治疗充血性心衰药概要.ppt

医学下载吧,1,治疗充血性心衰药Drugsusedinheartfailure,医学下载吧,2,MyocardialremodelinginCalcineurintransgenichearts(Cell,Vol93,215-228,1998),医学下载吧,3,Heartfailure,Reducedcardiacoutput,Sympatheticnervoussystemactivation,Vasoconstriction,Elevatedcardiacfillingpressure,Sodiumandwaterretention,Angiotensin,Renin,Cardiacremodeling,Aldosterone,Angiotensin,Pathophysiologicalmechanismsofheartfailureandmajorsitesofdrugaction,digoxin,-blockers,digoxin,Vasodilators,ACEinhibitors,Spironolactone,Diuretics,医学下载吧,4,Structureofdigoxin,atypicalcardiacglycoside,医学下载吧,5,K+,3Na+,2K+,Na+,3Na+,Ca2+,Ca2+,Ca2+,SR,Cardiacglycosides,RegulationofintracellularCa2+iandtheactionofcardiacglycosides,医学下载吧,6,Effectsofacardiacglycoside,Ouabain,onisolatedcardiactissue(fromBasicandclinicalpharmacology,8th2001),医学下载吧,7,Signsandsymptomsofcardiacglycosidetoxicity,PsychiatricDelirium,fatigue,confusion,dizziness,abnormaldreamsVisualBlurredoryellowvision,halosGastrointestinalNausea,vomiting,abdominalpainCardiacarrhythmiasAtrialandventricularectopicarrhythmiasConductiondisturbancesSinoatrialandatrioventricularnodeconductiondisturbances,医学下载吧,8,Effectofspironolactoneonsurvivalinpatientswithmoderateorseverecongestiveheartfailureinarandomizeddouble-blindclinicalstudy.(fromBasicandclinicalpharmacology,8th2001),医学下载吧,9,Vasodilatordrugsusedtotreatheartfailure,医学下载吧,10,MajoreffectsofangiotensinIIandthemechanismthatmediatethem,AngiotensinII,Alteredperipheralresistance,Alteredcardiovascularstructure,Alteredrenalfunction,A.Directvasoconstriction.B.Enhancementofperipheralnoradrenergicneurotransmission.C.Increasedsympatheticdischarge.D.Releaseofcatechola-minesfromadrenalmedulla.,A.DirecteffecttoincreaseNa+reabsorptioninproximaltubule.B.Releaseofaldosteronefromadrenalcortex.C.Alteredrenalhemo-dynamics.,A.Increasedexpressionofproto-oncogence.B.Increasedproductionofgrowthfactors.C.Increasedsynthesisofextracellularmatrixproteins.D.Increasedafterload.E.Increasedwalltension.,医学下载吧,11,renin,Angiotensinogen,AngiotensinI,Otherpathways,AngiotensinII,Receptors,AT1,AT2,Vasoconstriction,Prolif