Section 10. Section 10. Nervous systemNervous system

Chapter 5.Chapter 5.Drugs acting on Drugs acting on nervous systemnervous system

Chapter 5. Drugs acting on Chapter 5. Drugs acting on nervous systemnervous system

Including:Including: Drugs acting on efferent Drugs acting on efferent nervousnervous

Drugs acting on afferent Drugs acting on afferent nervousnervous

Drugs acting on central Drugs acting on central nervousnervous

Drugs acting on efferent Drugs acting on efferent nervous:nervous:

Part 1. General consideration of eff-Part 1. General consideration of eff-erent nervous pharmacologyerent nervous pharmacology

Part 2. ParasympathomimeticsPart 2. Parasympathomimetics Part 3. Cholinoceptor blocking Part 3. Cholinoceptor blocking

drugsdrugs Part 4. Adrenoceptor agonistsPart 4. Adrenoceptor agonists Part 5. AdrenoceptorPart 5. Adrenoceptor antagonistsantagonists

Drugs acting on afferent Drugs acting on afferent nervous:nervous:

Part 6. Local anestheticsPart 6. Local anesthetics

Drugs acting on central Drugs acting on central nervous:nervous:

Part 7. Sedative-hypnoticsPart 7. Sedative-hypnotics Part 8. CNS stimulatantsPart 8. CNS stimulatants Part 9. Anti-epileptic drugs Part 9. Anti-epileptic drugs

and anticonvulsant and anticonvulsant drugsdrugs

Part 10. Drugs of anti-Part 10. Drugs of anti-Parkinson’s diseaseParkinson’s disease

Part 11. Drugs treated Part 11. Drugs treated psychiatric disorderspsychiatric disorders

Part 12. AnalgesicsPart 12. Analgesics Part 13. Antipyretic, analgesic Part 13. Antipyretic, analgesic

and anti-inflammatory and anti-inflammatory drugsdrugs

Part 14. General anestheticsPart 14. General anesthetics

Part 1. Part 1. General consideration of General consideration of efferent nervous pharmaco-efferent nervous pharmaco-logylogy(( 传出神经系统药理概论传出神经系统药理概论 ))

1. Classification of efferent nerves1. Classification of efferent nerves 2. 2. Metabolism of Metabolism of

neurotransmitters neurotransmitters of efferent nof efferent nerveserves

3. 3. Receptors and responsesReceptors and responses 4. 4. Mechanism of the drugs Mechanism of the drugs

actionaction 5. 5. Classification of the drugsClassification of the drugs

1. Classification of efferent nerves:1. Classification of efferent nerves:

(1)Classification according to anatom(1)Classification according to anatomy:y:

Sympathetic n.Sympathetic n.

Autonomic n.Autonomic n.

Efferent n.Efferent n. Parasymthetic n.Parasymthetic n.

SSomatic momatic motor n.otor n.

General General considerationconsideration

(2)(2)Classification according to Classification according to neuro-transmitters:neuro-transmitters:

①①Noradrenergic nerves:Noradrenergic nerves: Noradrenaline(NA)Noradrenaline(NA)

②② Cholinergic nerves:Cholinergic nerves: Acetylcholine(ACh)Acetylcholine(ACh)

▲ ▲ Most of sympatheticMost of sympathetic postganglionic fibers.postganglionic fibers.

▲ ▲ All sympathetic and All sympathetic and parasympathetic preganglionic parasympathetic preganglionic fibers;fibers;

▲▲ All parasympathetic All parasympathetic postganglionic fibers;postganglionic fibers;

▲▲ A few of sympathetic A few of sympathetic postganglionic fibers;postganglionic fibers;

▲▲ Somatic motor nerve fibers.Somatic motor nerve fibers.

