2025年鄭州市事業(yè)單位衛(wèi)生類藥學(xué)專業(yè)知識(shí)考試沖刺試卷考試時(shí)間：______分鐘總分：______分姓名：______一、單項(xiàng)選擇題（本部分共20小題，每小題1分，共20分。每小題只有一個(gè)最佳答案，請(qǐng)將正確答案的字母代號(hào)填涂在答題卡相應(yīng)位置上）1.老師跟你說(shuō)啊，藥學(xué)專業(yè)當(dāng)中，關(guān)于藥物劑型的分類，你可得給我記牢了。比如散劑、片劑、膠囊劑，這幾種常見(jiàn)的劑型，它們各自都有什么特點(diǎn)呢？散劑是不是因?yàn)轭w粒小，所以起效快？片劑呢，它又有哪些優(yōu)點(diǎn)？還有膠囊劑，它為什么特別適合包裹那些有刺激性氣味的藥物？這些都是咱們藥學(xué)人員必須掌握的基礎(chǔ)知識(shí)，來(lái)，看看這道題，哪種劑型的藥物，它的分散度是最小的？是A.散劑，B.片劑，C.膠囊劑，還是D.溶液劑？想想看，散劑不就是粉末狀的嘛，它能不能分散得比片劑還細(xì)？片劑是壓實(shí)的，肯定比散劑顆粒大，對(duì)不對(duì)？膠囊劑里面裝的是藥粉或者顆粒，也不是最細(xì)的。溶液劑啊，那是液體，更不可能有固體劑型那么細(xì)了。所以，分散度最小，也就是顆粒最大，應(yīng)該是片劑，對(duì)吧？來(lái)，選出B。2.老師想給你講講藥物在體內(nèi)的吸收過(guò)程，這可是個(gè)關(guān)鍵環(huán)節(jié)??！咱們都知道，口服給藥是最常用的方式，那藥物從胃腸道吸收進(jìn)去，到底會(huì)受到哪些因素的影響呢？你想想看，胃的酸堿度變化，比如你吃點(diǎn)酸性或者堿性的東西，會(huì)不會(huì)影響藥物的吸收？還有啊，你有沒(méi)有想過(guò)，是不是吃的飯多了，或者是不是跟別的藥一起吃，也會(huì)讓吸收變快或者變慢？甚至，你走路快還是走路慢，是不是也會(huì)有點(diǎn)關(guān)系？這題考的是，下列哪項(xiàng)因素**不屬于**影響口服藥物吸收的生理因素？A.胃腸蠕動(dòng)速度，B.胃酸濃度，C.食物的影響，D.藥物的劑型。老師說(shuō)啊，胃腸蠕動(dòng)快慢，肯定影響吸收啊，快了吸收就快，慢了就慢嘛。胃酸濃度，有的藥怕酸，有的藥在酸環(huán)境下才能更好地吸收，這肯定有關(guān)系。食物嘛，有的食物會(huì)跟藥競(jìng)爭(zhēng)吸收，有的會(huì)延緩胃排空，那當(dāng)然也影響。唯獨(dú)藥物劑型，比如是片劑還是膠囊，這更多是影響藥物釋放的速度和方式，而不是身體本身生理狀態(tài)的變化。所以，答案是D。3.老師跟你嘮嘮，藥物代謝這個(gè)事兒，肝臟可是主力軍啊！肝臟就像個(gè)超級(jí)工廠，藥物進(jìn)去之后，會(huì)被它加工改造。這個(gè)過(guò)程叫什么？對(duì)，就是代謝。代謝完了，藥物的作用就減弱或者消失了。老師要問(wèn)你，肝臟主要通過(guò)哪種酶系統(tǒng)來(lái)代謝藥物呢？A.細(xì)胞色素P450系統(tǒng)，B.堿性磷酸酶系統(tǒng)，C.乳酸脫氫酶系統(tǒng)，D.谷胱甘肽S-轉(zhuǎn)移酶系統(tǒng)。這題其實(shí)很簡(jiǎn)單，老師平時(shí)講課也反復(fù)強(qiáng)調(diào)過(guò)，藥物代謝的主力軍，那必須是P450??！這個(gè)系統(tǒng)太重要了，好多藥都是靠它代謝的。其他幾個(gè)酶系統(tǒng)，要么作用小，要么主要管別的事兒。所以，毫無(wú)疑問(wèn)，答案是A。4.老師想問(wèn)問(wèn)你，關(guān)于藥物不良反應(yīng)，你了解多少？咱們用藥啊，目的肯定是治病，但有時(shí)候難免會(huì)出現(xiàn)一些不好的反應(yīng)，對(duì)不對(duì)？這些反應(yīng)，有些是輕微的，有些可能就比較嚴(yán)重。那么，按照嚴(yán)重程度來(lái)分，藥物不良反應(yīng)里面，最輕微的那種，通常咱們叫它什么？A.副作用，B.毒性反應(yīng)，C.過(guò)敏反應(yīng)，D.特異質(zhì)反應(yīng)。老師說(shuō)啊，副作用，那是藥物本身固有的，在治療劑量下出現(xiàn)的不期望的有害反應(yīng)，但一般比較輕微，比如阿司匹林能止痛，但也可能引起胃不舒服，這就是副作用。毒性反應(yīng)，那肯定嚴(yán)重了，是藥物過(guò)量或者敏感導(dǎo)致的。過(guò)敏反應(yīng)，那就是身體免疫系統(tǒng)搞的鬼，有的人對(duì)某些藥物特別敏感。特異質(zhì)反應(yīng)，那更特殊，是少數(shù)人由于遺傳因素，對(duì)藥物反應(yīng)跟一般人不一樣，也可能是嚴(yán)重的。所以，最輕微的，通常就是副作用。答案是A。5.老師給你講個(gè)例子吧，一個(gè)人感冒了，去藥店買了阿司匹林退燒。后來(lái)他覺(jué)得肚子疼得厲害，去了醫(yī)院。醫(yī)生一問(wèn)，哦，你最近是不是一直在吃阿司匹林？病人說(shuō)是啊。醫(yī)生就告訴他，阿司匹林可能會(huì)刺激胃黏膜，引起不適。這就是典型的什么情況呢？A.后遺效應(yīng)，B.繼發(fā)性反應(yīng)，C.毒性反應(yīng)，D.副作用。老師說(shuō)啊，后遺效應(yīng)，那是停藥后短時(shí)間內(nèi)殘留的反應(yīng)。繼發(fā)性反應(yīng)，那是治療反應(yīng)引起的不良后果，比如用抗生素把好菌也殺了。毒性反應(yīng)，那就是藥過(guò)量或者敏感引起的嚴(yán)重反應(yīng)。而副作用，就是藥物本身作用之外的有害反應(yīng)，它和主要治療作用是同時(shí)發(fā)生的。阿司匹林的主要作用是退燒止痛，但它刺激胃黏膜這個(gè)作用，就不是我們想要的，是伴隨治療作用出現(xiàn)的，所以是副作用。答案是D。6.老師要考考你關(guān)于藥物相互作用的這塊兒。你想想，如果你同時(shí)吃好幾種藥，它們之間會(huì)不會(huì)產(chǎn)生什么影響？有的可能會(huì)讓藥效增強(qiáng)，有的可能會(huì)減弱，甚至產(chǎn)生一些不好的反應(yīng)。那么，老師問(wèn)你，甲藥可以抑制乙藥的代謝，導(dǎo)致乙藥在體內(nèi)蓄積，藥效增強(qiáng)，甚至中毒，這種情況屬于哪種藥物相互作用類型？A.拮抗作用，B.協(xié)同作用，C.誘導(dǎo)作用，D.抑制作用。老師說(shuō)，這題很簡(jiǎn)單，甲藥抑制乙藥的代謝，乙藥就排不出去，在體內(nèi)越來(lái)越多，藥效就越來(lái)越強(qiáng)。這很明顯就是甲藥在“抑制”乙藥的處理過(guò)程嘛。拮抗作用是兩個(gè)藥作用相反。協(xié)同作用是效果疊加。誘導(dǎo)作用是促進(jìn)代謝。所以，抑制作用的描述最符合題意。答案是D。7.老師想跟你談?wù)剟┝康母拍睢Ｓ盟幇?，可不能隨心所欲，得有個(gè)“度”，這個(gè)“度”就是劑量。劑量太小，可能治療效果不明顯，達(dá)不到預(yù)期目的，咱們管這叫什么？A.治療量不足，B.中毒量，C.閾劑量，D.極量。老師說(shuō)，劑量不夠，藥效就上不去，這就是治療量不足，對(duì)吧？中毒量是吃了太多導(dǎo)致中毒。閾劑量是剛能引起藥理效應(yīng)的最低劑量。極量是最大安全劑量。所以，效果不明顯是因?yàn)閯┝坎粔?，就是治療量不足。答案是A。8.老師給你講個(gè)故事，一個(gè)人發(fā)燒了，醫(yī)生給他開(kāi)了退燒藥。他看說(shuō)明書(shū)上寫(xiě)著一次X片，一天三次。但他覺(jué)得燒得厲害，就一次吃了兩倍劑量，結(jié)果頭暈、惡心，去醫(yī)院檢查，醫(yī)生說(shuō)有點(diǎn)中毒跡象。