没有标题浙江大学教学信息化平台PPT学习教案.pptx
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1、会计学1没有没有(mi yu)标题浙江大学教学信息化平台标题浙江大学教学信息化平台第一页,共48页。Contentsn n Overviewn n ACE inhibitorsn n Diureticsn n receptor blockersn n Cardiac glycosiden n OthersHeart(cardiac)failure is said to have occurred when the heart is no longer Heart(cardiac)failure is said to have occurred when the heart is no long
2、er able to maintain the circulation to the tissues for normal metabolism.able to maintain the circulation to the tissues for normal metabolism.第1页/共48页第二页,共48页。1.1.Pathophysiological changes of congestive heart failure Pathophysiological changes of congestive heart failure(CHF)(CHF)(1)Function and s
3、tructure changes(1)Function and structure changes(2)Increased sympathetic activity and(2)Increased sympathetic activity and down-regulation of down-regulation of receptor receptor(3)Activated renin-angiotensin-aldosterone system(3)Activated renin-angiotensin-aldosterone system(RAAS)(RAAS)A.Overview第
4、2页/共48页第三页,共48页。第3页/共48页第四页,共48页。Pathophysiological changes of CHFPathophysiological changes of CHF第4页/共48页第五页,共48页。Pathophysiological changes of CHFPathophysiological changes of CHF第5页/共48页第六页,共48页。Cardiac failureCardiac failureCardiac outputCardiac outputVenous pressureVenous pressureVenous hypere
5、miaVenous hyperemiaPulmonary circulation:Pulmonary circulation:cough,emptysis,dyspneacough,emptysis,dyspneaSystemic circulationSystemic circulation hyperemiahyperemia :jugular vein distension,edemajugular vein distension,edemaBlood supplyBlood supplyRenal blood flowRenal blood flowRenin-angiotension
6、 Renin-angiotension Aldosterone Aldosterone Sodium and waterSodium and waterretentionretentionChanges in hemodynamics of CHFChanges in hemodynamics of CHF第6页/共48页第七页,共48页。A.Overview2.2.Grades of CHFGrades of CHF (A):(A):no symptoms no symptoms (B):(B):physical activities were limited and physical ac
7、tivities were limited and symptoms could be induced by general symptoms could be induced by general activityactivity (C):(C):physical activities were markedly physical activities were markedly limited limited (D):(D):symptoms appear even at rest symptoms appear even at rest第7页/共48页第八页,共48页。3.Therape
8、utic strategies in CHF(1)Increasing contractility of the cardiac muscles(1)Increasing contractility of the cardiac muscles(2)Inhibiting RAAS(2)Inhibiting RAAS(3)Reducing sympathetic activity(3)Reducing sympathetic activity(4)Dilating vessels(4)Dilating vessels(5)Diuresis (5)Diuresis A.Overview Cardi
9、acCardiacremodelingremodeling DecreaseDecreaseoverloadoverload 第8页/共48页第九页,共48页。Drug therapy for CHFDrug therapy for CHF第9页/共48页第十页,共48页。ACEI:captopril 卡卡托普利托普利 enalapril 依那依那普利普利AT1 receptor antagonists:losartan 氯沙氯沙坦坦 irbesartan 伊伊白沙白沙(bi sh)坦坦B.Angiotensin converting enzyme inhibitors(ACEI)and an
10、giotensin receptor antagonists第10页/共48页第十一页,共48页。Cardiovascular remodelingCardiovascular remodelingvasodilatationvasodilatationSystemic and localSystemic and local第11页/共48页第十二页,共48页。ACEI1.Pharmacological effectsn nInhibiting the production of Ang IIInhibiting the production of Ang IIn n vasoconstric
11、tion vasoconstriction ;sodium retention;sodium retention ;n n cardiac remodeling(myocardial hypertrophy)cardiac remodeling(myocardial hypertrophy)n nInhibiting the degradation of bradykinin Inhibiting the degradation of bradykinin n n vasodilatation vasodilatation n nIncreasing ANP and scavenging fr
12、ee radicalsIncreasing ANP and scavenging free radicals B.B.Angiotensin converting enzyme inhibitors Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists(ACEI)and angiotensin receptor antagonists第12页/共48页第十三页,共48页。Box Actions of angiotensin II through activating AT1 rece