General General considerationconsideration

1. 1. ● <ACh● <NANA

< ACh

2. 2. ● <ACh● <ACh

3. 3. ● <ACh CNSCNS1. Sympathetic nerve;1. Sympathetic nerve; 2. Parasympathetic nerve; 2. Parasympathetic nerve; 3. 3. SSomatic momatic motor nerve.otor nerve.

effectorseffectors

2. 2. Metabolism of Metabolism of neurotransmitters neurotransmitters of efferent neof efferent nervesrves::

(1)Metabolism of ACh:(1)Metabolism of ACh:

Acetyl-CoAAcetyl-CoA ++ CholineCholine AChACh

releaserelease

CoACoA

AChEAChE AChACh Acetic acidAcetic acid ++

CholineCholine hydrolysishydrolysis

General General considerationconsideration

(2)(2)Metabolism of NA:Metabolism of NA:

HO- -CHHO- -CH22-CH-NH-CH-NH33 HO- -CH-CHHO- -CH-CH22--NHNH33

COOHCOOH HO HO

COOHCOOH (Tyrosine)(Tyrosine) ((Dopa)Dopa)

HO- -CHHO- -CH22-CH-NH-CH-NH33 HO- HO- -CH-CH-CH-CH22--NHNH33

HOHO HO HO OHOH (Dopamine)(Dopamine) (NA)(NA)

NA NA Release Release uptakeuptake11(vesicle/(vesicle/MAOMAO))

uptakeuptake22(extraneuronal(extraneuronal cell/cell/COMTCOMT))

General General considerationconsideration

3. 3. Receptors and responses:Receptors and responses:(1)Cholinoceptors:(1)Cholinoceptors: ①①Muscarinic receptorMuscarinic receptor(M-receptor):(M-receptor):

② ②Nicotinic receptorNicotinic receptor(N-(N-receptor):receptor):

MM11 receptor:receptor: gastric parietal cell, gastric parietal cell,

secretionsecretion MM22 receptor:receptor: heart, heart,

inhibitioninhibition MM33 receptor: receptor: smooth muscle, smooth muscle,

contractioncontraction MM44 receptor:receptor: exocrine glands, exocrine glands,

secretionsecretion MM55 receptor: receptor: CNS, CNS,

excitationexcitation

NN NN receptor:receptor: ganglion, ganglion, excitationexcitation

NN MM receptor:receptor: skeletal muscles, skeletal muscles,

contractioncontraction

General General considerationconsideration

(2)(2)Adrenoceptors:Adrenoceptors: ① ① receptors:receptors: 11 receptors:receptors: vascular smooth vascular smooth

muscle and pupillary dilatormuscle and pupillary dilator —— —— vasoconstriction, vasoconstriction,

mydriasis.mydriasis.

22 receptors:receptors: CNS, presynaptic m.CNS, presynaptic m. —— —— vasodilatation.vasodilatation. ② ② receptors:receptors: 11 receptors:receptors: heart —— heart ——

excitement.excitement.

22 receptors: receptors: bronchial smooth bronchial smooth musclemuscle

—— —— relaxation.relaxation.

General General considerationconsideration

4. 4. Mechanism of the drugs Mechanism of the drugs action:action: (1)Directly action on receptors:(1)Directly action on receptors: ① ①agonist: agonist: pilocarpine(pilocarpine( 毛果芸香毛果芸香

碱碱 ), ), adrenaline(adrenaline( 肾上腺肾上腺素素 ))

(2)(2)Influencing neurotransmitters Influencing neurotransmitters release release(indirect action):(indirect action):

① ①destruction:destruction: anti-AChE: anti-AChE: neostigminneostigmine (e ( 新斯的新斯的明明 ))

②② release:release: ephedrine(ephedrine( 麻黄碱麻黄碱 )) ③③depleting store:depleting store: reserpine(reserpine( 利舍利舍

平平 ))

② ②antagonist:antagonist: atropine(atropine( 阿托品阿托品 ), ), phentolamine(phentolamine( 酚妥拉酚妥拉明明 ), ), propranolol(propranolol( 普萘洛普萘洛尔尔 ))

General General considerationconsideration

5. 5. Classification of the drugs:Classification of the drugs:

(1)Cholinomimetics((1)Cholinomimetics( 拟胆碱药拟胆碱药 );); (2)Anti-c(2)Anti-choline drugs(holine drugs( 抗胆碱药抗胆碱药 );); (3)(3)Adrenoceptor angonist(Adrenoceptor angonist( 肾上肾上

腺素受体激动药腺素受体激动药 );); (4)(4)Adrenoceptor blocking Adrenoceptor blocking

drugs(drugs( 肾上腺素受体阻断药肾上腺素受体阻断药 ).).

