各论课件心绞痛药.pptVIP

抗心绞痛药Antianginal Drugs 浙江大学医学院药理学系 卢韵碧 yunbi@zju.edu.cn What’s Angina pectoris Cause and the classification of angina pectoris : Atheromatous obstruction of the large coronary vessels (atherosclerotic angina, classic angina); 劳累性心绞痛：稳定型，初发型，恶化型 Transient spasm of localized portions of the large coronary vessels (angiospastic or variant angina); 自发性心绞痛：卧位型，变异型，急性冠脉功能不全，梗死后心绞痛 Both causes 混合性心绞痛 Unstable angina pectoris: initial onset type(初发型); accelerated type(恶化型); spontaneous type（自发型） associated with atherosclerosis plaque and thrombus formation may lead to myocardial infarction Myocardial oxygen demand is diminished by: Reducing contractility Reducing heart rate Reducing the preload Reducing the afterload Myocardial oxygen supply is increased by: Dilating conduct coronary arteries ( ? coronary blood flow) Promoting regional distribution ( ? in ischemic regions) Treatments: Non-drug treatment:经皮冠状动脉成形术(percutaneous transluminal coronary angioplasty, PTCA), 冠脉搭桥术 ( coronary artery bypass graft surgery, CABG ) Drug treatment - Pharmacological actions Dilating vessels and reducing heart loads wall tension ?; reflex tachycardia Redistribution of coronary circulation dilating conduct artery: collateral circulation (侧支循环)? reducing wall tension: blood flow in ischemic subendocardial area ? Alleviating? ischemic injury (减轻缺血损伤) Anti- platelet coagulation NO-cGC-cGMP - Clinical uses Angina pectoris: all kinds, especially stable type Heart failure - Adverse reactions Symptoms due to vasodilation: headache, postural hypotension, etc. Increase in heart rate and contractility Others: methaemoglobinaemia（高铁血红蛋白） Tolerance : avoiding steady-state plasma concentration; supplement of agents containing –SH (captopril, NAC), VitC Other nitrates Isosorbide