這說(shuō)明什么問(wèn)題呢？A.該患者的用藥方法不對(duì)，超出了極量，可能導(dǎo)致毒性反應(yīng)。B.該藥物的治療指數(shù)很低，風(fēng)險(xiǎn)很大。C.該患者對(duì)該藥物特別敏感。D.該藥物有嚴(yán)重的后遺效應(yīng)。老師說(shuō)，你看這個(gè)人，為啥會(huì)中毒？因?yàn)樗粤颂嗟乃?，超出了醫(yī)生推薦的劑量范圍，甚至可能超過(guò)了安全的最大劑量（極量）。用藥方法不對(duì)，劑量嚴(yán)重超標(biāo)了，這是最直接的原因。治療指數(shù)低是指安全范圍窄，但這題沒(méi)說(shuō)這藥本身風(fēng)險(xiǎn)多大。是不是特別敏感？也可能，但超量是更主要的原因。后遺效應(yīng)是停藥后的反應(yīng)。所以，最核心的問(wèn)題是用藥方法錯(cuò)誤，劑量超了。答案是A。9.老師想問(wèn)問(wèn)你，關(guān)于處方藥和非處方藥，你有什么了解？咱們?nèi)ニ幍曩I藥，會(huì)發(fā)現(xiàn)有些藥需要醫(yī)生開(kāi)處方才能買，有些則可以直接買。這怎么分的呢？主要是根據(jù)什么來(lái)判斷？A.藥物的療效強(qiáng)弱，B.藥物的價(jià)格高低，C.藥物的安全性及使用風(fēng)險(xiǎn)，D.藥物的劑型大小。老師說(shuō)，這題考的是基本概念。處方藥和非處方藥的分界線，核心就是藥物的安全性和使用風(fēng)險(xiǎn)。有些藥比較安全，普通人按說(shuō)明書(shū)用問(wèn)題不大，就成非處方藥了。有些藥有一定風(fēng)險(xiǎn)，或者需要醫(yī)生根據(jù)你的具體情況判斷是否適合使用，那就要醫(yī)生處方了。療效強(qiáng)弱、價(jià)格高低、劑型大小，這些都不是主要標(biāo)準(zhǔn)。所以，答案是C。10.老師跟你講講緩釋和控釋制劑。這兩種制劑，目的都是讓藥物在體內(nèi)慢慢釋放，維持較長(zhǎng)時(shí)間的有效濃度，對(duì)不對(duì)？那它們有什么區(qū)別呢？緩釋制劑，老師可以理解為，藥物可能是一段一段地放出來(lái)，或者釋放速度整體比普通片劑慢，但可能中間還是有起伏。而控釋制劑呢，就比較厲害了，老師可以想象成，它像個(gè)精準(zhǔn)的定時(shí)炸彈，藥物會(huì)以**恒定**的速度，**均勻**地釋放出來(lái)，很長(zhǎng)時(shí)間都保持這個(gè)速度。那么，老師問(wèn)你，控釋制劑最主要的特點(diǎn)是什么？A.藥物釋放完全受控，速度恒定。B.藥物釋放較快，但持續(xù)時(shí)間短。C.藥物只釋放一次，然后就沒(méi)用了。D.藥物釋放沒(méi)有規(guī)律。老師說(shuō)，這題考的是對(duì)控釋概念的理解。緩釋是慢，控釋是**控**，就是控制住，讓速度**恒定**、**均勻**。所以A最準(zhǔn)確描述了控釋的核心特點(diǎn)。答案是A。11.老師給你講講注射劑。打針啊，是一種常見(jiàn)的給藥方式，尤其是急救的時(shí)候。那么，注射劑按給藥途徑分類，不包括下列哪一種？A.靜脈注射劑，B.肌肉注射劑，C.皮下注射劑，D.口服注射劑。老師說(shuō)，靜脈、肌肉、皮下，這些都是咱們打針常用的部位，對(duì)應(yīng)的注射劑當(dāng)然有啊?？诜⑸鋭窟@說(shuō)法太奇怪了，藥都注射進(jìn)去了，還用口服干嘛？所以，這肯定不是一種常見(jiàn)的分類。答案是D。12.老師想問(wèn)問(wèn)你，關(guān)于藥物穩(wěn)定性，你有什么看法？咱們藥品啊，不能放壞了，得在有效期內(nèi)保持質(zhì)量穩(wěn)定。那影響藥物穩(wěn)定性的因素有哪些呢？你想想，溫度、濕度、光照、空氣，這些是不是都會(huì)影響？還有包裝呢？是不是也很重要？那么，老師問(wèn)你，以下哪項(xiàng)**不是**影響藥物化學(xué)穩(wěn)定性的主要因素？A.溫度，B.濕度，C.包裝材料，D.藥物的有效期。老師說(shuō)，溫度、濕度、光照，這些都可能導(dǎo)致藥物發(fā)生化學(xué)變化，降解變質(zhì)。包裝材料也很關(guān)鍵，比如有些藥怕光，就得用避光包裝。有效期嘛，有效期是藥品保證質(zhì)量的期限，它描述的是穩(wěn)定性，而不是影響穩(wěn)定性的原因。所以，藥物穩(wěn)定性本身受很多因素影響，有效期是結(jié)果或指標(biāo)，不是影響因素。答案是D。13.老師跟你講講片劑的制備工藝。把藥粉壓成片劑，這個(gè)過(guò)程叫壓片。壓片過(guò)程當(dāng)中，老師要問(wèn)你，下列哪項(xiàng)**不是**壓片工藝中需要考慮的關(guān)鍵因素？A.物料流動(dòng)性，B.顆粒的粒度分布，C.壓片的壓力大小，D.藥物的熔點(diǎn)高低。老師說(shuō)，壓片要成功，藥粉得能順利通過(guò)模具，這叫流動(dòng)性，跟粒度分布關(guān)系很大。壓片需要一定的壓力把藥粉壓實(shí)成片，壓力大小很關(guān)鍵。還有啊，有些藥熔點(diǎn)低，容易在壓片時(shí)熔化粘連，那就得特別注意。但是，藥物的熔點(diǎn)高低，更多是影響工藝的難易程度或者需要采取的工藝措施（比如干法制粒、濕法制粒），它本身并不是壓片這個(gè)動(dòng)作本身的關(guān)鍵參數(shù)，不像流動(dòng)性、壓力那樣直接參與“壓”這個(gè)過(guò)程。所以，答案是D。14.老師給你講講膠囊劑。膠囊劑啊，就是把藥裝在空心膠囊里，看起來(lái)像個(gè)小膠囊。它為什么受歡迎呢？比如可以掩蓋藥物的不良?xì)馕?，保護(hù)藥物免受胃酸破壞，對(duì)吧？那么，老師問(wèn)你，膠囊劑最主要的缺點(diǎn)是什么？A.成本高，制作工藝復(fù)雜。B.不能像片劑那樣進(jìn)行質(zhì)量檢測(cè)。C.易溶性的藥物不能制成膠囊劑。D.服用不方便，容易吞咽困難。老師說(shuō)，膠囊劑的成本不比片劑高多少，工藝也成熟。質(zhì)量檢測(cè)當(dāng)然可以，片劑也一樣要檢測(cè)。易溶性的藥裝進(jìn)去，到了胃里還是會(huì)溶解的，只是可能先經(jīng)過(guò)了腸溶外殼的保護(hù)。膠囊劑最大的問(wèn)題，就是對(duì)于一些體積太大、太硬或者味道太難聞的藥，有些人吞咽起來(lái)比較困難，特別是老人和小孩。所以，服用不方便，容易吞咽困難，是它最主要的缺點(diǎn)。答案是D。15.老師想跟你談?wù)劦窝蹌Ｑ劬軏赡?，滴眼劑的要求就比較高。那么，關(guān)于滴眼劑，老師問(wèn)你，以下哪項(xiàng)要求**不是**滴眼劑通常必須滿足的條件？A.無(wú)菌，B.無(wú)刺激，C.滲透壓與淚液接近，D.含有防腐劑。老師說(shuō)，滴眼劑要給眼睛里用，肯定得**無(wú)菌**，否則眼睛會(huì)發(fā)炎。不能**刺激**眼睛，不然太難受了。眼睛里的液體是淚液，滴進(jìn)去的藥水，其**滲透壓**最好跟淚液差不多，不然會(huì)對(duì)眼睛細(xì)胞產(chǎn)生影響。但是，滴眼劑**不一定**都含防腐劑??！有些眼藥水，比如治療角膜炎的抗生素眼藥水，為了防止開(kāi)封后長(zhǎng)時(shí)間使用被污染，會(huì)加防腐劑。但有些眼藥水，比如人工淚液或者某些激素眼藥水，為了不刺激眼睛，反而**不加**防腐劑，甚至要求一次性用完。所以，含有防腐劑不是所有滴眼劑都必須滿足的條件。答案是D。16.老師給你講講栓劑。栓劑啊，就是塞在體腔里，比如肛門(mén)或者陰道，藥物通過(guò)局部吸收或者通過(guò)直腸吸收進(jìn)入血液循環(huán)。那么，栓劑在直腸給藥時(shí)，其吸收不受下列哪項(xiàng)因素影響？A.直腸的蠕動(dòng)速度，B.藥物在直腸的溶解度，C.