治疗充血性心衰药.pptVIP

医学下载吧 医学下载吧 医学下载吧 治疗充血性心衰药Drugs used in heart failure Major effects of angiotensin II and the mechanism that mediate them * * 医学下载吧 医学下载吧 Myocardial remodeling in Calcineurin transgenic hearts (Cell, Vol 93, 215-228,1998) 医学下载吧 Heart failure Reduced cardiac output Sympathetic nervous system activation Vasoconstriction Elevated cardiac filling pressure Sodium and water retention Angiotensin Ⅰ Renin Cardiac remodeling Aldosterone AngiotensinⅡ Pathophysiological mechanisms of heart failure and major sites of drug action digoxin β -blockers, digoxin Vasodilators ACE inhibitors Spironolactone Diuretics Angiotensin-R blockers 医学下载吧 Structure of digoxin, a typical cardiac glycoside 医学下载吧 K+ 3Na+ 2K+ Na+ 3Na+ Ca2+ Ca2+ Ca2+ SR Cardiac glycosides Regulation of intracellular [Ca]2+i and the action of cardiac glycosides 医学下载吧 Effects of a cardiac glycoside,Ouabain, on isolated cardiac tissue ( from Basic and clinical pharmacology, 8th 2001) 医学下载吧 Signs and symptoms of cardiac glycoside toxicity Psychiatric Delirium, fatigue, confusion, dizziness, abnormal dreams Visual Blurred or yellow vision, halos Gastrointestinal Nausea, vomiting,abdominal pain Cardiac arrhythmias Atrial and ventricular ectopic arrhythmias Conduction disturbances Sinoatrial and atrioventricular node conduction disturbances 医学下载吧 Effect of spironolactone on survival in patients with moderate or severe congestive heart failure in a randomized double-blind clinical study. (from Basic and clinical pharmacology, 8th 2001) 医学下载吧 Drug class Examples Mechanism of vasodilating action Preload reduction Afterload reduction Organic nitrates Nitroglycerin Nitric oxide-mediated vasodilation +++ + Nitric oxide donors Nitroprusside Nitric oxide-mediated vasodilation +++ +++ ACE inhibitors Captopril Inhibition of angiotensin generation ++ ++ Angiotensin receptor blockers Iosartan Blockade of angiotensin receptors ++ ++ Phosphodiesterase inhibito