第22章 抗心律失常药antianrrhythmic drugs.pptVIP

山东大学药理学研究所 丁华 dinghua@sdu.edu.cn ANTIARRHYTHMIC DRUGS 抗心律失常药 Arrhythmia: Abnormality in the site of origin of the impulse the rate or regularity the conduction The type of Arrhythmia: 缓慢型 : 窦性心动过缓 (sinus bradycardia) 房室传导阻滞 (atrio-ventricular block) 快速型 : 房性早搏 (atrial premature contraction) 房性心动过速 (atrial tachycardia,AT) 心房颤动 (atrial fibrillation, AF) 心房扑动 (atrial flutter, AFL) 阵发性室上性心动过速 (paroxysmal supraventricular tachycardia) 室性早搏 (ventricular premature contraction) 室性心动过速 (ventricular tachycardia,VT) 心室颤动 (ventricular fibrillation, VF) ? The Physiological Basis of Arrhythmia Vmax: maximum upstroke slope of phase 0. Determines conduction velocity. refractory period important in the genesis or suppression of certain arrhythmias effective refractory period (ERP) relative refractory period 2. The electrophysiological mechanism  of arrhythmias (1) Disturbances in impulse formation: 1) Increased automaticity: (2) Disturbances in impulse conduction 1) Simple conduction disturbances: conduction↓→conduction block→unidirectional block单向传导阻滞. 2) Reentry (circus movement) Section 2 The Basic Electrophysiologic Action of Antiarrhythmic Drugs and The Drug Classification 1. The basic electrophysiologic action 2.The classification  ClassⅠ Sodium channel-blocking agents: IA , IB, IC ClassⅡ β-blockers Class Ⅲ prolonging repolarization Class Ⅳ calcium antagonists Others: adenosine Section 3 Specific Antiarrhythmic Agents 1) ClassⅠA Qunidine(奎尼丁) Inhibits Na+ , Ca2+ influx, and K+ efflux M-cholinergic blocking α-adrenergic blocking Pharmacological effects: Inhibits Na+ influx moderately : ↓Vmax, ↓conduction ↓phase 4 slope, ↓automaticity ↓ K+ efflux , ↑ ERP ↓myocardial contractility Therapeutic use: Broad-spectrum Atrial fibrillation; Atrial flutter; Sup