作用于血液系统的药物.ppt

文档介绍：作用于血液及造血系统的药物DrugsAffectingBlood?Thrombosis?Plateletinhibitor?Anticoagulants?Thrombolyticagents?Treatmentof Bleeding?Treatment ofAnemia学衡?重点掌握肝素、双香豆素、抗栓药(抗血小板药和纤维蛋白溶解药)作用、作用特点、作用机制、临床应用及用药注意?了解止血药的作用和应用?一般了解抗贫血药叶酸、维生素B12的作用、作用机制和应用—自学?血液的流动性与凝固性的调节:凝血与抗凝机制;纤维蛋白溶解系统与抗纤溶机制。?血栓形成与血栓栓塞性疾病:1、静脉血栓形成与栓塞:2、动脉血栓形成与栓塞:3、播散性血管内凝血(DIC)。?概述?血栓形成Thrombosis?心血管内皮细胞的损伤动脉粥样硬化、动脉炎、静脉内膜炎、高脂血、高血压、免疫反应?血流状态的改变:静脉血栓?血液凝固性增高Blood hypercoagulability?血栓的种类白色血栓Palethrombus:动脉混合血栓Mixedthrombus:静脉红色血栓Redthrombus:hrombus:微循环小血管一、抗血小板药(Antiplateletdrugs)?抗栓药(Antithromboticdrugs)二、抗凝血药(Anticoagulants)三、纤维蛋白溶解药(Fibrinolytics)一、抗血小板药(Antiplateletdrugs)?环氧酶抑制剂:阿司匹林;?增加血小板内cAMP的药物:双嘧达莫(潘生丁)?抑制ADP活化血小板和GPIIb/IIIa受体干扰药物:噻氯吡啶Ticlopidine(抵克立得)?凝血酶抑制剂:水蛭素;?血小板膜GPIIb/IIIa受体拮抗剂:阿昔单抗?前列环素PGI2二、抗凝血药(Anticoagulants)?肝素Heparin?水蛭素Hirudin?香豆素类Coumarin三、纤维蛋白溶解药(Fibrinolytics)?链激酶:Streptokinase?尿激酶:Urokinase?组织型纤维蛋白溶酶原激活剂:t-pA,(Humantissue-typeplasminogenactivator)ChemicalmediatorsReleased by plateletsPlateletscoverandadhere toexposedsubendothelialsurface+ActivationofcoagulationfactorsinplasmaProthrombin(II)Thrombin(IIa)Fibrinogen(I)Fibrin1234Fig. Formationofa hemostatic plugDamageto vesselexposecollagento subendotheliumPlateletadhesion andreleaseof granulesPlateletaggregationandformationof fibrinplug132TXA2TXA2AspirinAAPGG2,`-AMPDipyridamolePGI25-HTADPBalancebetweenlevelsofPGI2andTXA2influenceswhetherplateletaggregatesorcirculatesfreely?Healthy,intactendotheliumreleasesPGI2intoplasma.?PGI2bindstoplateletmembranereceptorscausingsynthesisofcAMP.?cAMPinhibitsreleaseofgranules containingaggregatingagents.?Thrombin,TXA2andexposedcollagencausereleaseofAAfromplateletmembrane.?TXA2issynthesizedfromAAandreleasedfromtheplatelet.?