2015留学生心绞痛第23章课件.ppt

Antiangina Pectoris Agents ;;§1 Brief Introduction;;;;;Coronary heart disease ;Teatment of Angina Pectoris: 1. Dilation of blood vessels 2. Reducing blood lipid level 3. Reducing blood glucose level 4. Antithrombosis 5. Anti-pain;Contractility Heart Rate Cardiac Wall Tension Preload and Afterload;;;GTN:Glyceryl Nitrate PETN:pentaerythrityl tetranitrate ISDN :isosorbide dinitrate ISMN :isosorbide-5-mononitrate ;Soluble guanylyl cyclase (sGC) is the only known receptor for NO. It is soluble, i.e. completely intracellular. It is most notably involved in vasodilation. In humans, it is encoded by the genes GUCY1A2, GUCY1A3, and GUCY1B3;Effects of GTN;Before GTN;Pharmacokinetics of GTN ;INDICATIONS OF GTN;Isosorbide Dinitrate(消心痛） Isosorbide Mononitrate（异乐定）;;;目前常用于心绞痛的药物： 异乐定（欣康，硝酸酯类） 消心痛（硝酸酯类） 心痛定（硝苯地平） 圣通平（硝苯地平缓释） 拜新同（硝苯地平控释） 波依定（非洛地平） 络活喜（氨氯地平） 司乐平（拉西地平） 异搏定（维拉帕米） 比索洛尔（Beta1阻滞剂，选择性最高） 贝他乐克（Beta1阻滞剂） 阿替洛尔（Beta1阻滞剂） 心得安（Beta阻滞剂） 蒙诺（ACEI，福新普利），诺迪康（藏药） 万爽力（新型药物，改变心肌代谢）;The current commonly used in angina medicine: Xinkang, nitrates Isosorbide dinitrate (nitrate) Nifedipine Nifedipine（ slow-release） Nifedipine （controlled-release) Felodipine) Amlodipine Lacidipine Verapamil Bisoprolol (Beta1 blockers, the highest selectivity) Betaloc (Beta1 blocker) Atenolol (Beta1 blocker) Propranolol (Beta blocker) Fosinopril (ACEI), Nuodikang (Medicine) Trimetazidine ( changes in myocardial metabolism);Bisoprolol ( Bisoprolol, Beta1 blockers, high selectivity ) Metoprolol ( Beta1blockers ) Atenolol ( Beta1 blockers ) Propranolol ( Beta blockers );For Angina Pectoris: Beta Blockers + GTN?;;Contraindications of Beta-Blockers: Asthma Heart Failure Bradycardia Hyperlipidemia Variant Angina;§4 Ca2+ Channel Blockers ;Summary 1. Acute attacks of angina are treated with: Sublingual nitrates Nifedipine 2. Acute anginal pain is treated with morphine 3. Stable angina is treated with Long-lasting nitrates ?-adrenergic receptor blockers Ca2+ channel