第21章 抗心绞痛与抗动脉粥样硬化药英文

AntianginalDrugs,ZhuYiZhun,Dept.ofPharmacology,SPFDUEmail:zhuyz,Hypertension,Therefore,itisimportanttotreathypertensionandreducemortalityandmorbidityoftheseconditions,Endorgandamage,isassociatedwithincreasedriskfromischemicheartdisease,cerebrovascularaccidents,heartandrenalfailure.,Complicationsofuntreatedhypertension,HypertensivecardiovasculardiseaseHypertensivecerebrovasculardiseaseanddementiaHypertensiverenaldiseaseAorticdissectionAtheroscleroticcomplication,Myocardialinfarction(MI)isoneofthemostcommondiagnosesoccurringintheworld.Itsmortalityisapproximately30%.Althoughthesurvivalfollowingtreatmenthasimprovedinthelasttwodecades,themorbidityandmortalityofMIstillremainhigh.,MYOCAIDIALINFARCTION,LEADINGCAUSESOFMORTALITYINWHOREPORT,ThemortalityofischaemicheartdiseaseisrankedfirstamongotherdiseasesintheWHOstatistics,MYOCARDIALINFARCTION,MyocardialInfarctiongenerallyoccurswiththeabruptdecreaseincoronarybloodflowthatfollowsathromboticocclusionofacoronaryarteryleadstoirreversiblemyocardialcellsdamageandnecrosis.,Anginapectoris,Isthemostcommonconditioninvolvingintissueischemia,Vasodilatordrugsarecommonlyused(e.g.nitroglycerin,calciumchannelblocker),-blockersarealsouseful,Vasodilators,Calciumchannelsblockers: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):mixed,Cause,AtheromatousobstructionmostfrequentPrimarycause:imbalancebetweentheoxygenrequiredbytheheartandoxygensuppliedtoitbythecoronaryartery.,O2required,O2supplied,NitratesRash,fever,sedation,sleepdisturbance,andevendepression,-adrenoceptorblockingdrugs,DrugsforAtherosclerosis,ZhuYiZhun,Dept.ofPharmacology,SPFDUEmail:zhuyz,Hyperlipidemia:Lipoprotein,Agentsforhyperlipidemia,Acutepancreatitis,Atherosclerosis,(LDL)(HDL),Cholesterollevel,mg/dL(mmol/L),Metabolismofcholesterol,3-hydroxy-3-methyl-glutaryl-coenzymeA3-羟-3-甲戊二酰辅酶,-statin,LovasatinAtorvastatinFluvastatinPravastatinSimvastatinRosuvastatin,LDL,Oxidativestress,Lovastatin,Prodrug,Activeform,Dailydose:10-80mg,eveningadministration,Absorbtion:40-75%T1/2:1-3h,Othercholesterollowingagents:Niacin,Ezetimibeetc.,Vasodilators,Calciumchannelsblockers: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):mixed,Nitrates&Nitrites(硝酸盐&亚硝酸盐),MechanismsofactioninAngina:*Endothelial-derivedrelaxationfactor(EDRF内皮衍生的松弛因子)nitricoxide(NO):inducescoronaryvasodilation,*Nitratesdilatecoronaryarteriesto:,1)redistributebloodflowfromepicardialtoendocardialregions.,2)relievecoronaryspasmanddynamicstenosis,*Reduceoxygendemand,Nitrates/NitritesNORelaxation,Indications,Short-actingnitratesforacuteeffortangina:sublingualnitroglycerin(0.3to0.6mg)every5minutesuntilpaingoesoramax.of4to5tabletstobetaken.Nitroglycerinsprayisanalternativemodeoforaladministration.,Longactingnitratesforanginaprophylaxis:Oralpreparationofnitrateisfrequentlygivenfortheprophylaxisofangina.Long-actingnitratesarenotcontinuouslyeffectiveifregularlytakenoveraprolongedperiod,unlessallowanceismadeforanitrate-freeor-lowinterval.,Nitrates&Nitrites,MechanismsofactioninAngina:*Endothelial-derivedrelaxationfactor(EDRF)nitricoxide(NO):inducescoronaryvasodilation,*Nitratesdilatecoronaryarteriesto:,1)redistributebloodflowfromepicardialtoendocardialregions.,2)relievecoronaryspasmanddynamicstenosis,*Reduceoxygendemand,Nitrates/NitritesN