直腸內(nèi)容物的pH值，D.給藥劑量的大小。老師說(shuō)，藥物在直腸吸收，得先溶解才行，溶解度很重要。直腸是會(huì)蠕動(dòng)的，蠕動(dòng)快慢會(huì)影響藥物與黏膜接觸的時(shí)間和面積。直腸里大便的pH值，如果跟藥物相互作用，也會(huì)影響吸收。但是，給藥劑量的大小，一般來(lái)說(shuō)，在一定的合理范圍內(nèi)，增加劑量通常會(huì)增加吸收總量，而不是完全不受到影響。吸收過(guò)程本身是存在的，只是吸收速度和程度會(huì)受其他因素影響。所以，相對(duì)而言，劑量大小不是影響吸收的“否”的因素，其他幾個(gè)都可能顯著影響。這里可能需要再斟酌一下。老師再想想，直腸給藥，藥物從固體變成溶解態(tài)才能吸收，溶解度是前提。直腸蠕動(dòng)是促進(jìn)吸收的物理過(guò)程。直腸pH影響藥物解離和溶解。那么，是不是說(shuō)，只要藥物能溶解，直腸蠕動(dòng)和pH合適，吸收就發(fā)生？劑量大小，是影響吸收速率和最終吸收量的一個(gè)重要因素，但不是決定“能不能吸收”的因素。所以，老師覺(jué)得，說(shuō)劑量大小“不受影響”可能有點(diǎn)絕對(duì)，但相比其他選項(xiàng)，它的影響可能是最間接或者說(shuō)最“可變”的。老師還是傾向于選D，因?yàn)樗皇窍袢芙舛?、蠕?dòng)、pH那樣直接影響吸收發(fā)生的“必要條件”或“核心物理化學(xué)過(guò)程”。答案是D。（老師需要意識(shí)到這個(gè)選項(xiàng)的爭(zhēng)議性，但在標(biāo)準(zhǔn)考試中，通常會(huì)選那個(gè)相對(duì)“非核心”或“可變”的因素）17.老師跟你講講乳劑。乳劑啊，就是一種液體分散在另一種液體中形成的體系，比如我們吃的有些口服液，看起來(lái)就是白色渾濁的，那就是乳劑。那么，乳劑不穩(wěn)定，容易發(fā)生什么現(xiàn)象呢？A.分層，B.破乳，C.結(jié)塊，D.氧化。老師說(shuō)，乳劑不穩(wěn)定啊，最常見(jiàn)的就是分層，就是油水分開(kāi)了。還有就是破乳，就是乳滴變大、變大，最后完全分開(kāi)。結(jié)塊嘛，通常是固體粉末或者顆粒的物理現(xiàn)象。氧化是化學(xué)反應(yīng)，雖然也可能發(fā)生在乳劑中，但不是其特有的物理不穩(wěn)定性表現(xiàn)。所以，分層和破乳是乳劑不穩(wěn)定的主要物理現(xiàn)象。這道題只讓選一個(gè)，老師選A分層，因?yàn)樗亲畛Ｒ?jiàn)和最先出現(xiàn)的物理不穩(wěn)定性表現(xiàn)。答案是A。18.老師想問(wèn)你關(guān)于藥典的問(wèn)題。藥典是個(gè)啥？老師可以跟你說(shuō)，它就像藥品的“圣經(jīng)”，是記載藥品標(biāo)準(zhǔn)、規(guī)格、檢驗(yàn)方法等的權(quán)威性技術(shù)文件。那藥典的主要作用是什么？A.指導(dǎo)臨床合理用藥。B.規(guī)范藥品的生產(chǎn)、流通和使用。C.提供新藥研發(fā)的理論依據(jù)。D.預(yù)測(cè)藥物的市場(chǎng)需求。老師說(shuō)，藥典最重要的作用，就是統(tǒng)一標(biāo)準(zhǔn)，規(guī)范行為。藥品生產(chǎn)得按照藥典標(biāo)準(zhǔn)來(lái)，藥品檢驗(yàn)得依據(jù)藥典方法，藥品使用也得參考藥典說(shuō)明。所以，規(guī)范藥品的生產(chǎn)、流通和使用，是藥典最核心的作用。指導(dǎo)臨床用藥是其中的一部分，但不是全部。新藥研發(fā)需要很多理論依據(jù)，藥典是標(biāo)準(zhǔn)，但不全是理論依據(jù)。預(yù)測(cè)市場(chǎng)需求？那是市場(chǎng)學(xué)的事兒，跟藥典關(guān)系不大。所以，答案是B。19.老師給你講講生物利用度。這概念很重要，就是口服藥物吸收進(jìn)入血液循環(huán)的藥量占給藥總量的百分比。那么，生物利用度最高的給藥途徑通常是哪種？A.靜脈注射，B.肌肉注射，C.皮下注射，D.口服給藥。老師說(shuō)，靜脈注射，藥物直接進(jìn)入血液循環(huán)，沒(méi)有任何吸收過(guò)程，所以吸收率是100%，也就是生物利用度最高。肌肉和皮下注射需要一點(diǎn)時(shí)間從血管分布到給藥部位，再吸收進(jìn)入血液循環(huán)，所以生物利用度會(huì)比靜脈低，但通常也很高?？诜o藥呢，要經(jīng)過(guò)胃腸道吸收，這個(gè)過(guò)程受很多因素影響，吸收不完全，生物利用度通常是最低的。所以，生物利用度最高的給藥途徑是靜脈注射。答案是A。20.老師最后問(wèn)你一個(gè)關(guān)于藥物作用機(jī)制的問(wèn)題。你想想，有些藥物為什么能治??？它們是跟身體里的什么東西發(fā)生了相互作用？是跟特定的細(xì)胞、特定的分子，比如受體對(duì)不對(duì)？藥物通過(guò)與靶點(diǎn)結(jié)合，然后改變靶點(diǎn)的功能，從而產(chǎn)生藥理效應(yīng)。那么，藥物作用機(jī)制的核心是？A.藥物的吸收過(guò)程，B.藥物與靶點(diǎn)（如受體）的結(jié)合并發(fā)揮作用，C.藥物的排泄過(guò)程，D.藥物在體內(nèi)的分布過(guò)程。老師說(shuō)，藥物要想產(chǎn)生治療效果，必須得找到它的“靶點(diǎn)”，這個(gè)靶點(diǎn)通常是細(xì)胞膜上的受體或者細(xì)胞內(nèi)的酶等等。藥物跟靶點(diǎn)結(jié)合了，然后才能改變靶點(diǎn)的功能，比如讓某個(gè)酶失活或者讓某個(gè)通道打開(kāi)，這才是藥物發(fā)揮作用的直接原因。吸收、分布、排泄是藥物在體內(nèi)的轉(zhuǎn)運(yùn)過(guò)程，是藥物能到達(dá)靶點(diǎn)并發(fā)揮作用的前提，但不是作用機(jī)制本身。所以，藥物作用機(jī)制的核心就是藥物與靶點(diǎn)相互作用。答案是B。二、多項(xiàng)選擇題（本部分共10小題，每小題2分，共20分。每小題有兩個(gè)或兩個(gè)以上正確答案，請(qǐng)將正確答案的字母代號(hào)填涂在答題卡相應(yīng)位置上。錯(cuò)選、漏選、多選均不得分）1.老師跟你說(shuō)啊，影響藥物吸收的劑型因素，有很多，你想想，哪些屬于這個(gè)范疇？A.藥物的溶解度，B.藥物的粒度，C.片劑的硬度，D.藥物是否包衣。老師說(shuō)，藥物得先溶解才能吸收，所以溶解度是關(guān)鍵，A對(duì)。藥物顆粒越細(xì)，跟水的接觸面積就越大，溶解越快，吸收越快，所以粒度很重要，B對(duì)。片劑壓得太硬，在胃腸道里不容易崩解，藥物就出不來(lái)，吸收就慢了，所以硬度也影響，C對(duì)。包衣可以保護(hù)藥物，延緩釋放，或者掩蓋不良?xì)馕叮@些都會(huì)影響吸收的時(shí)間和速度，所以包衣也是劑型因素，D對(duì)。這四項(xiàng)都是影響吸收的劑型因素。答案是ABCD。2.老師給你講講藥物代謝的途徑。藥物進(jìn)入身體后，肝臟這個(gè)“加工廠”會(huì)怎么處理它呢？老師可以跟你總結(jié)一下，主要有哪兩條路？A.氧化反應(yīng)，B.還原反應(yīng)，C.水解反應(yīng)，D.結(jié)合反應(yīng)。老師說(shuō)，肝臟代謝藥物，主要就是讓藥物的結(jié)構(gòu)發(fā)生改變，使其水溶性增加，更容易從身體排出去。這些改變主要通過(guò)氧化、還原、水解這幾種化學(xué)反應(yīng)實(shí)現(xiàn)。同時(shí)，肝臟還會(huì)把一些藥物或者代謝產(chǎn)物跟體內(nèi)的葡萄糖醛酸、硫酸鹽等結(jié)合，形成結(jié)合物，這也叫結(jié)合反應(yīng)，同樣是為了好排泄。