antianginaldrugs抗心绞痛药—医学课件

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1、Part6AntianginalDrugsOrganicnitratesreceptorblockersCalciumchannelblockersCoronaryvessels:bloodsupplyfortheheart1.OVERVIEWCoronaryatherosclerosis:causeofcardiacischemiaDistributionofcoronaryarteriesintheheartIschemia(anginapectoris):imbalancebetweenoxygendemandandsupplyClassific

2、ationofanginapectoris:Exertionalangina(劳累性心绞痛)Stableangina(稳定性心绞痛)Initialonsetangina(初发型心绞痛)Acceleratedangina(恶化性心绞痛)Spontaneousangina(自发性心绞痛)Anginadecubitus(卧位型心绞痛)Variantorvasospasticangina(变异性[痉挛性]心绞痛)Acutecoronaryinsufficiency(急性冠脉功能不全)Postinfarctionangina(梗死后心绞痛)Mixedangina(混

3、合性心绞痛)Unstableangina(不稳定性心绞痛)1.OVERVIEWMyocardialoxygendemandischieflydeterminedby:ContractilityHeartrateWalltensionPreload(venousreturn)Afterload(arteriolarresistance)1.OVERVIEWpreloadafterloadMyocardialoxygendemandisdiminishedby:ReducingcontractilityReducingheartrateReducingthep

4、reloadReducingtheafterload1.OVERVIEWWalltension1.OVERVIEWMyocardialoxygensupplyischieflydeterminedby:AVoxygendifferenceRegionalmyocardialdistributioncoronarybloodflow:vascularresistance,arterypressureEffectsofantianginaldrugs:ReducingoxygendemandsReducingheartrateandcontractility

5、Dilatingsystemicarteriesandveins(walltensionbyloweringheartloads)IncreasingoxygensupplyDilatingconductcoronaryarteries(coronarybloodflow)Promotingregionaldistribution(inischemicregions)Others:Anti-plateletcoagulationandthrombusformation1.OVERVIEW2.1NitratesNitroglycerin(硝酸甘油)A.

6、PharmacologicalactionsDilatingvesselsandreducingheartloadswalltension;reflextachycardiaRedistributionofcoronarycirculationdilatingconductartery:collateralcirculationreducingwalltension:bloodflowinischemicsubendocardialarea2.AntianginaldrugsInfluenceoforganicnitratesanddipyridam

7、oleonthebloodsupplyofischemicarea2.AntianginaldrugsMechanismoftheeffectofnitroglycerinandothernitrates2.AntianginaldrugsMechanismoftheeffectofnitroglycerinandothernitratesB.ClinicalusesAnginapectoris:allkinds,especiallystabletypeHeartfailure：reducingheartloadsduetovasodilationC.Ad

8、versereactionsIncreaseinheartrate