留学生心绞痛演示文稿

留学生心绞痛演示文稿当前1页，总共37页。（优选）留学生心绞痛当前2页，总共37页。当前3页，总共37页。§1BriefIntroduction当前4页，总共37页。当前5页，总共37页。当前6页，总共37页。当前7页，总共37页。当前8页，总共37页。当前9页，总共37页。Coronaryheartdisease当前10页，总共37页。TeatmentofAnginaPectoris:1.Dilationofbloodvessels2.Reducingbloodlipidlevel3.Reducingbloodglucoselevel4.Antithrombosis5.Anti-pain当前11页，总共37页。ContractilityHeartRateCardiacWallTensionPreloadandAfterload1.Beta-Blockers2.Glyceryltrinitrate

3.L-CBAnti-anginapectorisAgentsCoronaryheartdiseaseprescription:NitrateestersAntihypertensiveagentsAntilipemicagents当前12页，总共37页。§2NitrateVasodilator

Inbloodvesselwall,GTNproduceNOwiththehelpofmitochondrialaldehydedehydrogenase(mtALDH)NOinducedilationofbloodvesselsOverdose/longtimeadministrationofGTNalsocaninduceactiveoxygenandinducetolerance.Bloodvesseldilationmechanism当前13页，总共37页。当前14页，总共37页。GTN:GlycerylNitratePETN:pentaerythrityltetranitrateISDN:isosorbidedinitrateISMN:isosorbide-5-mononitrate当前15页，总共37页。Solubleguanylylcyclase(sGC)istheonlyknownreceptorforNO.Itissoluble,pletelyintracellular.Itismostnotablyinvolvedinvasodilation.Inhumans,itisencodedbythegenesGUCY1A2,GUCY1A3,andGUCY1B3当前16页，总共37页。EffectsofGTNTolowertheoxygendemandoftheheart2.Todilatecoronaryarteryandincreasetheischemiaareabloodirrigation3.Todecreasetheleftventricularendocardialpressure,increasetheendocardialbloodsupplyandimprovetheadaptabilityoftheleftventricle4.Toprotectischemiccardiaccells：

NO-inducedPGI2andcalcitoningene-relatedpeptides(CGRP)5.Anti-arrythmiaandInhibitionofplateletaggregation当前17页，总共37页。BeforeGTNAfterGTNIschemiczoneNormalzone当前18页，总共37页。PharmacokineticsofGTNHighlipophilicpropertyExtensivefirst-passeffectsforP.O.:Ifsublingualroute,Fis80%,theonsetofactionis1to2minutes,andthedurationofactionis20to30minutes.当前19页，总共37页。INDICATIONSOFGTN1.Acuteanginapectorisattack2.ProphylaxisofanginapectorisGTNpatches,ointment3.Acutemyocardialinfarction4.Congestiveheartfailure当前20页，总共37页。IsosorbideDinitrate(消心痛）IsosorbideMononitrate（异乐定）AnginaPreventionHeartFailureTreatmentP.O.WeakTolerance医大一院有大夫：高血压合并心绞痛，异乐定+福新普利？当前21页，总共37页。AdsofGTNPosturalhypotensionReflextachycardiaThrobbingheadacheFlushing,DizzinessHighIntracerebral/IntraocularPressureTolerance当前22页，总共37页。当前23页，总共37页。目前常用于心绞痛的药物：异乐定（欣康，硝酸酯类）消心痛（硝酸酯类）心痛定（硝苯地平）圣通平（硝苯地平缓释）拜新同（硝苯地平控释）波依定（非洛地平）络活喜（氨氯地平）司乐平（拉西地平）异搏定（维拉帕米）比索洛尔（Beta1阻滞剂，选择性最高）贝他乐克（Beta1阻滞剂）阿替洛尔（Beta1阻滞剂）心得安（Beta阻滞剂）蒙诺（ACEI，福新普利），诺迪康（藏药）万爽力（新型药物，改变心肌代谢）当前24页，总共37页。Thecurrentcommonlyusedinanginamedicine:Xinkang,nitratesIsosorbidedinitrate(nitrate)NifedipineNifedipine（slow-release）Nifedipine（controlled-release)Felodipine)AmlodipineLacidipineVerapamilBisoprolol(Beta1blockers,thehighestselectivity)Betaloc(Beta1blocker)Atenolol(Beta1blocker)Propranolol(Betablocker)Fosinopril(ACEI),Nuodikang(Medicine)Trimetazidine(changesinmyocardialmetabolism)当前25页，总共37页。Bisoprolol(Bisoprolol,Beta1blockers,highselectivity)Metoprolol(Beta1blockers)Atenolol(Beta1blockers)Propranolol(Betablockers)§3Beta-RBlockers

{Tolowerheartrate,V-pressureandcontractilityToslowfatdecompositionToincreaseV-volumeTocontractcoronaryarteries(Propranolol)-blockersiseffectiveagainstthestableanginapectorisnotinvariantanginapectoris.

和硝酸之类的区别？当前26页，总共37页。ForAnginaPectoris:BetaBlockers+GTN?当前27页，总共37页。当前28页，总共37页。ContraindicationsofBeta-Blockers:

AsthmaHeartFailureBradycardiaHyperlipidemiaVariantAngina当前29页，总共37页。§4Ca2+ChannelBlockers1.Reductionofmyocardialoxygendemand?2.Dilationofcoronaryvessels3.Protectionofischemicmyocardialcell4.InhibitionofplateletaggregationNifidipine:variantanginaNifedipine+-blockers?Verapamil,diltiazem:variant,stable,andunstableanginapectoris.当前30页，总共37页。Summary1.

Acuteattacksofanginaaretreatedwith:SublingualnitratesNifedipine2.Acuteanginalpainistreatedwithmorphine3.StableanginaistreatedwithLong-lastingnitrates

-adrenergicreceptorblockersCa2+channelblockers4.Unstableanginaistreatedwith:AspirinHeparin

疏血通，金纳多等当前31页，总共37页。当前32页，总共37页。当前33页，总共37页。当前34页，总共37页。病例高血压合并心绞痛一职业高中教师，男76岁（退休）。当年45岁时候，患高血压，主要靠复方降压片治疗。随着时间的推移，药物逐渐失效，并患有冠心病。某“地方小医院”处方卡托普利、复方降压片（北京0号类似）和心痛定（硝苯地平片）。后来发生脑梗塞，经治疗，基本恢复。最近感到头疼，血压升高，来到中国医大一院心血管内科。患者及其家属，告诉大夫上述降压药物已经使用多年，效果不理想，希望换药。大夫将如何处方？早晨：替米沙坦（35h），阿替罗尔（24h）晚上：贝尼地平（24h，抗心绞痛），小剂量阿司匹林（间隔半小时），饭后。你认为处方是否合理，为什么？当前35页，总共37页。复方降压片：本品为复方制剂，其成分为每片含：利血平0.032mg，氢氯噻嗪3.1mg，维生素B61.0mg，混旋泛酸钙1.0mg，三硅酸镁30mg，氯化钾30mg，维生素B11.0mg，硫酸双肼屈嗪4.2mg，盐酸异丙嗪2.1mg，辅料适量。当前36页，总共37页。患者女性，82岁，有典型的劳力型心绞痛发作史，口含硝酸甘油均可以迅速缓解。患者于2006年7月15日5pm呕血约400ml后突发心前区剧烈疼痛，经查是胃底静脉曲张破裂，查心电图示：心房纤颤，伴快速心室率，普遍导联ST压低，反复含服硝酸甘油无效，即刻输血800ml后患者心前区疼痛