所以，這四項(xiàng)都是藥物代謝的主要途徑。答案是ABCD。3.老師跟你聊聊藥物不良反應(yīng)的分類。藥物不良反應(yīng)啊，種類繁多，咱們可以按不同的標(biāo)準(zhǔn)分類。那么，按照反應(yīng)的性質(zhì)來(lái)分，主要包括哪些類型？A.副作用，B.毒性反應(yīng)，C.過(guò)敏反應(yīng)，D.致癌反應(yīng)。老師說(shuō)，這題考的是基本分類。副作用是藥物本身固有的，治療劑量下出現(xiàn)的不期望作用。毒性反應(yīng)是劑量過(guò)大或敏感引起的中毒。過(guò)敏反應(yīng)是免疫介導(dǎo)的。致癌反應(yīng)是長(zhǎng)期用藥可能增加癌癥風(fēng)險(xiǎn)的。這些都是按照反應(yīng)的性質(zhì)來(lái)劃分的常見(jiàn)類型。還有一種遺傳藥理反應(yīng)（特異質(zhì)反應(yīng)），也常被單列出來(lái)。但就這四個(gè)選項(xiàng)來(lái)看，都屬于按性質(zhì)分類的類型。答案是ABCD。（老師需要意識(shí)到特異質(zhì)反應(yīng)有時(shí)也被單獨(dú)列出，但題目給了這四個(gè)，都算合理分類）4.老師想問(wèn)問(wèn)你，關(guān)于影響藥物相互作用的因素，有哪些呢？A.藥物的吸收過(guò)程，B.藥物的代謝過(guò)程，C.藥物的作用部位，D.給藥的途徑和時(shí)間。老師說(shuō)，藥物相互作用的發(fā)生，可能是在吸收階段，比如一種藥抑制了另一種藥的吸收。也可能是在代謝階段，比如一種藥抑制了另一種藥的代謝酶，導(dǎo)致后者蓄積。藥物如果在同一個(gè)部位競(jìng)爭(zhēng)受體，肯定會(huì)產(chǎn)生相互作用。給藥途徑和時(shí)間也很重要，比如同時(shí)空腹吃和隨餐吃，效果可能完全不同。所以，這四項(xiàng)都是影響藥物相互作用的因素。答案是ABCD。5.老師跟你講講片劑的常用輔料。把藥粉壓成片劑，光有藥粉可不行，還需要加很多輔料幫忙。這些輔料，老師可以跟你概括一下，主要有哪些作用？A.填充劑，B.粘合劑，C.崩解劑，D.潤(rùn)滑劑。老師說(shuō)，藥粉量可能不夠，得加點(diǎn)東西填滿，這就是填充劑。藥粉是散的，得把它粘成一塊，才能壓片，這就是粘合劑。壓成片后，還得讓它能在水里裂開(kāi)，讓藥粉出來(lái)，這就是崩解劑。壓片過(guò)程還得順滑，不能太干澀，還得方便從沖頭取出，這就是潤(rùn)滑劑。這四類都是片劑中非常常用的輔料，各自有重要作用。答案是ABCD。6.老師給你講講注射劑的特點(diǎn)。打針啊，是一種重要的給藥方式。注射劑相比其他劑型，有哪些顯著優(yōu)點(diǎn)呢？A.吸收迅速，生物利用度高，B.可以注入無(wú)法口服的部位，C.適用于不能口服給藥的病人，如昏迷或嘔吐者，D.藥物可以制成無(wú)菌粉末，在使用前臨時(shí)溶解。老師說(shuō)，注射劑直接入血或者接近入血，吸收快，效果好，這是優(yōu)點(diǎn)，A對(duì)。可以肌肉、靜脈注射，這些部位口服不到，B對(duì)?；杳?、嘔吐的病人吃不下藥，只能打針，C對(duì)。有些藥物不穩(wěn)定，做成無(wú)菌粉末，用前再臨時(shí)配制，方便保存，D也對(duì)。這四項(xiàng)都是注射劑的優(yōu)點(diǎn)。答案是ABCD。7.老師跟你談?wù)動(dòng)绊懰幬锓€(wěn)定性的物理因素。藥物放久了，可能會(huì)變質(zhì)，這跟它存放的環(huán)境條件關(guān)系很大。哪些環(huán)境因素會(huì)加速藥物分解呢？A.溫度，B.濕度，C.光照，D.氧氣。老師說(shuō)，溫度高，化學(xué)反應(yīng)速率加快，藥物分解就快，A對(duì)。濕度大，尤其對(duì)于固體制劑，容易吸潮，甚至霉變。對(duì)于液體制劑，也可能影響溶劑的揮發(fā)或引起其他化學(xué)變化。光照，特別是陽(yáng)光直射，很多藥物會(huì)被光分解，尤其是含有不飽和鍵或易氧化結(jié)構(gòu)的，C對(duì)。氧氣，很多藥物容易氧化變質(zhì)，比如維生素C、阿司匹林，D對(duì)。這些物理因素都會(huì)影響藥物穩(wěn)定性。答案是ABCD。8.老師想問(wèn)問(wèn)你，關(guān)于軟膏劑，你有什么了解？軟膏劑啊，就是藥物分散在油脂性基質(zhì)中制成的外用制劑。那么，軟膏劑的特點(diǎn)通常有哪些？A.易于涂布，能在皮膚上形成保護(hù)膜，B.藥物釋放緩慢，作用持久，C.適用于無(wú)破損的皮膚黏膜，D.可以用于腔道給藥。老師說(shuō)，軟膏劑涂在皮膚上，比較容易抹開(kāi)，還能保護(hù)皮膚，A對(duì)?；|(zhì)是油脂，藥物在里面釋放比較慢，所以效果能維持時(shí)間長(zhǎng)，B對(duì)。它主要用來(lái)外涂，比如皮膚炎癥，前提是皮膚黏膜沒(méi)有破損，C對(duì)。如果用在口腔、陰道等腔道，藥物會(huì)溶解或被吸收，軟膏劑就不太合適了，D不對(duì)。答案是ABC。9.老師跟你講講口服固體制劑的分類。咱們吃的藥，很多是片劑或者膠囊，這些都是口服固體制劑。它們可以根據(jù)什么來(lái)分呢？A.按形狀，B.按是否需要咀嚼，C.按是否需要吞咽，D.按劑量單位。老師說(shuō)，片劑有圓形的、異形的，按形狀分是有的，A對(duì)。有的片劑比如咀嚼片，需要嚼碎再咽，有的普通片就需要吞咽，按這個(gè)分，B也行，C也行。還有，像散片，每片含量固定，按劑量單位分也很常見(jiàn)，D對(duì)。所以，這四項(xiàng)都可以作為口服固體制劑的分類依據(jù)。答案是ABCD。（老師需要審視這四個(gè)選項(xiàng)，按形狀、是否咀嚼/吞咽、劑量單位都是常見(jiàn)的分類維度，題目可能設(shè)計(jì)得有點(diǎn)寬泛，但都算合理）10.老師最后問(wèn)你一個(gè)關(guān)于藥學(xué)服務(wù)的問(wèn)題。作為藥學(xué)專業(yè)人員，我們的工作不僅僅是發(fā)藥，更重要的是什么？A.指導(dǎo)患者合理用藥，B.監(jiān)測(cè)藥物不良反應(yīng)，C.參與臨床藥物治療方案的制定，D.提供藥物信息咨詢服務(wù)。老師說(shuō)，藥學(xué)服務(wù)現(xiàn)在越來(lái)越重要了。指導(dǎo)患者怎么用藥，吃多少，什么時(shí)候吃，有沒(méi)有副作用要注意，這是核心，A對(duì)。用藥過(guò)程中可能會(huì)出現(xiàn)不良反應(yīng)，我們要幫醫(yī)生監(jiān)測(cè)，及時(shí)發(fā)現(xiàn)問(wèn)題，B對(duì)?，F(xiàn)在很多醫(yī)院藥師會(huì)參與查房，和醫(yī)生一起討論用藥方案，優(yōu)化治療，C也體現(xiàn)了藥學(xué)服務(wù)的深化。給患者、醫(yī)護(hù)人員、其他醫(yī)務(wù)人員提供專業(yè)的藥物信息，答疑解惑，D也是藥學(xué)服務(wù)的重要組成部分。這四項(xiàng)都是現(xiàn)代藥學(xué)服務(wù)的重要內(nèi)容。答案是ABCD。三、簡(jiǎn)答題（本部分共5小題，每小題4分，共20分。請(qǐng)將答案寫(xiě)在答題卡相應(yīng)位置上）1.老師跟你講講，啥叫藥物的治療指數(shù)？這玩意兒挺重要的，它反映了啥？你給我說(shuō)說(shuō)看。還有，治療指數(shù)是用啥來(lái)表示的？這個(gè)數(shù)值的大小意味著什么？老師覺(jué)得啊，這題考察的是對(duì)治療指數(shù)這個(gè)概念的理解。藥物的治療指數(shù)，說(shuō)白了，就是衡量藥物**安全性**的一個(gè)指標(biāo)。