management of ischaemic heart disease stroke 缺血性心脏病药物治疗中风课件

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1、PharmacologicalmanagementofIschaemicheartdiseaseandacutemyocardialinfarctionOctober2006AtherosclerosisThecomplicationsofatherosclerosisconstitutethegreatestcauseofmorbidityandmortalityintheWesternWorldaccountingfor40%ofalldeathsAtherosclerosisProgressiveluminalnarrowing-anginapectoris

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3、duresAnginapectorisMyocardialoxygendemandexceedssupplychestpainStableangina-transientmyocardialischaemia-predictable,reproducible-relievedbyrestorGTNPrinciplesoftreatmentIncreaseoxygensupplyorreduceoxygendemandsofmyocardiumReduceheartrateReducepreloadReduceafterloadImprovecoronaryblo

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5、rates-ModeofactionMetabolisedtoreleaseNitricoxide(NO)cGMPDephosphorylationofmyosinlightchainsIncreasedintracellularcalciumMusclerelaxationNitrates-ModeofactionVenodilation-preloadCoronaryarteryvasodilation-supplyModeratearteriolardilation-afterloadPharmacologicalpropertiesGlyceryl

6、trinitrate(GTN)shortacting,firstpassmetabolismsublingual/intravenous/patchadministrationIsosorbidedinitrateintermediateactingsublingual/intravenous/oraladministrationIsosorbidemononitratelongactingoraladministrationAlfredNobelPharmacologicalpropertiesTolerance(tachyphylaxis)-reducedth

7、erapeuticeffects“Mondaymorningsickness”?duetodepletionoffreetissue–SHLong-actingpreparations/infusions/transdermalpatches“Nitratefreeperiod”IndicationsReliefofacuteanginaattackProphylaxisofstableangina(priortoexerciseGTNorlong-acting)LeftventricularfailureCautions/ContraindicationsHyp

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