临床药理治疗充血性心力衰竭药物课件.pptVIP

2021/1/12 ACE inhibitors first-line therapy in all patients with heart failure improve symptoms, slow progression of the disease, reduce mortality, and decrease the incidence of hospitalization The most common adverse effects of ACE inhibitors are directly related to lowering angiotensin II concentrations (hypotension and renal insufficiency) and increasing concentrations of kinins (cough and angioneurotic edema) 2021/1/12 血管紧张素原 AngiotensinⅠ 收缩血管 肾素 激肽原 缓激肽↑ 降解失活 AngⅢ ACE ACEIs AngⅡ ↓ 分泌醛固酮 NO PGI ( - ) ACE和ACEIs作用示意图 舒张血管 2021/1/12 Captopril 第1个在临床上广泛应用的ACEI。含巯基，可致味觉异常。 Enalapril 前体药，不含巯基。药效和作用时间比cartopril强。 2021/1/12 ARBs - angiotensin receptor blockers angiotensin receptor antagonists (AT1 Receptor Antagonists) are as effective as ACE inhibitors in treating heart failure, but it appears that therapeutic efficacy may be comparable losartan, candesartan, valsartan 2021/1/12 Inotropic Drugs- digitalis The beneficial effects of cardiac glycosides in the treatment of heart failure have been attributed to a positive inotropic effect on failing myocardium and efficacy in controlling the ventricular rate response to atrial fibrillation. The cardiac glycosides also modulate autonomic nervous system activity, and it is likely that this mechanism contributes substantially to their efficacy in the management of heart failure. 2021/1/12 Positive Inotropic Effect 〔抑制Na+,K+-ATPase 〕 Electrophysiological Actions 〔加上增强迷走〕 Regulation of Sympathetic Nervous System Activity There is evidence that digitalis may act directly to sensitization of baroreceptor response and thereby exert some of its beneficial effects through reduction of sympathetic tone 2021/1/12 The recent Digitalis Investigation Group (DIG) clinical trial indicated digoxin did not reduce overall mortality in patients with heart failure (who were receiving diuretics and ACE inhibitors), but did reduce the rate of hospitalization 2021/1/12 Other inotropic agents 只适用于急性心衰，长期应用于慢性心衰后，病人死亡率增加。 Beta