Cardiovascular Pharmacology课件.pptVIP

ANTIHYPERTENSIVE AGENTS:C. Vasodilators e.g. Hydralazine, Sodium nitroprusside, Diazoxide (K-channel opener) Hydralazine diazoxide - mostly arterial dilator Nitroprusside - both arterial venous dilator (肼肽嗪) (硝酸鈉) (二氮嗪) ANTIHYPERTENSIVE AGENTS: C. Vasodilators Systemic Side effects and limitation Reflex tachycardia, palpitations Headache, flushing, sweating ? CO, may provoke angina; Na and fluid retention Accumulation of cyanide for nitroprusside (-CN group release during metabolism) ANTIHYPERTENSIVE AGENTS: D. Calcium channel blockers, Calcium antagonists e.g. Verapamil, Diltiazem, Nifedipine, Felodipine, Nimodipine ? Ca entry into vascular smooth muscle cells Vasodilation ? blood pressure (維拉帕米) (硝苯地平) (非洛地平) (尼莫地平) (地尔硫卓) Systemic Side effects and limitation Nifedipine (vascular effect) ? reflex tachycardia ? CO Verapamil diltiazam (cardiac + vascular effects) ? ? HR, worsen heart failure, produce heart block ANTIHYPERTENSIVE AGENTS: E. Calcium channel blockers, Calcium antagonists Cardiovascular Pharmacology Antianginal Drugs TREATMENT OF ANGINA PECTORIS Angina Pectoris: O2 Demand Supply Classic angina (atherosclerotic angina) - obstruction of major coronary arteries Variant angina (vasoplastic angina) - transient spasm of coronary artery Unstable angina - angina at rest; may be caused by thrombi Revision on Pathobiology TREATMENT OF ANGINA PECTORISA. Nitrates and Nitrites e.g. Nitroglycerin, Isosorbide dinitrate/mononitrate Relaxation of vascular smooth muscle ? ? spasm ? ? coronary blood flow Vasodilation ? ? venous capacitance ? ? venous return ? ? cardiac work ? ? myocardial O2 requirement ? relief of anginal pain (硝酸甘油) (硝酸异山梨酯) (單硝酸异山梨酯) TREATMENT OF ANGINA PECTORIS A. Nitrates and Nitrites Mostly venous dilatation, also effective for coronary arteries Mostly fast-acting but also have short duration of action Sublingual application (for emergency) Transdermal patch to produce sustained