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A The Scope of Pharmacology 药理学范畴

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2018年10月12日

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A The Scope of Pharmacology

药理学范畴

In its entirety, pharmacology embraces the knowledge of the history, source, physical and chemical properties, compounding, biochemical and physiological effects, mechanisms of action, absorption, distribution, biotransformation and excretion, and therapeutic and other uses of drugs. Since a drug is broadly defined as any chemical agent that affects living processes, the subject of pharmacology is obviously quite extensive.

总体来说,药理学包括药物的以下诸方面内容:历史背景、来源、理化特性、合成、生化生理作用、作用机制、吸取、分布、生物转化和排泄以及治疗作用和其他作用。由于药物被一般性定义为影响生命过程的化学物质,因而药理学范畴显然是极其广泛的。

For the physician and the medical student, however, the scope of pharmacology is less expansive than indicated by the above definitions. The clinician is interested primarily in drugs that are useful in the prevention, diagnosis, and treatment of human disease, or in the prevention of pregnancy. His study of the pharmacology of these drugs can be reasonably limited to those aspects that provide the basis for their rational clinical use. Secondarily, the physician is also concerned with chemical agents that are not used in therapy but are commonly responsible for household and industrial poisoning as well as environmental pollution. His study of these substances is justifiably restricted to the general principles of prevention, recognition, and treatment of such toxicity or pollution. Finally, all physicians share in the responsibility to help resolve the continuing sociological problem of the abuse of drugs.

然而,就医生和医学生生而言,药理学范畴并没有上述定义那么广泛。临床医生的主要兴趣在于药物对人类疾病的预防、诊断及治疗.或是在避孕方而所起的作用。因而他对这些药物的药理学研究不仅仅周限于某些方面,只要能为其合理的临床用药提供理论根据就行。其次,医生也关注某些化学物质,这些物质虽然不用于治疗,但通常与家庭中毒;工业中毒以及环境污染有关。医生对这些物质的研究当然仅限于一般性了解。对这类中毒或汚污染的防范、诊断和治疗。最后,所有医生都应责无旁贷地为解决药品滥用所引起的社会问题而做出自己的努力。

A brief consideration of its major subject areas will further clarify how the study of pharmacology is best approached from the standpoint of the specific requirements and interests of the medical student and practitioner. At one time, it was essential for the physician to have a broad botanical knowledge, since he had to select the proper plants from which to prepare his own crude medicinal preparations. However, fewer drugs are now obtained from natural sources, and, more importantly, most of these are highly purified or standardized and differ little from synthetic chemicals. Hence, the interests of the clinician in pharmacognosy are correspondingly limited. Nevertheless, scientific curiosity should stimulate the physician to learn something of the sources of drugs, and this knowledge often proves practically useful as well as interesting. He will find the history of drugs of similar value.

从医学生和从业医师的特別耑求和一般兴趣的角度来看,什么才是药理学学习的最佳途径呢?只要对其主要学科领域稍加研究便可知晓。以前,医师必须拥有广泛的植物方而的常识,因为他得挑选适当的植物,且将其制备成简单的药物制剂。然而,现在的药物已很少取自于天然植物,而且更为重要的是大多数天然药物已被高度提纯,且与合成的化学药物无甚区别,所以,临床医生对生药学的兴趣也相应减弱。尽管如此,应该激励临床医生了解药物的来源的科学好奇心,这方面常识往往被证明不但有趣,而且有用。他将会发现了解药物的历史同样具有价值。

The preparing, compounding, and dispensing of medicines at one time lay within the province of the physician, but this work is now delegated almost completely to the pharmacist1. However, to write intelligent prescription orders, the physician must have some knowledge of the physical and chemical properties of drugs and their available dosage forms, and he must have a basic familiarity with the practice of pharmacy. When the physician shirks his responsibility in this regard, he invariably fails to translate his knowledge of pharmacology and medicine into prescription orders and medication best suited for the individual patient.

药物的制备、合成与销售一度都是医生的职责,但这项工作现在几乎全归药师了。不过临床医师要想开出合理的处方,必须对药物的理化性质及其现有剂型有所了解,必须基本了解药房业务。若临床医师逃避这方面责任,他肯定用不好药理学及药物常识,从而难以开出适合每位患者的最佳医疗处方。 I

Pharmacokinetics deals with the absorption, distribution, biotransformation, and excretion of drugs. These factors, coupled with dosage, determine the concentration of a drug at its sites of action and, hence, the intensity of its effects as a function of time. Many basic principles of biochemistry and enzymology and the physical and chemical principles that govern the active and passive transfer and the distribution of substances across biological membranes are readily applied to the understanding of this important aspect of pharmacology2.

药物动力学涉及药物的吸取、分布、生物转化以及排泄等方面。这些因素再加上剂量便决定了药物在其作用点的浓度,进而决定了其与时间成函数关系的药效强度。在对药理学这一重要方面的理解过程中,常常运用到许多有关生物化学和酶学方面的基本原理和物理化学方面的一些基本法则,而这些原理和法则决定着物质在生物膜之间的主动和被动转移及分布。

The study of the biochemical and physiological effects of drugs and their mechanisms of action is termed as pharmacodynamics. It is an experimental medical science that dates back only to the later half of the nineteenth century. As a border science, pharmacodynamics borrows freely from both the subject matter and the experimental techniques of physiology, biochemistry, microbiology, immunology, genetics, and pathology. It is unique mainly in that attention is focused on the characteristics of drugs. As the name implies, the subject is a dynamic one. The student who attempts merely to memorize the pharmacodynamic properties of drugs is foregoing one of the best opportunities for correlating the entire field of preclinical medicine. For example, the actions and effects of the saluretic agents can be fully understood only in terms of the basic principles of renal physiology and of the pathogenesis of edema. Conversely, no greater insight into normal and abnormal renal physiology can be gained than by the study of the pharmacodynamics of the saluretic agents.

