28抗心绞痛药-白--1

《28抗心绞痛药-白--1》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、Chapter28抗心绞痛药Anti-anginaPectorisDrugsTeachinggoals列举抗心绞痛药物分类及代表药。简述硝酸甘油抗心绞痛作用及机理。分析硝酸酯类与－R阻断药合用治疗心绞痛是否合理。I.Introduction(概述)Anginapectoris(心绞痛)isacommonsymptomofcoronaryartery(冠状动脉)diseasecausedbytransient(短暂)episodes(发作)ofmyocardialischemia(缺血)andanoxia(

2、缺氧).Anattackofanginapectorisoccurswhentheneedofthemyocardiumforoxygenexceedstheamountdeliveredtoitbythecoronarycirculation.【ClassificationofAnginaPectoris】Stableanginapectoris(稳定型、劳累型心绞痛)：冠脉粥样硬化，激动、劳累时发作Unstableanginapectoris(不稳定型心绞痛)：（非典型性或梗死前心绞痛）冠脉粥样硬化，血

3、栓，可发展为心梗或猝死，也可恢复为稳定型心绞痛。Variantanginapectoris(变异型心绞痛)：冠脉痉挛所致，夜间或休息时发作。【发病机理】Determinantsofmyocardialoxygenconsumption(决定心肌耗氧量主要因素):Ventricularwalltension(室壁张力)Heartrate(心率)Ventricularcontractility(心室收缩力)Ejectiontime(射血时间)Anginapectorisresultsfromanimbalanc

4、e(失衡)betweenoxygensupply-demandrelationshipinischemic(缺血的)regionsofthemyocardium(心肌).NormalOxygensupplyOxygendemandAngina供氧耗氧冠脉硬化痉挛栓塞射血时间↑心室容积↑收缩力↑HR↑Principlesoftreatment(治疗原则)：耗氧室壁张力心率心肌收缩力心脏负荷冠脉血流量侧枝循环心舒张时间供氧〓Torecoverthebalancebetweenoxygensupplyandoxy

5、genconsumption.(恢复氧供需平衡)【Classificationofanti-anginapectoris】(抗心绞痛药物分类)1）Organicnitrates(硝酸酯类)2）－Rblockers3）Calciumchannelblockers(钙拮抗剂)II.Organicnitrates(硝酸酯类)Nitroglycerin(硝酸甘油)【Pharmacokinetics】1.Becauseofmarkedfirst-passeliminationitcannotbegivenorall

6、y,andusuallygivensublingually(舌下).（首过消除明显,口服无效，舌下含服）2.可透皮吸收【pharmacologicalactions】Reductionofmyocardialoxygenconsumption（降低心肌耗氧量）Dilationofveins(扩V)myocardialoxygenconsumption心肌耗氧量cardiacpreload(心脏前负荷)Dilationofarteries(扩A)Cardiacafterload(心脏后负荷)Note:HR↑、

7、心肌收缩力↑→耗氧↑why2.Dilatecoronaryartery,increasethebloodflowinischemicareas.(扩张冠脉，↑缺血区血流)Nitroglycerin→舒张侧枝血管→血流重新分布→从非缺血区经侧枝流向缺血区→缺血区血供↑3.Increasethebloodflowinsubendocardialarea.(↑心内膜下区域血供)Nitroglycerin硝酸甘油扩V→LVEDP↓扩心外膜大血管扩侧支血管心内膜下缺血区血供↑4.保护缺血的心肌细胞，减轻缺血损伤mec

8、hanism【clinicaluses】1.Alltypesofanginapectoris(各型心绞痛):急性发作首选,舌下(sublingually)给药2.Acutemyocardialinfarction(急性心肌梗死)3.Congestiveheartfailure(充血性心衰)【Adversereactions】Vasodilation(扩血管)：面部潮红、搏动性头痛、体位性低血压、眼压↑、颅内压↑2