為啥要衡量安全性呢？因?yàn)橛盟幇?，目的肯定是治病，但不能把人治壞了，?duì)吧？治療指數(shù)就是通過(guò)比較藥物的**半數(shù)有效量（ED50）**和**半數(shù)中毒量（LD50）**來(lái)得出來(lái)的。啥叫ED50？就是能讓50%的人出現(xiàn)療效的那個(gè)劑量。啥叫LD50？就是能讓50%的人出現(xiàn)中毒反應(yīng)的那個(gè)劑量。得到了這兩個(gè)劑量，那治療指數(shù)（TI）就是LD50除以ED50。老師要問(wèn)你，這個(gè)治療指數(shù)數(shù)值的大小意味著啥？數(shù)值越大，說(shuō)明啥？數(shù)值越小呢，又說(shuō)明啥？數(shù)值大，說(shuō)明啥？說(shuō)明ED50和LD50之間的差距大，也就是說(shuō)，要達(dá)到有效劑量，跟出現(xiàn)中毒劑量之間有足夠的安全距離，這藥就比較**安全**。反之，數(shù)值小，說(shuō)明啥？說(shuō)明ED50和LD50之間的差距小，有效劑量跟中毒劑量靠得近，稍微一不小心就可能中毒，這藥就**風(fēng)險(xiǎn)比較大**，或者說(shuō)**安全性較低**。所以，治療指數(shù)是醫(yī)生選擇藥物時(shí)的重要參考依據(jù)?；卮穑核幬锏闹委熤笖?shù)是衡量藥物安全性的指標(biāo)，通常用半數(shù)中毒量（LD50）除以半數(shù)有效量（ED50）來(lái)表示。數(shù)值越大，表示藥物的安全性越高，即有效劑量與中毒劑量之間的差距越大；數(shù)值越小，表示藥物的安全性越低，即有效劑量與中毒劑量之間的差距越小。治療指數(shù)高的藥物相對(duì)更安全。2.老師給你講講影響藥物吸收的因素。咱們吃藥啊，不管是吃的還是喝的，都得先被身體吸收了才能起作用。這個(gè)過(guò)程受啥影響呢？老師覺(jué)得啊，這題考的是基礎(chǔ)。影響藥物吸收的因素可多了，老師給你總結(jié)幾個(gè)主要的：第一，藥物本身的性質(zhì)，比如藥物在水里的溶解度，溶解得越快越容易吸收，對(duì)吧？還有藥物的粒度，顆粒越細(xì)，跟水的接觸面積就越大，也越容易吸收。第二個(gè)，給藥的劑型，不同的劑型，比如是片劑、膠囊還是溶液，它們的吸收速度和程度都可能不一樣。第三個(gè)，跟咱們身體有關(guān)系，比如胃腸道的蠕動(dòng)快慢，胃里的酸堿度，有沒(méi)有食物在影響，這些都是重要因素。第四個(gè)，給藥的途徑，靜脈注射肯定比口服吸收快得多，這是肯定的。所以，藥物吸收是一個(gè)受多種因素綜合影響的過(guò)程?；卮穑河绊懰幬镂盏囊蛩刂饕ǎ核幬锉旧淼男再|(zhì)（如溶解度、粒度）、給藥劑型、機(jī)體因素（如胃腸道蠕動(dòng)、胃酸度、食物影響）以及給藥途徑等。這些因素共同決定了藥物吸收的速度和程度。3.老師跟你聊聊藥物相互作用?，F(xiàn)在人吃藥啊，經(jīng)常不是一種藥，可能好幾種藥一起吃，這時(shí)候就容易發(fā)生藥物相互作用，這個(gè)事兒得重視啊！老師問(wèn)你，藥物相互作用可能產(chǎn)生哪些后果？你給我列舉幾個(gè)常見(jiàn)的。老師說(shuō)，藥物相互作用啊，可不是啥好事兒，它可能會(huì)導(dǎo)致各種各樣的結(jié)果。有的呢，是藥物的效果增強(qiáng)了，咱們管這叫協(xié)同作用或者增敏作用，可能治療效果更好，但也可能增強(qiáng)副作用，甚至導(dǎo)致中毒。比如，一種藥能降低血糖，另一種藥也能降血糖，一起吃，血糖降得過(guò)低，人就可能出現(xiàn)低血糖反應(yīng)。還有的呢，藥物的效果減弱了，咱們管這叫拮抗作用，可能治療效果就不理想。比如，一種解熱鎮(zhèn)痛藥跟另一種一起吃，可能退燒效果就不好了。再有的呢，會(huì)產(chǎn)生一些咱們意料之外的新反應(yīng)，比如一些藥物合用可能會(huì)引起皮膚過(guò)敏、肝損傷、腎損傷等等。所以，藥物相互作用可能的結(jié)果包括：增強(qiáng)療效、減弱療效、產(chǎn)生新的不良反應(yīng)、毒副作用增加等。回答：藥物相互作用可能產(chǎn)生的后果包括：增強(qiáng)療效（協(xié)同作用或增敏作用）、減弱療效（拮抗作用）、產(chǎn)生新的不良反應(yīng)、毒副作用增加等。4.老師想問(wèn)問(wèn)你，啥叫藥物代謝？藥物進(jìn)了咱們身體，最后是怎么消失的呢？這個(gè)過(guò)程叫啥？藥物代謝主要在哪個(gè)器官進(jìn)行？老師覺(jué)得啊，這題考察的是藥物代謝的基本概念和場(chǎng)所。藥物代謝，老師可以簡(jiǎn)單跟你理解為，就是藥物在進(jìn)入身體后，發(fā)生了一系列的化學(xué)結(jié)構(gòu)變化的過(guò)程，目的通常是讓藥物變得更水溶，更容易從身體排出去，從而失去藥理活性。這個(gè)過(guò)程，咱們專業(yè)上叫藥物代謝，或者叫生物轉(zhuǎn)化。藥物代謝主要發(fā)生在哪個(gè)器官呢？絕大部分藥物，可以說(shuō)超過(guò)90%以上，都是在一個(gè)非常重要的器官里代謝的，那就是咱們的**肝臟**。肝臟就像個(gè)巨大的化學(xué)工廠，里面有各種各樣的酶，專門(mén)負(fù)責(zé)處理這些進(jìn)入身體的“外來(lái)客”——藥物。所以，藥物代謝主要在肝臟進(jìn)行?；卮穑核幬锎x是指藥物在體內(nèi)發(fā)生的化學(xué)結(jié)構(gòu)轉(zhuǎn)變的過(guò)程，目的是使藥物更容易從身體排出，從而降低其藥理活性。藥物代謝主要在肝臟進(jìn)行。5.老師給你講講緩釋、控釋制劑?，F(xiàn)在市面上很多藥啊，都做成緩釋或者控釋的，這是為啥呢？老師要問(wèn)你，跟普通制劑相比，緩釋、控釋制劑有什么優(yōu)點(diǎn)？你給我說(shuō)說(shuō)看。老師說(shuō)，緩釋、控釋制劑之所以受歡迎，肯定是因?yàn)樗泻锰幇?！第一個(gè)最大的好處，就是可以**減少給藥次數(shù)**，比如一天吃一次，甚至一天吃兩次都行，不用像普通片劑那樣一天吃三次還必須按時(shí)按量，對(duì)病人來(lái)說(shuō)太方便了。第二個(gè)好處，是能讓藥物在體內(nèi)**作用時(shí)間更長(zhǎng)**，維持比較平穩(wěn)的血藥濃度，這樣治療效果更穩(wěn)定，不容易出現(xiàn)血藥濃度忽高忽低的情況。第三個(gè)好處，是可能**減少副作用**，因?yàn)檠帩舛绕椒€(wěn)，不太會(huì)出現(xiàn)濃度高峰那么高的現(xiàn)象，從而降低出現(xiàn)副作用的風(fēng)險(xiǎn)。當(dāng)然，有時(shí)候也可能提高療效。所以，緩釋、控釋制劑的主要優(yōu)點(diǎn)就是減少給藥次數(shù)、延長(zhǎng)作用時(shí)間、維持平穩(wěn)血藥濃度、減少副作用等?；卮穑壕忈?、控釋制劑與普通制劑相比的主要優(yōu)點(diǎn)包括：減少給藥次數(shù)、延長(zhǎng)藥物作用時(shí)間、維持平穩(wěn)的血藥濃度、減少副作用等。四、簡(jiǎn)答題（本部分共5小題，每小題5分，共25分。請(qǐng)將答案寫(xiě)在答題卡相應(yīng)位置上）1.老師跟你聊聊藥物不良反應(yīng)的分類。咱們平時(shí)說(shuō)藥物有不良反應(yīng)，這事兒挺復(fù)雜的，涉及到很多方面。那么，按照引起反應(yīng)的原因來(lái)分，主要可以分成哪幾類？你給我說(shuō)說(shuō)看。老師說(shuō)，按原因分類啊，主要是區(qū)分一下是藥物本身的問(wèn)題，還是跟咱們身體互動(dòng)出了問(wèn)題。第一類，就是藥物本身固有的性質(zhì)導(dǎo)致的，在治療劑量下出現(xiàn)的不期望的有害反應(yīng)，咱們管這叫**副作用**。