Antianginal-Drugs(抗心绞痛药)VIP免费

Part6AntianginalDrugs•••第一页，共三十一页。Coronaryvessels:bloodsupplyfortheheart1.OVERVIEW第二页，共三十一页。Coronaryatherosclerosis:causeofcardiacischemia第三页，共三十一页。Distributionofcoronaryarteriesintheheart第四页，共三十一页。Ischemia(anginapectoris):imbalancebetweenoxygendemandandsupply第五页，共三十一页。Classificationofanginapectoris:Exertionalangina(劳累性心绞痛)Stableangina(稳定性心绞痛)Initialonsetangina(初发型心绞痛)Acceleratedangina(恶化性心绞痛)Spontaneousangina(自发性心绞痛)Anginadecubitus(卧位型心绞痛)Variantorvasospasticangina(变异性[痉挛性]心绞痛)Acutecoronaryinsufficiency(急性冠脉功能不全)Postinfarctionangina(梗死后心绞痛)Mixedangina(混合性心绞痛)Unstableangina(不稳定性心绞痛)1.OVERVIEW第六页，共三十一页。Myocardialoxygendemandischieflydeterminedby:•Contractility•Heartrate•Walltension•Preload(venousreturn)•Afterload(arteriolarresistance)1.OVERVIEWpreloadafterload第七页，共三十一页。Myocardialoxygendemandisdiminishedby:•Reducingcontractility•Reducingheartrate•Reducingthepreload•Reducingtheafterload1.OVERVIEWWalltension第八页，共三十一页。1.OVERVIEW•Myocardialoxygensupplyischieflydeterminedby:•AVoxygendifference•Regionalmyocardialdistribution•coronarybloodflow:•vascularresistance,arterypressure第九页，共三十一页。Effectsofantianginaldrugs:ReducingoxygendemandsReducingheartrateandcontractilityDilatingsystemicarteriesandveins(walltensionbyloweringheartloads)IncreasingoxygensupplyDilatingconductcoronaryarteries(coronarybloodflow)Promotingregionaldistribution(inischemicregions)Others:Anti-plateletcoagulationandthrombusformation1.OVERVIEW第十页，共三十一页。2.1NitratesNitroglycerin(硝酸甘油)A.PharmacologicalactionsDilatingvesselsandreducingheartloadswalltension;reflextachycardiaRedistributionofcoronarycirculationdilatingconductartery:collateralcirculationreducingwalltension:bloodflowinischemicsubendocardialarea2.Antianginaldrugs第十一页，共三十一页。Influenceoforganicnitratesanddipyridamoleonthebloodsupplyofischemicarea2.Antianginaldrugs第十二页，共三十一页。Mechanismoftheeffectofnitroglycerinandothernitrates2.Antianginaldrugs第十三页，共三十一页。Mechanismoftheeffectofnitroglycerinandothernitrates第十四页，共三十一页。B.ClinicalusesAnginapectoris:allkinds,especiallystabletypeHeartfailure：reducingheartloadsduetovasodilationC.AdversereactionsIncreaseinheartrateandcontractilitySymptomsduetovasodilation:headache,flash,posturalhypotension,collapse,ect.Others:methaemoglobinaemia〔高铁血红蛋白〕Tolerance:avoidingsteady-stateplasmaconcentration;supplementofagentscontaining–SH(captopril)2.Antianginaldrugs第十五页，共三十一页。2.1OthernitratesIsosorbidedinitrate(硝酸异山梨酯)Isosorbide-5-mononirate(5-硝酸异山梨酯)Comparedwithnitroglycerin:•Similarbutweakereffect•Actingslowlybutlastinglonger•Largerindividualvariationandmoreadverseeffects2.Antianginaldrugs第十六页，共三十一页。第十七页，共三十一页。2.2receptorblockersA.Pharmacologicalaction•Reducingoxygendemand:•heartrateandcontractility•Increasingoxygensupply:•diastolicperiod:perfusiontime•vasculartoneinnormalregions:•bloodflowinischemicregions•Others:•Improvingmyocardialmetabolism•Inhibitingcoagulationofplatelets2.Antianginaldrugs第十八页，共三十一页。B.Clinicalusesstableandunstablepectoris,especiallyassociatedwithhypertensionorarrhythmias,evenwithmyocar...