General General considerationconsideration

(1)Cholinomimetics((1)Cholinomimetics( 拟胆碱药拟胆碱药 ):): ① ①Cholinoceptor agonist:Cholinoceptor agonist: M, N receptor:M, N receptor: Acetylcholine(Acetylcholine( 乙乙

酰胆碱酰胆碱 )) M receptor:M receptor: Pilocarpine( Pilocarpine( 毛果芸香毛果芸香

碱碱 )) N receptor:N receptor: Nicotine(Nicotine( 烟碱烟碱 )) Neostigmine(Neostigmine( 新斯的明新斯的明 )) ② ②AnticholinesteraseAnticholinesterase(( 抗胆碱酯酶药抗胆碱酯酶药 ):):

③③ Promoting ACh release(Promoting ACh release( 促促 AChACh 释释放药放药 ):): Fampridine(Fampridine( 法普利定法普利定 ))

General General considerationconsideration

(2)Anti-c(2)Anti-choline drugs(holine drugs( 抗胆碱药抗胆碱药 ):): ① ① Cholinoceptor blocking drugs:Cholinoceptor blocking drugs: M receptor:M receptor: atropine(atropine( 阿托品阿托品 ))

② ② Cholinesterase reactivators Cholinesterase reactivators (( 胆碱酯酶复活药胆碱酯酶复活药 ):):

PAM (PAM ( 碘解磷定碘解磷定 ), ), PAM-Cl(PAM-Cl( 氯解磷定氯解磷定 ))

MM1 1 receptor:receptor: pirenzepine(pirenzepine( 哌仑西哌仑西平平 ))

MM22 receptor:receptor: gallamine gallamine triethiodidetriethiodide

(( 戈拉碘铵戈拉碘铵 )) MM3 3 receptor:receptor:

hexahydrosiladifenidolhexahydrosiladifenidol (( 六氢硅杂二苯哌丁醇六氢硅杂二苯哌丁醇 ))

N receptor:N receptor: NNN N receptor:receptor: mecamylamine(mecamylamine( 美美

卡拉明卡拉明 )) NNM M receptor:receptor: tubocurarine(tubocurarine( 筒箭毒筒箭毒

碱碱 ))

General General considerationconsideration

(3)(3)Adrenoceptor angonist:Adrenoceptor angonist: ① ① receptorreceptor agonist: agonist: 11,, 2 2 receptorreceptor agonist:agonist: noradrenalinenoradrenaline(( 去甲肾上腺素去甲肾上腺素 )) 1 1 receptorreceptor agonist:agonist: phenylephrinephenylephrine(( 去氧肾上腺素去氧肾上腺素 )) 2 2 receptorreceptor agonist:agonist: clonidineclonidine(( 可可

乐定乐定 )) ② ②, , receptor receptor agonist:agonist:

③ ③ receptorreceptor agonist: agonist: adrenalineadrenaline(( 肾上腺素肾上腺素 ))

11, , 2 2 receptorreceptor agonist:agonist: isoprenalineisoprenaline(( 异丙肾上腺素异丙肾上腺素 )) 1 1 receptorreceptor agonist:agonist: dobutaminedobutamine(( 多巴酚丁胺多巴酚丁胺 )) 2 2 receptorreceptor agonist:agonist: sabutamolsabutamol(( 沙丁胺醇沙丁胺醇 ))

General General considerationconsideration

(4)(4)Adrenoceptor blocking drugs:Adrenoceptor blocking drugs: ① ① blocking drugs:blocking drugs:

11,, 22:: phentolamine(phentolamine( 酚妥拉明酚妥拉明 )) 11:: prazosin(prazosin( 哌唑嗪哌唑嗪 )) 22:: yohimbine(yohimbine( 育亨宾育亨宾 )) ② ② blocking drugs: blocking drugs: 11, , 22:: propranolol(propranolol( 普萘洛尔普萘洛尔 ) ) 11:: atenolol(atenolol( 阿替洛尔阿替洛尔 ) ) 22:: butasamine(butasamine( 布他沙明布他沙明 )) ③ ③ , , blocking drugs:blocking drugs: labetalol(labetalol( 拉贝洛尔拉贝洛尔 ))

General General considerationconsideration

Part 2.Part 2.

