最新哈尔滨医科大药学医学药理学课件-治疗充血性心衰药-药学医学精品资料.ppt

《最新哈尔滨医科大药学医学药理学课件-治疗充血性心衰药-药学医学精品资料.ppt》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、最新哈尔滨医科大药学医学药理学课件-治疗充血性心衰药-药学医学精品资料MyocardialremodelinginCalcineurintransgenichearts(Cell,Vol93,215-228,1998)HeartfailureReducedcardiacoutputSympatheticnervoussystemactivationVasoconstrictionElevatedcardiacfillingpressureSodiumandwaterretentionAngiotensinⅠReninCardiacremodelingAldost

2、eroneAngiotensinⅡPathophysiologicalmechanismsofheartfailureandmajorsitesofdrugactiondigoxinβ-blockers,digoxinVasodilatorsACEinhibitorsSpironolactoneDiureticsAngiotensin-RblockersSignsandsymptomsofcardiacglycosidetoxicityPsychiatricDelirium,fatigue,confusion,dizziness,abnormaldreamsVi

3、sualBlurredoryellowvision,halosGastrointestinalNausea,vomiting,abdominalpainCardiacarrhythmiasAtrialandventricularectopicarrhythmiasConductiondisturbancesSinoatrialandatrioventricularnodeconductiondisturbancesEffectofspironolactoneonsurvivalinpatientswithmoderateorseverecongestivehea

4、rtfailureinarandomizeddouble-blindclinicalstudy.(fromBasicandclinicalpharmacology,8th2001)DrugclassExamplesMechanismofvasodilatingactionPreloadreductionAfterloadreductionOrganicnitratesNitroglycerinNitricoxide-mediatedvasodilation++++NitricoxidedonorsNitroprussideNitricoxide-mediated

5、vasodilation++++++ACEinhibitorsCaptoprilInhibitionofangiotensingeneration++++AngiotensinreceptorblockersIosartanBlockadeofangiotensinreceptors++++PhosphodiesteraseinhibitorsMilrinoneInhibitionofcAMPdegradation++++Direct-actingHydralazineUnknown++++α1-receptorantagonistsPrazosinSelect

6、iveα1-receptorblockade+++++Nonselectiveα-receptorantagonistsPhemtolamineNonselectiveα-receptorblockade++++++Ca2+channelblockersNifedipineInhibitionofL-typeCa2+channels++++β-receptoragonistsIsoproterenolStimulationofvascularβ2-receptors+++VasodilatordrugsusedtotreatheartfailureMajoref

7、fectsofangiotensinIIandthemechanismthatmediatethemAngiotensinIIAlteredperipheralresistanceAlteredcardiovascularstructureAlteredrenalfunctionA.Directvasoconstriction.B.Enhancementofperipheralnoradrenergicneurotransmission.C.Increasedsympatheticdischarge.D.Releaseofcatechola-minesfroma

8、drenalmedull