药理学（二）英文版课件Drugs-for-heart-failure.pptVIP

Drugs for heart failure congestive heart failure 1.force 2.heart rate : output = stroke volume × HR 3.preload : (LVEDP;LVEDV) 4.after load Cardiac glycosides 1. Chemistry The basicle structure of digitalis cardiac glycosides contains: a. aglycone whose structure is similar to steroides ,such as adrencortical and sex hormons .(pharmacologically active portion of glycosides) b. one to four sugars (solubility potency and duration) 2.Pharmacological effects: (1).positive inotropic effect a. increasing the peak force developed b. increasing the rate of development of force and decreasing the time to peak tension c. increasing stroke volume (2).negative chronotropic effects : Cardiac output blocking sympathetic reflex and stimulating vagus heart rate (3). Effects on the cardiac electrical activity : a. S-A node : automaticity  b. atria :ERP c. A-V node :ERP and conduction velocity d. ventricle :ERP and automaticity S-A Atria A-V ventricles Direct effect ERP ERP conduct automat indirect effect automat ERP ERP conduct adverse effect bradycard tachycard A-V block filbrilla fibrilla tachycardia (4).extracardiac effects a. peripheral vascular resistance , blood flow b. systolic blood pressure c. diastolic pressure d. diuretic effect 3. Mechanism of digitalis effects Inhibiting Na+--K+ ATPase on the membrance Inhibiting Ca+ uptake by sarcoplasmic reticulum Drug GI absorp. Pro. binding T1/2 elimi. Conc.(ng/ml)