ParasympathomimeticsParasympathomimetics

(( 拟副交感神经药拟副交感神经药 ))

Parasympathomimetics Parasympathomimetics can be divided into:can be divided into: ●●Cholinergic agonists(Cholinergic agonists( 胆碱能激动药胆碱能激动药 )) —— —— cholinomimetics(cholinomimetics( 拟胆碱药拟胆碱药 ):): (A)M(A)M cholinoceptor agonistscholinoceptor agonists

●●Anticholinesterase agents(Anticholinesterase agents( 抗胆碱酯抗胆碱酯酶药酶药 ):):

(B)N(B)N cholinoceptorcholinoceptor agonists:agonists:

Ⅰ Ⅰ. Choline esters(. Choline esters( 胆碱酯类胆碱酯类 )) Methacholine(Methacholine( 醋甲胆碱醋甲胆碱 ),), Ⅱ Ⅱ. . Alkaloids(Alkaloids( 生物碱类生物碱类 )) Pilocarpine(Pilocarpine( 毛果芸香碱毛果芸香碱 ))

Nicotine(Nicotine( 烟烟碱碱 ))

(A)Reversible anti-AChE agents:(A)Reversible anti-AChE agents: Neostigmine(Neostigmine( 新斯的明新斯的明 ),), (B)Irreversible anti-AChE agents:(B)Irreversible anti-AChE agents: Organophosphates(Organophosphates( 有机磷酸酯类有机磷酸酯类 ).).

(A)M cholinoceptor agonists:(A)M cholinoceptor agonists: Ⅰ Ⅰ. Choline esters(. Choline esters( 胆碱酯类胆碱酯类 )) Acetylcholine(Acetylcholine( 乙酰胆碱乙酰胆碱 );); Methacholine(Methacholine( 醋甲胆碱醋甲胆碱 ):): Xerostomia(Xerostomia( 口腔干燥症口腔干燥症 )) Carbachol(Carbachol( 卡巴胆碱卡巴胆碱 ): ): Glaucoma(Glaucoma( 青光眼青光眼 )) Bethanechol chloride(Bethanechol chloride( 氯贝胆碱氯贝胆碱 ):): Post-operativePost-operative abdominal abdominal

distension (distension ( 腹胀腹胀 ) ) and uroschesis(and uroschesis( 尿尿潴留潴留 ));;

Xerostomia.Xerostomia.

● ●Cholinergic agonists(Cholinergic agonists( 胆碱能激动胆碱能激动药药 ))

—— —— cholinomimetics(cholinomimetics( 拟胆碱拟胆碱药药 ):):

ⅡⅡ. . Alkaloids(Alkaloids( 生物碱类生物碱类 ):):Pilocarpine(Pilocarpine( 毛果芸香碱毛果芸香碱 , , 匹鲁卡品匹鲁卡品 ))

1. 1. Pharmacological effects:Pharmacological effects: It It can excite M receptor can excite M receptor directly, the sensitivity for directly, the sensitivity for eyeeye and and exocrine glands.exocrine glands.

(1)(1)Eye:Eye: ①①PupillaryPupillary constrictionconstriction ②② Intraocular pressureIntraocular pressure(( 降低眼内降低眼内压压 ));;

③ ③Constrict ciliary muscleConstrict ciliary muscle(( 睫状睫状肌肌 ))

—— —— spasm of accommodation.spasm of accommodation.

②②;;

PilocarpinPilocarpinee

(1)(1)EyeEye ▲ ▲ pupillary constriction(myosis)pupillary constriction(myosis) ▲▲ Fall in intraocular pressureFall in intraocular pressure ▲▲ Spasm of accommodationSpasm of accommodation —— ——constrict ciliary muscleconstrict ciliary muscle (2)Exocrine glands(2)Exocrine glands promoting glands secretingpromoting glands secreting (3)Smooth muscle(3)Smooth muscle constriction: GI, biliary tract, constriction: GI, biliary tract,

bronchus, womb, bladderbronchus, womb, bladder (4)Cardiovascular system(4)Cardiovascular system heart rate↓heart rate↓

PilocarpinPilocarpinee

2. 2. Clinical Uses:Clinical Uses: (1)Glaucoma((1)Glaucoma( 青光眼青光眼 ):): Angle-closure type(Angle-closure type( 闭角型闭角型 )) ((acute congestive type, acute congestive type, 急性充血急性充血

型型 )) Open-angle type(Open-angle type( 开角型开角型 )) ((chronic simple type, chronic simple type, 慢性单纯型慢性单纯型 )) (2)(2)Iritis(Iritis( 虹膜炎虹膜炎 ):): myoticsmyotics(( 缩瞳药缩瞳药 ))//mydriaticsmydriatics(( 扩瞳扩瞳

