抗心绞痛药物.ppt

文档介绍：2016/2/231抗心绞痛药AntianginalDrugsAntianginals2016/2/232TypesofAngina1、Stableangina(稳定型)冠脉硬化,劳累时发作Therapeuticrationale:Decreasecardiacloadandoxygenconsumption2016/2/2332、Variantangina(变异型)冠脉痉挛,夜间/清晨时发作。Therapeuticrationale:Decreasevasospasmofcoronaryvessels3、Unstableangina(不稳定型)上二者兼有Therapeuticrationale:Inhibit plateletaggregationandthrombusformation,decreasecardiacloadandvasospasmofcoronaryarteries*抗血小板药、溶栓药、吸O2、阿片以减轻疼痛并降低过高的交感N张力和ACEI等。2016/2/234Pathophysiology of angina pectorisEjectiontimeAnimbalancebetweenmyocardialoxygendemand andoxygen supplied2016/2/monUsed Drugs?itrates(Nitrateesters)??受体阻断药?-Blocker?钙拮抗药CalciumAntagonist2016/2/itrate硝酸甘油nitroglycerin2016/2/237I. Effects::?回心血量??心室容积??室壁肌张力??心肌耗氧??改善心肌血流分布:对穿透心肌的血管压迫力??心内膜下供血?2016/2/?外周阻力??射血t??耗O2??血从输送血管经侧枝血管?更多的分流到缺血区?改善缺血区血供图1.*无冠脉窃流(coronarysteal)2016/2/239Beforenitrates administrationAfternitrates输送血管阻力血管2016/2/2310MechanismofAction硝酸酯类在SMC内?被巯基还原成?NO或硝基硫醇类??GC?cGMP??Vessel :guanylatecyclase鸟苷酸环化酶