对药物的生化生理作用及其作用机制的研究称为药效学。这是一门实验医学,其历史仅可追溯到19世纪后半叶。作为边缘学科,药效学从生理学、生化学、微生物学、免疫学、遗传学和病理学等诸多学科的主要理论和实验技术中汲取了大量内容。该学科的独到之处主要在于其关注的要点是药物的特征。顾名思义,该科目属于动态学科。学生如果仅仅打算死记硬背药物的药效学特性的话,那他将会丧失把整个临床前期医学连为—体的这一最佳机会。例如:利盐排泄剂的活性和效用只有在肾脏生理学和水肿发病机制的基本原理的基础上才能完全理解。换句话说,只有通过对利盐排泄剂的药效学研究,才能最深人地了解肾脏生理学正常和异常两方面情况。

Another ramification of pharmacodynamics is the correlation of the actions and effects of drugs with their chemical structures. Such structure-activity relationships are an integral link in the analysis of drug action, and exploitation of these relationships among established therapeutic agents has often led to the development of better drugs. However, the correlation of biological activity with chemical structure is usually of interest to the physician only when it provides the basis for summarizing other pharmacological information.

药效学的另一分支是研究药物活性和效用与其化学结构的相互关系。这种构效关系是分析药物作用不可或缺的部分,将这种关系应用于现有的治疗药物中往往会促使药品的更新换代。然而,只有当生物活性与化学结构的关联能够为总结其他药物学信息提供基础时,临床医师才会对此产生兴趣。

The physician is understandably interested mainly in the effects of drugs in man. This emphasis on clinical pharmacology is justified, since the effects of drugs are often characterized by significant interspecies variation, and since they may be further modified by disease. In addition, some drug effects, such as those on mood and behavior, can be adequately studied only in man. However, the pharmacological evaluation of drugs in man may be limited for technical, legal, and ethical reasons, and the choice of drugs must be based in part on their pharmacological evaluation in animals. Consequently, some knowledge of animal pharmacology and comparative pharmacology is helpful in deciding the extent to which claims for a drug based upon studies in animals can be reasonably extrapolated to man3.

临床医师的兴趣主要集中于药物对人体的疗效。临床药理重视这一点是合理的,因为药物的作用往往因种属的明显差异而大相径庭,并可能由于疾病的作用而发生进一步改而且有些药物作用——诸如对情绪和行为的作用—只有通过人体才能得以充分研究,不过药物对人体的药理学评价可能因技术、法律及伦理道德方面的原因而受到限制,对药物的选择在一定程度上也只得以它们在动物身上所进行的药理学评价为基础。因此,动物药理学和比较药理学方面的常识有助于确定以动物实验为基础的某种新药研制何时才可用于人体。

Pharmacotherapeutics deals with the use of drugs in the prevention and treatment of disease. Many drugs stimulate or depress biochemical or physiological function in man in a sufficiently reproducible manner to provide relief of symptoms or, ideally, to alter favorably the course of disease. Conversely, chemicotherapeutic agents are useful in therapy because they have only minimal effects on man but can destroy or eliminate parasites. Whether a drug is useful for therapy is crucially dependent upon its ability to produce its desired effects with only tolerable undesired effects. Thus, from the standpoint of the physician interested in the therapeutic uses of a drug, the selectivity of its effects is one of its most important characteristics. Drug therapy is rationally based upon the correlation of the actions and effects of drugs with the physiological, biochemical, microbiological, immunological, and behavioral aspects of disease. Pharmacodynamics provides one of the best opportunities for this correlation during the study of both the preclinical and the clinical medical sciences.

药物治疗学涉及如何在疾病防治中使用药物。许多药物以强有力的可重现方式促进或抑制着人体的生理生化功能,进而使症状得以缓解或促使病程朝着令人满意的方向转变。相反,化疗药物的治病功能是因为其对人体作用很小但却能杀死或清除寄生生物。—种药物是否可以用于治疗,关键取决于其能否产生预期的治疗效果,同时其副作用在可容忍的范围内。这样,从关注药物疗效的临床医师的观点来看,药物作用的选择性便是其最重要特点之一。药物的活性和疗效与疾病诸方面——生理、生化、微生物、免疫和行为——的联系理所当然地成为药物治疗的基础。药效学便为临床前期和临床期医学研究这种联系提供了一个绝好的机会。

Toxicology is that aspect of pharmacology that deals with the adverse effects of drugs. It is concerned not only with drugs used in therapy but also with the many other chemicals that may be responsible for household, environmental, or industrial intoxication. The adverse effects of the pharmacological agents employed in therapy are properly considered an integral part of their total pharmacology. The toxic effects of other chemicals are such an extensive subject that the physician must usually confine his attention to the general principles applicable to the prevention, recognition, and treatment of drug poisonings of any cause.

毒理学是研究药物副作用的药理学分支。它不仅涉及治疗药物,还涉及引起家庭、环境或工业中毒的许多其他化学物质。治疗性药物的副作用应被视为整个药理学的一个组成部分。其他化学物质的毒副作用范围太广,临床医师通常只能将注意力放在预防、确认和处理各种药物中毒的基本原则上。


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