药药 )) (3)Xerostomia((3)Xerostomia( 口腔干燥症口腔干燥症 ): ): popo

PilocarpinPilocarpinee

(B)N cholinoceptor agonists(B)N cholinoceptor agonists

Nicotine(Nicotine( 烟碱烟碱 ))

(A)Reversible anti-AChE (A)Reversible anti-AChE agents:agents: NeostigmineNeostigmine(( 新斯的明新斯的明 ),), PhysostigminePhysostigmine(( 毒扁豆碱毒扁豆碱 ))

((B)Irreversible anti-AChE B)Irreversible anti-AChE agents:agents:

OrganophosphatesOrganophosphates(( 有机磷酸酯有机磷酸酯类类 ))

● ● Anticholinesterase agents:Anticholinesterase agents:

(A)Reversible anti-AChE (A)Reversible anti-AChE agents:agents: Main pharmacological Main pharmacological effects:effects:

inhibit AChE inhibit AChE ACh ACh (1)Increasing contraction strength (1)Increasing contraction strength

of skeletal muscle;of skeletal muscle;

(2)Enhancing contraction of (2)Enhancing contraction of smooth muscle of GI / bladder / smooth muscle of GI / bladder / branchus;branchus;

(3)(3)Myosis, Myosis, intraocular pressure intraocular pressure ;; (4)Exocrine glands secretion.(4)Exocrine glands secretion.

Neostigmine(Neostigmine( 新斯的明新斯的明 ))1. 1. Pharmacokinetics:Pharmacokinetics: (1)Absorbed poorly after oral (1)Absorbed poorly after oral

adminis-tration:adminis-tration: ItIt is a chemical is a chemical compound ofcompound of quarternary quarternary ammonium(ammonium( 季铵类化合物季铵类化合物 ), ),

im im oror sc: sc: 0.5mg0.5mg ～～ 2mg/once;2mg/once; po: po: 15mg15mg ～～ 30mg/once30mg/once

(2)It is destroyed by plasma (2)It is destroyed by plasma esterase.esterase.

(3)t(3)t½½: 1: 1 ～～ 2 hr. 2 hr.

2. 2. Pharmacological effects:Pharmacological effects: (1)Increasing contraction (1)Increasing contraction

strength of skeletal muscle:strength of skeletal muscle: inhibit AChE;inhibit AChE; direct stimulate Ndirect stimulate NMM receptor. receptor.

(2)Enhancing contraction of (2)Enhancing contraction of smoothsmooth

muscle of GI muscle of GI /bladder/branchus./bladder/branchus.

NeostigminNeostigminee

3. Clinical uses:3. Clinical uses: (1)Myasthenia gravis((1)Myasthenia gravis( 重症肌无力重症肌无力 );); (2)Post-operative abdominal (2)Post-operative abdominal

disten-tion or urinary disten-tion or urinary retention(retention( 手术后腹胀气和尿潴留手术后腹胀气和尿潴留 ););

(3)Paroxysmal atrial tachycardia (3)Paroxysmal atrial tachycardia ( ( 阵发性室上性心动过速阵发性室上性心动过速 ););

(4)Overdose of (4)Overdose of tubocurarine(tubocurarine( 筒筒箭毒碱箭毒碱 ): ): 对抗对抗竞争性肌松药竞争性肌松药过量时的中过量时的中毒毒 ..

NeostigminNeostigminee

4. 4. Adverse reaction:Adverse reaction:

(1)Overdose:(1)Overdose: Cholinergic crisisCholinergic crisis(( 胆碱能危象胆碱能危象 ).).

(2)Contraindications((2)Contraindications( 禁忌证禁忌证 ):): mechanical ileusmechanical ileus(( 机械性肠梗阻机械性肠梗阻 );); urinary obstructionurinary obstruction(( 尿道梗阻尿道梗阻 );); bronchial asthmabronchial asthma(( 支气管哮喘支气管哮喘 )). .

NeostigminNeostigminee

Physostigmine(Physostigmine( 毒扁豆碱毒扁豆碱 ))1. Pharmacokinetics:1. Pharmacokinetics: ItIt is a is a chemical compound chemical compound of tertiary amine(of tertiary amine( 叔胺类化合物叔胺类化合物 ).).

(1)easy to be absorbed by po;(1)easy to be absorbed by po; (2)easy to cross cornea;(2)easy to cross cornea; (3)easy to cross blood brain (3)easy to cross blood brain barrier.barrier.

