3-drugs for CHF(s-pbl)分析课件.pptVIP

Drugs for Congestive Heart Failure Pharmacology Many etiologies of CHF Coronary artery disease Hypertension Valvular heart disease Congenital heart disease Toxins Peripartum cardiomyopathy Many others New York Heart Association (NYHA) NYHA Ⅰ级：日常活动不出现心力衰竭症状 NYHA Ⅱ级：日常活动即诱发症状NYHA Ⅲ级：轻度运动即诱发症状NYHA Ⅳ级：休息状态即出现症状 心功障碍 （收缩功能↓①，舒张功能↓⑧ ）  输出量↓  血管收缩 神经激素↑ 心肌β1R↓⑦ （RAS↑④、CA↑）  阻抗↑ 水钠潴留 ⑤ 心缩力↓ 后负荷↑② 顺应性↓ 血容量↑  血管肥厚、重构⑥ 心肌肥大、重构⑥ 静脉淤血 前负荷↑③ 心功障碍的病理生理学与药物作用的环节 治疗充血性心力衰竭药物的分类 1．强心苷类药 地高辛等 2．肾素-血管紧张素-醛固酮系统抑制药 3．利尿药 氢氯噻嗪、呋塞米等 4．β受体阻断药：美托洛尔、卡维地洛等 5．其他治疗CHF的药物 Section 1: RAAS inhibitors Mechanism of Action of ACEI Afterload reduction Preload reduction  Reduction of facilitation of sympathetic nervous system  Reduction of cardiac hypertrophy ATII antagonists Aldosterone antagonist Aldosterone antagonist, K-sparing diuretic Prevention of aldosterone effects on: Kidney Heart? Aldosterone inappropriately elevated in CHF Mobilizes edema fluid in heart failure Prevention of hypokalemia induced by loop diuretics (protection against digitalis toxicity?) Prolongs life in CHF patients Section 2: Diuretics Preload reduction: reduction of excess plasma volume and edema fluid Afterload reduction: lowered blood pressure Section 3 β-Adrenoceptor blockers Mechanism of action: 1. Antagonize the sympathetic nerve activity ①↓damage on cardiac muscle from CA ②↓renin , ↓RAS，↓ cardiac load  ③↑β-R，come back the transmit ability ④↑sensitivity of β-R to catecholamines 2. Antioxidation , blocking α1-R — carvedilol 3. Antia