第21章+抗心绞痛与抗动脉粥样硬化药

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1、AntianginalDrugsZhuYiZhun,Dept.ofPharmacology,SPFDUEmail:zhuyz@fudan.edu.cnHypertensionTherefore,itisimportanttotreathypertensionandreducemortalityandmorbidityoftheseconditionsEndorgandamageisassociatedwithincreasedriskfromischemicheartdisease,cerebrovascularaccidents,heartandrenalfailur

2、e.ComplicationsofuntreatedhypertensionHypertensivecardiovasculardiseaseHypertensivecerebrovasculardiseaseanddementiaHypertensiverenaldiseaseAorticdissectionAtheroscleroticcomplicationMyocardialinfarction(MI)isoneofthemostcommondiagnosesoccurringintheworld.Itsmortalityisapproximately30%.A

3、lthoughthesurvivalfollowingtreatmenthasimprovedinthelasttwodecades,themorbidityandmortalityofMIstillremainhigh.MYOCAIDIALINFARCTIONLEADINGCAUSESOFMORTALITYINWHOREPORTThemortalityofischaemicheartdiseaseisrankedfirstamongotherdiseasesintheWHOstatisticsMYOCARDIALINFARCTIONMyocardialInfarcti

4、ongenerallyoccurswiththeabruptdecreaseincoronarybloodflowthatfollowsathromboticocclusionofacoronaryarteryleadstoirreversiblemyocardialcellsdamageandnecrosis.AnginapectorisIsthemostcommonconditioninvolvingintissueischemiaVasodilatordrugsarecommonlyused(e.g.nitroglycerin,calciumchannelbloc

5、ker)-blockersarealsousefulVasodilatorsCalciumchannelsblockers:arteriodilator(e.g.Nifedipine硝苯地平,verapamil异搏定,diltiazem硫氮卓酮)Nitrites(increaseNO):venodilator(+++),Arterioles(+),ischemiczone(+).ACEinhibitors(e.g.Captopril开普通)andangiotensinIIreceptorantagonists(Losartan氯沙坦):mixedCauseAthero

6、matousobstruction—mostfrequentPrimarycause:imbalancebetweentheoxygenrequiredbytheheartandoxygensuppliedtoitbythecoronaryartery.O2requiredO2suppliedNitrates&Nitrites(硝酸盐&亚硝酸盐)MechanismsofactioninAngina:*Endothelial-derivedrelaxationfactor(EDRF内皮衍生的松弛因子)—nitricoxide(NO•):inducescoronaryvas

7、odilation*Nitratesdilatecoronaryarteriesto:1)redistributebloodflowfromepicardialtoendocardialregions.2)relievecoronaryspasmanddynamicstenosis*ReduceoxygendemandNitrates/NitritesNORelaxationDrugsusedtotreatAnginaNitrates:Nitroglycerin(glyceryltrinitrate)Pentaerythritoltetr