抗心绞痛药白.pptxVIP

抗心绞痛药白第1页/共24页 Teaching goals列举抗心绞痛药物分类及代表药。简述硝酸甘油抗心绞痛作用及机理。分析硝酸酯类与?－R 阻断药合用治 疗心绞痛是否合理。第2页/共24页 I. Introduction (概述) Angina pectoris(心绞痛) is a common symptom of coronary artery (冠状动脉) disease caused by transient (短暂) episodes (发作) of myocardial ischemia (缺血) and anoxia (缺氧). An attack of angina pectoris occurs when the need of the myocardium for oxygen exceeds the amount delivered to it by the coronary circulation.第3页/共24页 【 Classification of Angina Pectoris 】Stable angina pectoris(稳定型、劳累型心绞痛) ： 冠脉粥样硬化，激动、劳累时发作Unstable angina pectoris(不稳定型心绞痛) ： （非典型性或梗死前心绞痛） 冠脉粥样硬化，血栓，可发展为心梗 或猝死，也可恢复为稳定型心绞痛。Variant angina pectoris(变异型心绞痛) ： 冠脉痉挛所致，夜间或休息时发作。第4页/共24页 【发病机理】Determinants of myocardial oxygen consumption (决定心肌耗氧量主要因素 ):Ventricular wall tension (室壁张力)Heart rate (心率)Ventricular contractility (心室收缩力)Ejection time (射血时间) Angina pectoris results from an imbalance (失衡) between oxygen supply- demand relationship in ischemic (缺血的) regions of the myocardium (心肌).第5页/共24页 Normal Oxygen supplyOxygen demandAngina 供氧耗氧冠脉硬化痉挛栓塞射血时间↑心室容积↑收缩力↑HR ↑第6页/共24页 Principles of treatment (治疗原则) ：耗氧室壁张力心率心肌收缩力心脏负荷冠脉血流量侧枝循环心舒张时间供氧〓 To recover the balance between oxygen supply and oxygen consumption.(恢复氧供需平衡)第7页/共24页 【 Classification of anti-angina pectoris 】 (抗心绞痛药物分类)1） Organic nitrates (硝酸酯类) 2）? －R blockers 3）Calcium channel blockers(钙拮抗剂) 第8页/共24页 II. Organic nitrates (硝酸酯类)Nitroglycerin (硝酸甘油)【Pharmacokinetics】 1. Because of marked first-pass elimination it can not be given orally, and usually given sublingually(舌下). （首过消除明显,口服无效，舌下含服） 2. 可透皮吸收第9页/共24页 【pharmacological actions】Reduction of myocardial oxygen consumption （降低心肌耗氧量） Dilation of veins (扩V) myocardial oxygen consumption心肌耗氧量cardiac preload (心脏前负荷)Dilation of arteries(扩A)Cardiac afterload (心脏后负荷)Note:HR↑、心肌收缩力↑→耗氧↑why第10页/共24页 2. Dilate coronary artery, increase the blood flow in ischemic areas. (