 weeks
1%--Pregnancy
99%--OK
4. Progesterone IUD
Low Progesterone Dose
38 mg of microcrystalline progesterone
dispersed in silicone oil
The dispersion is contained in a flexible
polymer in the approximate shape of a T
The Polymer acts as a membrane to permit
65ug of progesterone to be released
Slowly into the uterus each day for 1 year.
Problem:perforation of Uterus and Cervix
5. Contraceptive Implants
Norplant
6. Capsules of Levonorgestrel
Implanted in the midportion of the upper
arm provided contraception for up to 5 years
性 腺
Secondary Sex Characteristics
Testes:Testosterone
睪丸功能異常
隱睪症
性腺功能不足
Ovaries:Estrogen,Progesterone
卵巢功能異常
月經異常
卵巢瘤
孩提時代引起性早熟
排卵引起微幅體溫上升
0.2 C
36.4--------------------36.6 C
安全避孕方法
卵子存活不超過72hrs
精子在陰道存活不超過72hrs
72+72=144hrs=6 days
危險期
8. Antidiabetic Drugs
9. Antibiotics
(1) Penicillin
Penicillin G
Abuse-------Resistance
Allergic Reaction
6-APA—Semisynthetic
(2) Cephalosporin
Cephalexin
(3) Streptomycin
Neurotoxic reactions
Disturbance of Equilibrium
Diminished Auditory
Perception
(4)Vancomycin
Inhibition of Cell Wall
(peptidoglycan)
Toxic Side Effect:Slight
Cotinued use may lead to Impaired Auditory
(5) Tetracycline
Ca,Mg,Fe and Al ion
(6) Chloramphenicol
(7) Erythromycin
10. Poisoning
An Introduction to Drug Education
1.Efforts to limit the use and abuse of
various drugs
Drug,Alcohol,Tobacco
Drug:Alter the structure and
Functions of the body.
Drug Abuse:
Chronic,Excessive use of the drug,physical
or personal harm is very likely to occur.
Addiction:
Uncontrolled compulsion
To use a drug.
Withdrawal:
A variety of physical and emotional
symptoms that occur when an accustomed
dose level of a drug is abruptly cut off.
Prevention:
Avoid or decrease health
Problems.
Intervention:
Early identification and treatment of an
alcohol or other drug problem that has
already begun.
Treatment:
Activities done with the objective of
eliminating an individual’s drug abuse and
repairing some of the damage and disability
that has occurred.
Central Nerve System Inhibitors
1. Alcohols
Stimulation first,
Then Inhibition of CNS
Disulfiram(Antabuse)
Block Metabolism of EtOH
2. Barbituates
Secobarbital
Seconal,Red,红中 紅色膠囊
Amobarbital
Amital 青發 青色膠囊
Methaqualone
Nominox,White白板 白色藥片
To CNS
Like Morphine
Benzodiazepine
Triazolam(Halcion)
小白板
has all of the characteristic benzodiazepine
pharmacological actions.It is
marked as a sedative-hypnotic drug.
3.CNS depressant
Anxiolytic,Sedative,
Hypnotic
Morphine
Extracted From Opium
Papaver somniferum
Analgestic
Heroine
Pentazocine
Talwin, Sosegone(Taiwan)
30-50mg=10mg of Morphine
White Crystalline Powder
3. Cocaine
Since 1800,Chewing coca
leaves
Mountain of South America
In 1860, Cocaine was
Isolated
1880s was used by German
military to combat fatigue.
Addictive properties
At low dose,
Feeling of well-being,
Decreased fatigue
Local Anesthetic
Clinical Symptoms of Drug Abuse
1. Convulsion
2. Inhibition of Respiration
3. Hallucination
4. Ataxia
5. Hypertension
6. Hypotension
Story of Cocaine
Cocaine , Amphetamine
CNS Stimulant
Cocaine:more strong than Amphetamine
More Euphoria and Addiction
Erythroxylum coca leaves
印地安人認為上帝賜予減輕飢渴禮物含有改
變心智之神秘物質 咬嚼古柯葉
Spanish brought coca leaves to Europe,
路途遙遠運送時間太長作用消失故未在歐洲
引起流行
Clinical Symptoms of Cocaine
Intoxication
1. Death
Overdose
Suicide
Accidents
2. CNS
Headache
Convulsion
3.Psychosis
Cocaine Euphoria
Cocaine Dysphoria
Cocaine Schizophreniform
Involuntary(Passive) Smoking
1. Main Stream 15%
5% CO
2. Side Stream 85%
10-15% CO
1. IS and Children’s Health
Asthma
支氣管炎
肺炎
2. IS and Adult’s Health
Eye Stimulation
Headache
Cough
Induce Asthma
3. IS and Lung Cancer
More than 1 box/day
Lung Cancer罹患率增加2.1-3.0 X
Below 1 box/day,Lung Cancer
罹患率增加1.6X
4. IS and Fetus
Baby of Smoking Mother
體重較輕 200g
Newborn BW小於 2500g之機率增加2倍