這是最常見(jiàn)的一種。第二類，就是藥物的使用不當(dāng)，比如劑量太大，或者用藥時(shí)間太長(zhǎng)，或者病人對(duì)藥物特別敏感，導(dǎo)致出現(xiàn)嚴(yán)重的不良反應(yīng)，這包括**毒性反應(yīng)**、**過(guò)度作用**、**后遺效應(yīng)**等等。第三類呢，就是跟身體免疫系統(tǒng)有關(guān)，藥物作為抗原或者刺激了免疫系統(tǒng)，引發(fā)了反應(yīng)，這就是**過(guò)敏反應(yīng)**，包括過(guò)敏性休克、皮疹等等。第四類呢，還有一類比較特殊，就是少數(shù)人由于遺傳因素，對(duì)某些藥物的反應(yīng)跟一般人不一樣，可能會(huì)出現(xiàn)嚴(yán)重甚至危及生命的不良反應(yīng)，咱們管這叫**遺傳藥理反應(yīng)**或者叫**特異質(zhì)反應(yīng)**。所以，按原因分，主要就是副作用、毒性反應(yīng)、過(guò)敏反應(yīng)、特異質(zhì)反應(yīng)這幾類。回答：按照引起反應(yīng)的原因分類，藥物不良反應(yīng)主要包括：副作用（藥物本身固有的不期望的有害反應(yīng)）、毒性反應(yīng)（藥物使用不當(dāng)或敏感引起的有害反應(yīng)）、過(guò)敏反應(yīng)（免疫介導(dǎo)的反應(yīng)）、特異質(zhì)反應(yīng)（遺傳因素導(dǎo)致的特殊反應(yīng)）。2.老師給你講講片劑的制備工藝。把藥粉壓成片劑，這個(gè)過(guò)程叫壓片。壓片過(guò)程當(dāng)中，老師要問(wèn)你，有哪些常用的輔料？這些輔料各自主要起到什么作用？你給我說(shuō)說(shuō)看。老師說(shuō)，壓片啊，不能光有藥粉，還得加些“輔助材料”，不然壓不成片，或者壓出來(lái)的片劑不好。常用的輔料主要有這幾類：第一類，叫**填充劑**或者稀釋劑，作用就是增加藥粉量，讓片劑能達(dá)到一定的重量和體積，這樣劑量才準(zhǔn)確，而且壓片時(shí)也更容易操作。第二類，叫**粘合劑**，作用就是把散的藥粉粘成一塊，形成有形的片劑，沒(méi)有它，藥粉就壓不實(shí)，一碰就散了。第三類，叫**崩解劑**，作用是片劑壓好了之后，能在水里或者唾液里快速裂開(kāi)，讓里面的藥粉出來(lái)，這樣才能保證藥物能被吸收，不至于在胃里呆太久而失效。第四類，叫**潤(rùn)滑劑**，作用是在壓片過(guò)程中讓藥粉和沖頭、沖模之間摩擦力減小，片子能順利出來(lái)，而且表面也比較光滑。有時(shí)候還會(huì)加些**著色劑**讓片子好看，或者**矯味劑**讓味道好點(diǎn)。所以，填充劑是增加重量體積，粘合劑是粘合藥粉，崩解劑是幫助裂解，潤(rùn)滑劑是幫助壓片和出片。回答：片劑的常用輔料及其主要作用包括：填充劑/稀釋劑（增加藥粉量，使片劑達(dá)到一定體積和重量）、粘合劑（將藥粉粘合成塊，形成有定形的片劑）、崩解劑（幫助片劑在水中或唾液中快速崩解，利于藥物溶出）、潤(rùn)滑劑（減小壓片過(guò)程中的摩擦力，使片劑順利從沖模中推出，并使片面光潔）。3.老師想問(wèn)你關(guān)于注射劑的特點(diǎn)。打針啊，是一種常見(jiàn)的給藥方式。注射劑相比其他劑型，有哪些顯著優(yōu)點(diǎn)？你給我說(shuō)說(shuō)看。老師說(shuō)，注射給藥啊，優(yōu)點(diǎn)挺多的，這也是為啥它應(yīng)用這么廣泛。第一個(gè)顯著的優(yōu)點(diǎn)，就是**吸收迅速，生物利用度高**。尤其是靜脈注射，藥物直接進(jìn)入血液循環(huán)，哪里需要，哪里就用，效果來(lái)得快。第二個(gè)優(yōu)點(diǎn)，就是**可以注入一些口服無(wú)法進(jìn)入的部位**。比如肌肉、靜脈，有些藥物口服會(huì)分解，或者刺激胃腸道，只能通過(guò)注射給藥。第三個(gè)優(yōu)點(diǎn)，就是**適用于一些無(wú)法口服給藥的病人**。比如昏迷的病人，嘔吐的病人，或者胃腸道功能衰竭的病人，他們吃不下藥，只能打針。還有一個(gè)優(yōu)點(diǎn)，就是有些藥物不穩(wěn)定，容易分解，可以做成無(wú)菌粉末，在使用前臨時(shí)溶解，方便保存和運(yùn)輸。所以，注射劑的主要優(yōu)點(diǎn)就是吸收快、可注入特殊部位、適用于特殊病人、部分藥物可制成粉針劑?；卮穑鹤⑸鋭┫啾绕渌麆┬偷娘@著優(yōu)點(diǎn)包括：吸收迅速，生物利用度高；可以注入無(wú)法口服的部位（如肌肉、靜脈）；適用于無(wú)法口服給藥的病人（如昏迷、嘔吐者）；部分藥物可制成無(wú)菌粉末，在使用前臨時(shí)溶解。4.老師跟你講講影響藥物穩(wěn)定性的物理因素。藥物放久了，可能會(huì)變質(zhì)，這跟它存放的環(huán)境條件關(guān)系很大。哪些環(huán)境因素會(huì)加速藥物分解呢？你給我說(shuō)說(shuō)看。老師說(shuō)，藥物穩(wěn)定性這事兒，跟存放在啥環(huán)境密切相關(guān)。物理因素啊，主要就是溫度、濕度、光照、氧氣這些。第一，**溫度**。溫度越高，化學(xué)反應(yīng)越快，藥物分解就越快。所以，藥品通常都有溫度要求，要避光、陰涼處保存。第二，**濕度**。濕度大，固體制劑容易吸潮，可能導(dǎo)致結(jié)塊、霉變。對(duì)于液體制劑，也可能影響溶劑的揮發(fā)或者引起其他化學(xué)變化。第三，**光照**。很多藥物，尤其是含有不飽和鍵或者易被氧化的藥物，在陽(yáng)光或者紫外線的照射下會(huì)分解變質(zhì)。所以，很多藥要避光保存。第四，**氧氣**。氧氣是個(gè)反應(yīng)物，很多藥物，像維生素C、阿司匹林，都比較容易跟氧氣反應(yīng)，發(fā)生氧化分解。所以，有些藥物需要充入惰性氣體保護(hù)，或者密封保存。這些物理因素，都會(huì)加速藥物的分解，降低藥物穩(wěn)定性。回答：影響藥物穩(wěn)定性的主要物理因素包括：溫度（高溫加速化學(xué)反應(yīng)）、濕度（影響固體制劑吸潮和液體制劑揮發(fā)）、光照（使某些藥物發(fā)生光分解）、氧氣（引起藥物氧化分解）。5.老師給你講講軟膏劑。軟膏劑啊，就是一種藥物分散在油脂性基質(zhì)中制成的外用制劑。那么，軟膏劑的特點(diǎn)通常有哪些？你給我說(shuō)說(shuō)看。老師說(shuō)，軟膏劑這種劑型，它有幾個(gè)挺明顯的特點(diǎn)：第一個(gè)，**易于涂布**。因?yàn)樗容^軟，用手指或者藥膏管就能涂在皮膚上，操作方便。第二個(gè)，**能在皮膚上形成保護(hù)膜**。涂在皮膚上后，基質(zhì)能封閉皮膚表面，減少水分蒸發(fā)，還能隔絕外界刺激，起到一定的保護(hù)作用。第三個(gè)，**藥物釋放緩慢，作用持久**。因?yàn)榛|(zhì)是油脂性的，藥物在里面釋放比較慢，所以藥效維持的時(shí)間通常比較長(zhǎng)。第四個(gè)，**主要適用于無(wú)破損的皮膚黏膜**。如果皮膚有傷口，軟膏劑里的油脂可能會(huì)堵塞傷口，或者引起感染，就不太適合了。所以，軟膏劑的特點(diǎn)就是易于涂布、形成保護(hù)膜、作用持久，主要適用于無(wú)破損皮膚黏膜?；卮穑很浉鄤┑奶攸c(diǎn)通常包括：易于涂布、能在皮膚上形成保護(hù)膜、藥物釋放緩慢、作用持久、主要適用于無(wú)破損的皮膚黏膜。五、論述題（本部分共2小題，每小題10分，共20分。請(qǐng)將答案寫(xiě)在答題卡相應(yīng)位置上）1.老師想跟你深入聊聊藥物相互作用?，F(xiàn)在人生活節(jié)奏快，很多人同時(shí)吃好幾種藥，或者吃保健品，這藥物相互作用的風(fēng)險(xiǎn)就增加了。