Antianginal-Drugs(抗心绞痛药)VIP免费

Part6Part6AntianginalDrugsAntianginalDrugs•OrganicnitratesOrganicnitrates•receptorblockersreceptorblockers•CalciumchannelblockersCalciumchannelblockersCoronaryvessels:Coronaryvessels:bloodsupplyforthebloodsupplyfortheheartheart1.OVERVIEW1.OVERVIEWCoronaryatherosclerosis:Coronaryatherosclerosis:causeofcardiacischemiacauseofcardiacischemiaDistributionofcoronaryarteriesintheheartDistributionofcoronaryarteriesintheheartIschemia(Ischemia(anginapectorisanginapectoris):):imbalancebetweenoxygendemandandsupplyimbalancebetweenoxygendemandandsupplyClassificationofanginapectoris:Classificationofanginapectoris:Exertionalangina(Exertionalangina(劳累性心绞痛劳累性心绞痛))StableanginaStableangina((稳定性心绞痛稳定性心绞痛))Initialonsetangina(Initialonsetangina(初发型心绞痛初发型心绞痛))Acceleratedangina(Acceleratedangina(恶化性心绞痛恶化性心绞痛))Spontaneousangina(Spontaneousangina(自发性心绞痛自发性心绞痛))Anginadecubitus(Anginadecubitus(卧位型心绞痛卧位型心绞痛))VariantorvasospasticanginaVariantorvasospasticangina((变异性变异性[[痉挛性痉挛性]]心绞心绞痛痛))Acutecoronaryinsufficiency(Acutecoronaryinsufficiency(急性冠脉功能不全急性冠脉功能不全))Postinfarctionangina(Postinfarctionangina(梗死后心绞痛梗死后心绞痛))Mixedangina(Mixedangina(混合性心绞痛混合性心绞痛))UnstableanginaUnstableangina((不稳定性心绞痛不稳定性心绞痛))1.OVERVIEW1.OVERVIEWMyocardialMyocardialoxygendemandoxygendemandischieflydeterischieflydeterminedby:minedby:•ContractilityContractility•HeartrateHeartrate•WalltensionWalltension•Preload(venousreturn)Preload(venousreturn)•Afterload(arteriolarresistance)Afterload(arteriolarresistance)1.OVERVIEW1.OVERVIEWpreloadpreloadafterloadafterloadMyocardialMyocardialoxygendemandoxygendemandisdiisdiminishedminishedby:by:•ReducingcontractilityReducingcontractility•ReducingheartrateReducingheartrate•ReducingthepreloadReducingthepreload•ReducingtheafterloadReducingtheafterload1.OVERVIEW1.OVERVIEWWalltensionWalltension1.OVERVIEW1.OVERVIEW•MyocardialMyocardialoxygenoxygensupplysupplyischieflyischieflydeterminedby:determinedby:•AVoxygendifferenceAVoxygendifference•RegionalmyocardialRegionalmyocardialdistributiondistribution•coronarybloodflow:coronarybloodflow:•vascularresistance,arterypressureEffectsofantianginaldrugs:Effectsofantianginaldrugs:ReducingoxygendemandsReducingoxygendemandsReducingheartrateandcontractilityReducingheartrateandcontractilityDilatingsystemicarteriesandveins(Dilatingsystemicarteriesandveins(walltensionbylowewalltensionbyloweringheartloads)ringheartloads)IncreasingoxygensupplyIncreasingoxygensupplyDilatingconductcoronaryarteries(Dilatingconductcoronaryarteries(coronarybloodflow)coronarybloodflow)Promotingregionaldistribution(Promotingregionaldistribution(inischemicregions)inischemicregions)Others:Others:Anti-plateletcoagulationandthrombusformationAnti-plateletcoagulationandthrombusformation1.OVERVIEW1.OVERVIEW2.1Nitrates2.1NitratesNitroglycerinNitroglycerin((硝酸甘油硝酸甘油))A.PharmacologicalactionsA.PharmacologicalactionsDilatingvesselsandreducingheartloadsDilatingvesselsandreducingheartloadswalltensionwalltension;;reflextachycardiareflextachycardiaRedistributionofcoronarycirculationRedistributionofcoronarycirculationdilatingconductartery:dilatingconductartery:collateralcirculationcollateralcirculationreducingwalltensi...