最新AntianginalDrugs抗心绞痛药教学讲义ppt.ppt

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1、AntianginalDrugs抗心绞痛药Coronaryvessels:bloodsupplyfortheheart1.OVERVIEWCoronaryatherosclerosis:causeofcardiacischemiaMyocardialoxygendemandischieflydeterminedby:ContractilityHeartrateWalltensionPreload(venousreturn)Afterload(arteriolarresistance)1.OVERVIEWpreloadafterloadMyocard

2、ialoxygendemandisdiminishedby:ReducingcontractilityReducingheartrateReducingthepreloadReducingtheafterload1.OVERVIEWWalltension1.OVERVIEWMyocardialoxygensupplyischieflydeterminedby:AVoxygendifferenceRegionalmyocardialdistributioncoronarybloodflow:vascularresistance,arterypres

3、sureEffectsofantianginaldrugs:ReducingoxygendemandsReducingheartrateandcontractilityDilatingsystemicarteriesandveins(walltensionbyloweringheartloads)IncreasingoxygensupplyDilatingconductcoronaryarteries(coronarybloodflow)Promotingregionaldistribution(inischemicregions)Other

4、s:Anti-plateletcoagulationandthrombusformation1.OVERVIEW2.1NitratesNitroglycerin(硝酸甘油)A.PharmacologicalactionsDilatingvesselsandreducingheartloadswalltension;reflextachycardiaRedistributionofcoronarycirculationdilatingconductartery:collateralcirculationreducingwalltension:bl

5、oodflowinischemicsubendocardialarea2.AntianginaldrugsInfluenceoforganicnitratesanddipyridamoleonthebloodsupplyofischemicarea2.AntianginaldrugsMechanismoftheeffectofnitroglycerinandothernitrates2.AntianginaldrugsMechanismoftheeffectofnitroglycerinandothernitratesB.Clinicaluses

6、Anginapectoris:allkinds,especiallystabletypeHeartfailure：reducingheartloadsduetovasodilationC.AdversereactionsIncreaseinheartrateandcontractilitySymptomsduetovasodilation:headache,flash,posturalhypotension,collapse,ect.Others:methaemoglobinaemia（高铁血红蛋白）Tolerance:avoidingsteady

7、-stateplasmaconcentration;supplementofagentscontaining–SH(captopril)2.Antianginaldrugs2.1OthernitratesIsosorbidedinitrate(硝酸异山梨酯)Isosorbide-5-mononirate(5-硝酸异山梨酯)Comparedwithnitroglycerin:SimilarbutweakereffectActingslowlybutlastinglongerLargerindividualvariationandmoreadverse

8、effects2.Antianginaldrugs2.2receptorblockersA.Pharmacologica