那么，你結(jié)合實(shí)際，談?wù)勊幬锵嗷プ饔糜心男┲饕念愋停坎⑴e例說(shuō)明每種類型可能帶來(lái)的后果。老師說(shuō)，這題得好好說(shuō)道說(shuō)道，藥物相互作用確實(shí)是個(gè)大問(wèn)題。主要的類型，老師給你梳理一下：第一，**藥物與藥物之間的相互作用**。這是最常見(jiàn)的。比如，甲藥能抑制乙藥的代謝酶，導(dǎo)致乙藥在體內(nèi)蓄積，血藥濃度升高，可能引起中毒。比如，酶誘導(dǎo)劑，像利福平，能加速很多藥物的代謝，導(dǎo)致這些藥物的療效降低。再比如，競(jìng)爭(zhēng)性抑制，兩個(gè)藥都跟同一個(gè)靶點(diǎn)結(jié)合，一個(gè)來(lái)了，另一個(gè)就進(jìn)不去了，效果就打折扣了。第二，**藥物與食物之間的相互作用**。有些食物可能會(huì)影響藥物吸收或者代謝。比如，高脂肪餐可能會(huì)延緩口服藥物的吸收。再比如，富含維生素C的食物可能會(huì)增強(qiáng)某些藥物的排泄。還有一些食物本身就有藥理作用，跟藥物合用可能會(huì)產(chǎn)生疊加或者拮抗效應(yīng)。第三，**藥物與飲料之間的相互作用**。比如，喝酒和服用某些藥物，像解熱鎮(zhèn)痛藥，可能會(huì)加重肝臟損傷。再比如，喝咖啡可能影響某些抗抑郁藥的療效。第四，**藥物與中草藥/保健品之間的相互作用**。這個(gè)現(xiàn)在越來(lái)越多了。很多中草藥或者保健品也含有活性成分，跟西藥合用可能會(huì)發(fā)生相互作用，影響藥效或者增加風(fēng)險(xiǎn)。比如，銀杏葉制劑和抗凝藥合用，可能會(huì)增加出血風(fēng)險(xiǎn)。所以，藥物相互作用后果挺嚴(yán)重的，輕則影響療效，重則導(dǎo)致嚴(yán)重不良反應(yīng)甚至危及生命。咱們作為藥學(xué)人員，一定要提醒患者注意，避免藥物、食物、飲料、保健品混用而不經(jīng)意的風(fēng)險(xiǎn)?；卮穑核幬锵嗷プ饔檬侵竷煞N或兩種以上藥物同時(shí)或先后使用時(shí)，其作用發(fā)生改變的現(xiàn)象。主要類型及后果舉例說(shuō)明如下：（1）藥物與藥物之間的相互作用：a.**代謝相互作用**：一種藥物抑制或誘導(dǎo)另一種藥物的代謝酶，導(dǎo)致其血藥濃度異常。例如，藥物A是肝藥酶誘導(dǎo)劑，藥物B需要通過(guò)肝藥酶代謝，同時(shí)使用藥物A會(huì)加速藥物B的代謝，導(dǎo)致藥物B療效降低。反之，藥物C是肝藥酶抑制劑，藥物D需要通過(guò)肝藥酶代謝，同時(shí)使用藥物C會(huì)抑制藥物D的代謝，導(dǎo)致藥物D血藥濃度升高，可能引起毒性反應(yīng)。后果可能是療效增強(qiáng)、療效減弱、毒性增加或產(chǎn)生新的不良反應(yīng)。b.**藥代動(dòng)力學(xué)相互作用**：藥物之間的競(jìng)爭(zhēng)性吸收或排泄。例如，藥物E和藥物F都通過(guò)腎臟排泄，同時(shí)使用這兩種藥物可能會(huì)競(jìng)爭(zhēng)腎小管排泄途徑，導(dǎo)致兩者在體內(nèi)蓄積，增加毒性風(fēng)險(xiǎn)。或者，兩種藥物競(jìng)爭(zhēng)吸收部位，如胃腸道吸收部位，可能會(huì)導(dǎo)致其中一種或兩種藥物吸收減少，療效降低。c.**受體相互作用**：藥物之間競(jìng)爭(zhēng)性結(jié)合相同的受體。例如，藥物G和藥物H都作用于相同的受體，當(dāng)它們同時(shí)使用時(shí)，可能會(huì)相互競(jìng)爭(zhēng)結(jié)合受體，導(dǎo)致其中一種藥物的效果減弱或消失。（2）藥物與食物之間的相互作用：a.**吸收相互作用**：食物成分影響藥物的吸收速度或程度。例如，高脂肪餐可能會(huì)延緩口服藥物X的吸收，因?yàn)橹緯?huì)影響藥物在胃腸道中的溶解和吸收過(guò)程，導(dǎo)致藥物起效時(shí)間延長(zhǎng)。b.**代謝相互作用**：食物成分影響藥物的代謝過(guò)程。例如，富含維生素K的食物，如菠菜、西蘭花，可能會(huì)增強(qiáng)口服抗凝藥Y的代謝，降低其抗凝效果，增加血栓形成的風(fēng)險(xiǎn)。（3）藥物與飲料之間的相互作用：a.**代謝相互作用**：飲料成分影響藥物的代謝過(guò)程。例如，酒精與某些藥物，如甲硝唑、頭孢類抗生素，合用可能會(huì)抑制肝臟中某些酶的活性，增加酒精或藥物在體內(nèi)的濃度，導(dǎo)致雙硫侖樣反應(yīng)或其他不良反應(yīng)。b.**藥效相互作用**：飲料成分影響藥物的效果。例如，咖啡因可能增強(qiáng)某些藥物，如某些抗抑郁藥，的興奮作用，導(dǎo)致失眠、心悸等副作用。（4）藥物與中草藥/保健品之間的相互作用：a.**代謝相互作用**：中草藥或保健品中的成分可能誘導(dǎo)或抑制肝藥酶，影響其他藥物的代謝。例如，圣約翰草中的活性成分可能誘導(dǎo)肝臟中的細(xì)胞色素P450酶系，加速多種藥物，如抗凝藥華法林、抗抑郁藥，的代謝，導(dǎo)致這些藥物的療效降低。b.**藥效相互作用**：中草藥或保健品中的成分可能增強(qiáng)或拮抗其他藥物的效果。例如，銀杏葉制劑中的銀杏黃酮類成分具有抗血小板聚集的作用，與抗凝藥華法林合用，可能會(huì)增加出血風(fēng)險(xiǎn)。藥物相互作用可能導(dǎo)致療效降低、療效增強(qiáng)、毒性增加或產(chǎn)生新的不良反應(yīng)。因此，患者在使用多種藥物、食物、飲料或中草藥/保健品時(shí)，應(yīng)告知醫(yī)生或藥師自己正在使用的所有藥物、食物、飲料或中草藥/保健品，以避免潛在的相互作用風(fēng)險(xiǎn)。2.老師想跟你聊聊藥物劑型的選擇。咱們藥廠啊，要把藥物制成各種劑型，比如片劑、膠囊、注射劑，到底選哪種，不能瞎選，得根據(jù)藥物的性質(zhì)、治療目的、給藥途徑，還有患者的具體情況來(lái)綜合考慮。那么，你結(jié)合實(shí)例，談?wù)動(dòng)绊懰幬飫┬瓦x擇的主要因素有哪些？并分析這些因素是如何影響劑型選擇的。老師說(shuō)，這題挺重要的，選對(duì)劑型，藥才能更好地發(fā)揮作用。影響藥物劑型選擇，老師覺(jué)得啊，主要得考慮這么幾個(gè)大方面：第一，**藥物本身的性質(zhì)**。這個(gè)最基本。比如，藥物是油溶性的，肯定不能直接口服，得先轉(zhuǎn)化成水溶性的，或者得有個(gè)載體把它包裹起來(lái)，不然在胃里就分解了。藥物的穩(wěn)定性怎么樣？如果藥物不穩(wěn)定，容易氧化或者水解，那是不是得選個(gè)能保護(hù)它的劑型？比如，腸溶膠囊就能保護(hù)藥物免受胃酸破壞。藥物的劑量大小也是個(gè)問(wèn)題。劑量太大，能不能做成片劑？如果劑量很小，做成片劑可能劑量不準(zhǔn)確，是不是得考慮制成膠囊或者顆粒劑，這樣劑量才能更精確？所以，藥物的性質(zhì)，比如溶解度、穩(wěn)定性、劑量大小，直接決定了劑型能不能用，或者需要什么樣的特殊處理。第二，**治療目的**。這個(gè)也挺關(guān)鍵的。比如，要是想快速起效，肯定是靜脈注射或者舌下含服，吸收快。如果想讓藥在體內(nèi)慢慢作用，維持時(shí)間長(zhǎng)，是不是就得選緩釋或者控釋制劑？還有啊，如果治療的是皮膚病，那外用劑型，比如軟膏劑，肯定比口服劑型更方便。所以，想要達(dá)到的治療效果，比如起效速度、作用持續(xù)時(shí)間、給藥的方便性，都會(huì)影響劑型的選擇。第三，**給藥途徑**。這個(gè)不用多說(shuō)了吧？口服是常見(jiàn)的，但能不能口服？比如胃潰瘍，是不是有些藥就不能吃？那是不是得選栓劑？還有，如果是急救，肯定得選靜脈給藥，對(duì)不對(duì)？所以，藥物能不能被吸收，以及吸收的快慢，直接決定了劑型怎么選。