抗心绞痛药.ppt

antianginaldrugs 抗心绞痛药 objectives knowthemajorclassesofdrugsusedtotreatanginaandtheirmechanismsofaction抗心绞痛药分类 代表药及其作用机制 whatisanginapectoris 冠脉供氧不足引起的暂时性急剧心肌缺血所致的临床综合征 表现为胸骨后疼痛 并可放射到左臂 是冠状动脉粥样硬化性心脏病 冠心病的常见症状 itistheprinciplesymptomofischemicheartdiseasetheconditionischaracterizedbysudden severesubsternalpainorpressure oxygensupply oxygendemand coronaryatherosclerosis冠状动脉硬化 95 coronaryarteryspasm冠状动脉痉挛coronarythrombosis冠状动脉血栓形成 myocardialcontractility 心肌收缩力hr 心率sports moodmodification运动 情绪改变 anginapectorispatterns factorsaffectingmyocardialoxygendemandandoxygensupply chemicalstructuresoftwonitrates nitroglycerine硝酸甘油 isosorbidedinitrate硝酸异山梨酯 pharmacologicalmechanism organicnitratesnoguanylylcyclase 鸟苷酸环化酶 gtpcgmpcgmpdependentproteinkinaseintracellularca2 vascularsmoothmusclerelaxation oxygendemand venousrelaxation静脉舒张 arteryrelaxation largedose 动脉舒张 大剂量 venousreturn回心血量 preload前负荷 ventricularend diastolicvolume心室舒张末期容积 ventricularwalltension心室壁张力 vet 心室射血时间 afterload后负荷 oxygendemand耗氧量 tpr 总外周阻力 oxygensupply ventricularwalltension心室壁张力 coronarybloodflow especiallytheischemicmyocardium 冠脉供血 特别是缺血区心肌 coronaryarteryrelaxation冠脉舒张 oxygensupply ventricularwalltension心室壁张力 subendocardialvascularresistance心内膜下血管阻力 ventricularpressure心室内压 bloodflowfromtheepicardialtoischemiczoneofendocardial血液从心外膜流向心内膜缺血区 coronarysteal冠脉窃血 pharmacokineticpropertiesofnitrates routesofadministration gtncanbeadministeredbysublingually inhalation transdermalorbuccal it snotsuitableformaintenancetherapy ivnitrogylcerincanbeusedtotreatsevererecurrentunstableangina gtn可吸入 颊部 透皮或舌下含服 作用时间短 不适合维持治疗 静注用于不稳定型的严重复发 bid qd 5 ismnisnotsubjecttofirst passmetabolismandis100 availableafteroraladministration slowlyonset longduration 口服生物利用度高 起效慢 维持久 clinicaluses adverseeffectsofnitrovasodilators ngtmaybecausemethemoglobinemiawhenadmistreateditwithlong termandlargedose 长期大剂量应用ngt可致高铁血红蛋白血症 toleranceanddependencewithnitrovasodilators effectsofnitratesaloneandwith blockersinanginapectoris ca2 channelblockers dhps non dhps relativecardiovasculareffectsofcalciumchannelblockers verapamil diltiazem nifedipine 0nicardipine 0 0 compound coronaryvasodilation suppressionofcardiaccontractility suppressionofsanode suppressionofavnode clinicalusesofccbs treatmentstrategy interactionofdrugs nitrateesters rbs nifedipine verapamildiltiazem partialfattyacidoxidation pfox inhibitors部分脂肪酸氧化酶抑制剂 atp sensitiv