24 第二十四章 抗慢性心功能不全药课件.pptVIP

24章 抗慢性心功能不全药;objective;心脏的泵血功能;心脏的泵血功能;心脏的泵血功能;§1 introduction;§1 introduction;§1 introduction ----pathology feature;§1 introduction -----prognosis预后;心功能不全 （心缩力↓） ;Others ↑ arginine vasopressin （ AVP 精氨酸加压素） ↑ endothelin（ET，内皮素） ↑tumor necrosis factor（TNF-?，肿瘤坏死因子） ↑ atrial natriuretic peptide （ANP，心房利钠肽） ↓endothelium derived relaxing factor (EDRF内皮细胞衍生舒张因子，NO) ↑PGI2（ 前列环素） ?-R down-regulation;§1 introduction---- pathophysiology;Comparison of normal and abnormal heart;§1 introduction;§1 introduction;§1 introduction;§2 usual drugs;§2 usual drugs----- cardiac glycosides;1、po. bioavailability is variation; digoxin F 60% ~ 80% (20% ~ 80%)； 2、distribute widely; 3、classification of CGs according to their elimination mode: long effect digitoxin洋地黄毒苷 moderate effect digoxin地高辛 short effect cedilanide （毛花苷）， strophanthin K （毒毛花苷）;§2 usual drugs----- cardiac glycosides;characteristics :;2? ↑CO in patient with CHF ; 3? ↓ myocardial oxygen consumption in patient with CHF（ ↓衰竭心脏的耗氧量 ）.; How reduce myocardial oxygen  consumption of CHF ？;【mechanism of action】;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;【adverse reactions】;§2 usual drugs----- cardiac glycosides;【treatment of untoward effects 】;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;§2 usual drugs----- cardiac glycosides;1、new method ： Daily maintenance dose (每日维持量)： ?digoxin: 0.25mg.d-1 →after 6~7d （4~5 t1/2） →Css(steady-state ) ? 1）↓toxicity occur；