13、ptors Constricting vessels,increase peripheral Constricting vessels,increase peripheral resistance and returned blood volume.resistance and returned blood volume.Increasing sympathetic tension,promote Increasing sympathetic tension,promote release of sympathetic transmitter.release of sympathetic tr
14、ansmitter.Stimulating release of aldosteroneStimulating release of aldosterone.Rapidly inducing expression of Rapidly inducing expression of c-fos,c-jun,c-fos,c-jun,Egr-1,c-myc,etc.Egr-1,c-myc,etc.第13页/共48页第十四页,共48页。Cardiovascular effectsCardiovascular effects Decrease resistance of peripheral vesse
15、ls Decrease resistance of peripheral vessels Dilate coronary artery,increase blood supply of heart and kidney,improve cardiac and renal function Dilate coronary artery,increase blood supply of heart and kidney,improve cardiac and renal function Reverse myocardial hypertrophy and ventricular remodeli
16、ng Reverse myocardial hypertrophy and ventricular remodeling B.B.Angiotensin converting enzyme Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor inhibitors(ACEI)and angiotensin receptor antagonistsantagonists第14页/共48页第十五页,共48页。B.B.Angiotensin converting enzyme Angiotensin conver
17、ting enzyme inhibitors(ACEI)and angiotensin inhibitors(ACEI)and angiotensin receptor antagonistsreceptor antagonists2.2.Clinical usesClinical uses(1)CHF(1)CHF increase motor increase motor tolerancetolerance decrease mortality decrease mortality(2)Hypertension(2)Hypertension 第15页/共48页第十六页,共48页。3.Adv
18、erse effects HypotensionHypotensionn nCough and angioedemaCough and angioedeman nHyperpotassemiaHyperpotassemia n nRashes and altered tastesRashes and altered tastesn nContraindications:Contraindications:pregnancy and stenosis of renal pregnancy and stenosis of renal artery artery B.B.Angiotensin co
19、nverting enzyme Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor inhibitors(ACEI)and angiotensin receptor antagonistsantagonists第16页/共48页第十七页,共48页。AT1 receptor antagonistsCompared with ACEI:n nBlocking actions of angiotensin II directlyBlocking actions of angiotensin II directl
20、yn nNot affecting bradykinin metabolismNot affecting bradykinin metabolismn nProtecting renal functionProtecting renal functionn nUsed for CHF and hypertensionUsed for CHF and hypertension B.B.Angiotensin converting enzyme Angiotensin converting enzyme inhibitors(ACEI)and angiotensin inhibitors(ACEI
21、)and angiotensin receptor antagonistsreceptor antagonists第17页/共48页第十八页,共48页。1.1.Pharmacological effectsPharmacological effects n nReduce blood volume by increasing NaReduce blood volume by increasing Na+and water excretion and water excretionn nReduce NaReduce Na+-Ca-Ca2+2+exchange in vascular smoot
22、h muscle cells exchange in vascular smooth muscle cells2.2.Clinical uses Clinical usesn nCHF:CHF:grand I IV(mainly used in II III),grand I IV(mainly used in II III),alone or combined alone or combined with other drugs with other drugs n nEdema,hypertension,Edema,hypertension,etc.etc.3.Adverse effect
23、s3.Adverse effects imbalance of electrolytes/acid-base;imbalance of electrolytes/acid-base;plasma level of renin plasma level of renin ;hypokalemia;hypokalemia;hyperuricemia;hyperglycemia/hyperlipidemiahyperuricemia;hyperglycemia/hyperlipidemiaC.Diuretics第18页/共48页第十九页,共48页。Therapeutic effects of The
24、rapeutic effects of diuretics in CHFdiuretics in CHF第19页/共48页第二十页,共48页。Main Main diureticsdiureticsThiazidesThiazidesLoop Loop diureticsdiureticsK+K+sparing sparing diureticsdiuretics第20页/共48页第二十一页,共48页。类类 别别(主要作用部位主要作用部位)其他分类名其他分类名作用机制作用机制利尿应用利尿应用非利尿应用非利尿应用碳酸酐酶抑制药碳酸酐酶抑制药碳酸酐酶抑制药碳酸酐酶抑制药(近曲小管)(近曲小管)(近
25、曲小管)(近曲小管)/抑制碳酸酐酶抑制碳酸酐酶抑制碳酸酐酶抑制碳酸酐酶利尿药耐受的病利尿药耐受的病利尿药耐受的病利尿药耐受的病人人人人,与袢利尿药合与袢利尿药合与袢利尿药合与袢利尿药合用用用用青光眼,高山病,青光眼,高山病,青光眼,高山病,青光眼,高山病,代谢性碱中毒代谢性碱中毒代谢性碱中毒代谢性碱中毒渗透性利尿药渗透性利尿药渗透性利尿药渗透性利尿药(髓袢及其他部(髓袢及其他部(髓袢及其他部(髓袢及其他部位)位)位)位)脱水药脱水药脱水药脱水药增高尿液渗透压增高尿液渗透压增高尿液渗透压增高尿液渗透压急性肾功能衰竭急性肾功能衰竭急性肾功能衰竭急性肾功能衰竭脑水肿,青光眼脑水肿,青光眼脑水肿,青光
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