第四，**患者的因素**。這個(gè)也很重要。比如，老年人，是不是吞咽困難，是不是肝腎功能不好？這時(shí)候是不是得選劑型簡(jiǎn)單點(diǎn)，比如顆粒劑，或者選擇生物利用度高、不需要特殊處理就能吸收的劑型？?jī)和?，是不是得考慮藥物的味道？是不是得選膠囊或者顆粒劑，方便吃？所以，患者的年齡、生理狀況、用藥依從性，都是咱們選劑型時(shí)得考慮的。第五，**經(jīng)濟(jì)成本和劑型的穩(wěn)定性**。有時(shí)候啊，一種劑型可能效果最好，但成本太高，或者穩(wěn)定性太差，那肯定也得忍痛割愛(ài)，選個(gè)既經(jīng)濟(jì)實(shí)惠，又能保證藥物質(zhì)量的選擇。比如，有些藥物制成普通片劑最便宜，但穩(wěn)定性差，是不是就得選成本高但穩(wěn)定好的緩釋片？所以，經(jīng)濟(jì)成本和劑型的穩(wěn)定性，也是咱們選劑型時(shí)得權(quán)衡的。第六，**法規(guī)要求**。有些劑型可能效果不錯(cuò)，但國(guó)家藥監(jiān)局不認(rèn)可，那也不能用啊！所以，得符合法規(guī)要求。所以，這些因素啊，都是咱們選劑型時(shí)得綜合考量的。比如，一種藥物，它本身溶解度不好，劑量也比較大，那是不是得考慮制成腸溶片劑，既能保護(hù)藥物，又能保證劑量準(zhǔn)確？如果患者是老年人，吞咽困難，是不是得考慮制成混懸劑或者溶液劑？如果藥物不穩(wěn)定，是不是得選腸溶膠囊？如果患者是兒童，是不是得考慮制成口感好的顆粒劑？所以，藥物的性質(zhì)、治療目的、給藥途徑、患者因素、經(jīng)濟(jì)成本和法規(guī)要求，這些因素相互影響，共同決定了最終的劑型選擇。咱們藥師啊，就得把這些因素都考慮到，才能給患者選到最合適的劑型，既安全有效，又方便經(jīng)濟(jì)。你想想看，比如有個(gè)藥物，它得保護(hù)起來(lái)，是不是得選腸溶膠囊？比如有個(gè)藥物，得快速起效，是不是得選溶液劑？比如有個(gè)藥物，得讓患者每天只吃一次，是不是就得選緩釋片？所以，劑型選擇是個(gè)系統(tǒng)工程，得綜合考慮，不能只看一個(gè)方面?；卮穑河绊懰幬飫┬瓦x擇的主要因素包括藥物本身的性質(zhì)、治療目的、給藥途徑、患者因素、經(jīng)濟(jì)成本和法規(guī)要求。這些因素是如何影響劑型選擇的：（1）藥物本身的性質(zhì)：藥物的溶解度、穩(wěn)定性、劑量大小直接影響劑型選擇。例如，藥物X溶解度很小，劑量較大，為了提高生物利用度，可以選擇制成顆粒劑或膠囊劑，以便藥物在胃腸道中更好地分散和溶解。如果藥物X不穩(wěn)定，容易在胃酸或腸道環(huán)境中分解，為了保護(hù)藥物或提高穩(wěn)定性，可以選擇腸溶膠囊劑，使藥物在腸道中釋放。如果藥物X劑量很小，為了確保劑量準(zhǔn)確，可以選擇片劑、膠囊劑或注射劑，以便精確控制劑量。（2）治療目的：治療目的直接影響劑型選擇。例如，如果治療需要快速起效，為了加速藥物進(jìn)入血液循環(huán)，可以選擇靜脈注射劑。如果治療需要長(zhǎng)期維持穩(wěn)定療效，可以選擇緩釋或控釋制劑，以延長(zhǎng)藥物作用時(shí)間，減少給藥次數(shù)。如果治療局部疾病，可以選擇外用劑型，如軟膏劑、滴眼劑，以便藥物直接作用于病灶。（3）給藥途徑：給藥途徑是影響劑型選擇的關(guān)鍵因素。例如，如果藥物需要口服給藥，但患者吞咽困難，可以選擇舌下含服劑型，以便藥物直接通過(guò)舌下黏膜吸收，避免胃腸道吸收過(guò)程。如果藥物需要注射給藥，但患者無(wú)法口服，可以選擇直腸給藥劑型，如栓劑，以便藥物通過(guò)直腸黏膜吸收，避免胃腸道吸收過(guò)程。（4）患者因素：患者的年齡、生理狀況、用藥依從性等都會(huì)影響劑型選擇。例如，老年人吞咽困難，可以選擇顆粒劑或口服混懸劑，以便更容易吞咽。兒童患者，可以選擇口感好的劑型，如口服液體制劑，以提高患者的用藥依從性。患者肝腎功能不全，需要選擇生物利用度高、不需要特殊處理就能吸收的劑型，以保證療效。（5）經(jīng)濟(jì)成本和劑型的穩(wěn)定性：經(jīng)濟(jì)成本和劑型的穩(wěn)定性也是影響劑型選擇的重要因素。例如，一種藥物，可以選擇經(jīng)濟(jì)實(shí)惠的普通片劑，但如果普通片劑的穩(wěn)定性差，可能會(huì)影響療效。這時(shí)候，為了確保藥物質(zhì)量，可以選擇成本高但穩(wěn)定性好的緩釋片，以延長(zhǎng)藥物作用時(shí)間，減少給藥次數(shù)。（6）法規(guī)要求：藥物劑型的選擇必須符合法規(guī)要求。例如，有些劑型可能效果不錯(cuò)，但國(guó)家藥監(jiān)局不認(rèn)可，那也不能用。所以，得符合法規(guī)要求。比如，有些藥物，因?yàn)榉€(wěn)定性問(wèn)題，可能需要選擇特殊劑型，比如腸溶膠囊劑，以保護(hù)藥物，延長(zhǎng)作用時(shí)間。綜合考慮這些因素，才能給患者選到最合適的劑型，既安全有效，又方便經(jīng)濟(jì)。咱們藥師啊，就得把這些因素都考慮到，才能給患者選到最合適的劑型，提高用藥的療效和安全性。本次試卷答案如下一、單項(xiàng)選擇題1.B解析：藥物劑型中，溶液劑的藥物分散度最大，所以片劑藥物分散度最小。2.A解析：藥物的治療指數(shù)是用LD50/ED50來(lái)表示的，數(shù)值越大，表示藥物的安全性越高；數(shù)值越小，表示藥物的安全性越低。3.C解析：緩釋制劑是藥物釋放完全受控，速度恒定。4.A解析：緩釋、控釋制劑可以減少給藥次數(shù)，比如一天吃一次，甚至一天吃兩次都行，不用像普通片劑那樣一天吃三次還必須按時(shí)按量。5.D解析：軟膏劑主要適用于無(wú)破損的皮膚黏膜。6.A解析：藥物代謝主要在肝臟進(jìn)行。7.D解析：藥物相互作用可能產(chǎn)生增強(qiáng)療效、減弱療效、產(chǎn)生新的不良反應(yīng)、毒副作用增加等后果。8.B解析：藥物相互作用可能是藥物與靶點(diǎn)競(jìng)爭(zhēng)受體。9.C解析：藥物相互作用可能產(chǎn)生新的不良反應(yīng)。10.A解析：藥物吸收迅速，生物利用度高，是靜脈注射的特點(diǎn)。11.B解析：藥物代謝是指藥物在體內(nèi)發(fā)生的化學(xué)結(jié)構(gòu)轉(zhuǎn)變的過(guò)程。12.A解析：藥物的治療指數(shù)是衡量藥物安全性的指標(biāo)。13.C解析：軟膏劑的特點(diǎn)是易于涂布，能在皮膚上形成保護(hù)膜。14.D解析：藥物代謝主要在肝臟進(jìn)行。15.B解析：軟膏劑主要適用于無(wú)破損的皮膚黏膜。16.B解析：藥物相互作用可能是藥物與靶點(diǎn)競(jìng)爭(zhēng)受體。17.A解析：藥物相互作用可能是藥物與靶點(diǎn)競(jìng)爭(zhēng)受體。18.C解析：藥物相互作用可能是藥物與靶點(diǎn)競(jìng)爭(zhēng)受體。19.D解析：藥物相互作用可能是藥物與靶點(diǎn)競(jìng)爭(zhēng)受體。20.A解析：藥物的治療指數(shù)是衡量藥物安全性的指標(biāo)。二、多項(xiàng)選擇題1.ABCD解析：影響藥物吸收的劑型因素包括藥物的溶解度、粒度、片劑的硬度、藥物是否包衣。2.ABCD解析：藥物代謝的途徑包括氧化反應(yīng)、還原反應(yīng)、水解反應(yīng)、結(jié)合反應(yīng)。3.ABCD解析：藥物不良反應(yīng)的分類包括副作用、毒性反應(yīng)、過(guò)敏反應(yīng)、致癌反應(yīng)。4.ABCD解濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟(jì)濟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