硝酸酯类药物规范化应用.pptVIP

小 结 硝酸酯类药物的药理学特性：显著的剂量依赖性 硝酸酯类药物在冠心病治疗中的地位：很多冠心病患者仍能从硝酸酯类药物治疗中获益,更要关注无痛性心肌缺血患者 因具有先进的Durules缓释技术，依姆多是很好的长效硝酸酯类药物，临床应用方便 耐药性问题应引起临床医师的高度重视 依姆多的抗心肌缺血治疗优势 独特的“Durules? ”制剂工艺： - 可掰开使用的缓释制剂，便于剂量调整，减少头痛发生 - 一天一次用药，极大改善顺应性 稳定的药代动力学特性： - 生物利用度高，个体间血药浓度几近一致 - 不受肠道PH和食物等影响 - 肝肾功能不全时无须调整剂量 - 老年人无须调整剂量 - 与心血管常用药物之间无相互作用 依姆多的抗心肌缺血治疗优势 Considering long-term nitrate therapy, in the form of Imudur, as a first choice - M. J. Kendall, M.D. 《Cardiovascular Drug Therapy》 * 小剂量硝酸酯静脉或容量系统的舒张效应已接近最大,随着剂量增加,静脉系统的舒张效应不会再额外增加; 在小剂量时亦舒张大动脉或传导动脉.随着剂量增加到高浓度水平,小动脉或阻力动脉扩张,导致体循环和局部血管阻力的下降. * In contrast to less life-threatening forms of angina, the effects of short-term treatment with nitrates on survival of patients with myocardial infarction have been studied extensively. In 1988, Yusuf et al. published a meta-analysis on the effects of nitrates in myocardial infarction revealing a total reduction of as much as 35% (134). This result was challenged in two large prospective clinical trials including 77,000 post-infarction patients who received a glyceryl trinitrate patch (46) or an oral sustained-formulation of isosorbide mononitrate (57). In both studies there was a trend but no significant effect on survival and similar result emerged from a subsequent metaanalysis (57). However, subgroup analysis in GISSI-3 showed a significant effect of glyceryl trinitrate on survival of elderly patients (70 years) and women. Furthermore, glyceryl trinitrate significantly improved the beneficial effect of lisinopril on survival (46). It is not known whether these favourable results have been adopted to clinical practice of pharmocotherapy of post-infarction patients. The reasons for the appearant discrepancy between the results of the initial meta-analysis and the subsequently performed prospective clinical investigations have been discussed in detail (50,59)