2. Clinical use: 2. Clinical use: glaucoma, the effect is glaucoma, the effect is longer and stronger than longer and stronger than pilocarpine.pilocarpine.

((B)Irreverible anti-ChE agents:B)Irreverible anti-ChE agents:OrganophosphatesOrganophosphates

(( 有机磷酸酯类有机磷酸酯类 ))

OrganophosphatesOrganophosphates ++ AChE AChE phosphorylated AChEphosphorylated AChE

1. Symptoms of acute intoxication 1. Symptoms of acute intoxication

ofof organophosphates:organophosphates: (1)Muscarinic effects(M(1)Muscarinic effects(M 样作用样作用 );); (2)Nicotinic effects(N(2)Nicotinic effects(N 样作用样作用 )); ; (3)Central effects((3)Central effects( 中枢作用中枢作用 ))

东京地铁毒气事件东京地铁毒气事件 时间时间 :: 1995 1995 年年 33 月月 2020 日日 ;; 地点地点 :: 日本东京地铁日本东京地铁 (3(3 条线路条线路 1111 个车个车

厢厢 );); 毒剂毒剂 :: 沙林沙林 ((Sarin)——Sarin)—— 甲氟磷异丙酯甲氟磷异丙酯 ;; 主犯主犯 :: 奥姆奥姆 ((AUM)AUM)真理教教主真理教教主麻原彰晃麻原彰晃 ;; 后果后果 :: 5500 5500 多人中毒多人中毒 , , 其中其中 1212人死亡人死亡 , ,

另有另有 1414人终身残疾人终身残疾 ;; 判决判决 :: 2004 2004 年年 22 月月 2727日日本东京最高法日日本东京最高法

院判处院判处麻原彰晃麻原彰晃死刑死刑 ..

2. 2. Prevention and treatment of Prevention and treatment of organophosphateorganophosphate intoxication:intoxication:

(1)Prevention of intoxication(1)Prevention of intoxication

(2)Treatment of intoxication:(2)Treatment of intoxication: ①①Clear away Clear away organophosphate;organophosphate; ②②Treatment with large dose of Treatment with large dose of atropine;atropine; ③③Treatment with Treatment with

CholinesteraseCholinesterase reactivatorsreactivators((PAMPAM or or PAM-ClPAM-Cl))

Cholinesterase reactivatorsCholinesterase reactivators

Pyraloxime methoiodidePyraloxime methoiodide(PAM, (PAM, 碘解磷定碘解磷定 ))

1. 1. Pharmacological effects:Pharmacological effects:(1)Reactivating(1)Reactivating phosphorylatedphosphorylated

AChEAChE

PAM PAM ++ Phosphorylated AChEPhosphorylated AChE Complex Complex

AChE(reactivition)AChE(reactivition)+ PAM-phosphoate(nontoxic).+ PAM-phosphoate(nontoxic).

(2)(2)Conjugation with free organo-Conjugation with free organo-phosphates: phosphates:

PAMPAM ++ FreeFree organophosphatesorganophosphates

PAM-phosphoate.PAM-phosphoate.

(3)Remarkably rapid reactivation (3)Remarkably rapid reactivation of AChE of neuromuscular of AChE of neuromuscular junction.junction.

PAPAMM

2. 2. Clinical uses:Clinical uses: Moderate-severe intoxication Moderate-severe intoxication of organophosphates and of organophosphates and combination withcombination with atropine.atropine.

3. Adverse reaction:3. Adverse reaction: (1)Central(1)Central symptoms, whensymptoms, when iviv

speedspeed > 0.5 g/min> 0.5 g/min (2)Inhibition of AChE/when (2)Inhibition of AChE/when PAMPAM overdose(> 2 g/once).overdose(> 2 g/once).

PAPAMM

Pyraloxime methylchloridePyraloxime methylchloride(PAM-Cl, (PAM-Cl, 氯解磷定氯解磷定 ))

The characteristics:The characteristics: (1)Solubility in water is high;(1)Solubility in water is high;

(2)Solution of water is stable;(2)Solution of water is stable;

(3)Used with iv or im, and the (3)Used with iv or im, and the effect of either is the same effect of either is the same asas PAM.PAM.

应颂敏应颂敏

yings@zju.edu.cnyings@zju.edu.cn