没有标题浙江大学教学信息化平台.pptx
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1、Contents OverviewOverview ACE inhibitors ACE inhibitors Diuretics Diuretics receptor blockers receptor blockers Cardiac glycoside Cardiac glycoside Others OthersHeart(cardiac)failure is said to have occurred when the heart Heart(cardiac)failure is said to have occurred when the heart is no longer ab
2、le to maintain the circulation to the tissues for is no longer able to maintain the circulation to the tissues for normal metabolism.normal metabolism.第1页/共48页1.1.Pathophysiological changes of Pathophysiological changes of congestive heart failure(CHF)congestive heart failure(CHF)(1)Function and str
3、ucture 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-(3)Activated renin-angiotensin-aldosterone system(RAAS)aldosterone system(RAAS)A.A.OverviewO
4、verview第2页/共48页第3页/共48页Pathophysiological Pathophysiological changes of CHFchanges of CHF第4页/共48页Pathophysiological changes of CHFPathophysiological changes of CHF第5页/共48页Cardiac failureCardiac failureCardiac outputCardiac outputVenous pressureVenous pressureVenous hyperemiaVenous hyperemiaPulmonary
5、 Pulmonary circulation:circulation:cough,emptysis,cough,emptysis,dyspneadyspneaSystemic circulationSystemic circulation hyperemiahyperemia :jugular vein distension,jugular vein distension,edemaedemaBlood supplyBlood supplyRenal blood flowRenal blood flowRenin-angiotension Renin-angiotension Aldoster
6、one Aldosterone Sodium and waterSodium and waterretentionretentionChanges in hemodynamics of CHFChanges in hemodynamics of CHF第6页/共48页A.Overview2.Grades of CHF (A):(A):no symptoms no symptoms (B):(B):physical activities were limited and physical activities were limited and symptoms could be induced
7、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3.3.Therapeutic strategies in CHF Therapeutic strategies in CHF(1)Incr
8、easing contractility of the(1)Increasing contractility of the cardiac musclescardiac 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.A.OverviewOverview CardiacCardiacremodelingr
9、emodeling DecreaseDecreaseoverloadoverload 第8页/共48页Drug therapy for CHFDrug therapy for CHF第9页/共48页ACEI:ACEI:captopril captopril 卡托普利卡托普利卡托普利卡托普利 enalapril enalapril 依那普利依那普利依那普利依那普利ATAT1 1 receptor antagonists:receptor antagonists:losartan losartan 氯沙坦氯沙坦氯沙坦氯沙坦 irbesartan irbesartan 伊白沙坦伊白沙坦伊白沙坦伊白沙
10、坦B.Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists第10页/共48页Cardiovascular remodelingCardiovascular remodelingvasodilatationvasodilatationSystemic and localSystemic and local第11页/共48页ACEI1.1.Pharmacological effectsPharmacological effectsInhibiting the production of
11、Ang IIInhibiting the production of Ang II vasoconstriction vasoconstriction ;sodium;sodium retention retention ;cardiac remodeling(myocardial cardiac remodeling(myocardial hypertrophy)hypertrophy)Inhibiting the degradation of Inhibiting the degradation of bradykinin bradykinin vasodilatation vasodil
12、atation Increasing ANP and scavenging free Increasing ANP and scavenging free radicalsradicals B.Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists第12页/共48页Box Actions of angiotensin II through activating AT1 receptorsConstricting vessels,increase peripheral Constrict
13、ing 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 transmitter.Stimulating release of aldosteroneStimulating
14、release of aldosterone.Rapidly inducing expression of Rapidly inducing expression of c-fos,c-c-fos,c-jun,Egr-1,c-myc,etc.jun,Egr-1,c-myc,etc.第13页/共48页Cardiovascular effectsCardiovascular effects Decrease resistance of peripheral vessels Decrease resistance of peripheral vessels Dilate coronary arter
15、y,increase blood supply of heart and kidney,Dilate coronary artery,increase blood supply of heart and kidney,improve cardiac and renal functionimprove cardiac and renal function Reverse myocardial hypertrophy and ventricular remodeling Reverse myocardial hypertrophy and ventricular remodeling B.Angi
16、otensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists第14页/共48页B.Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists2.Clinical uses(1)CHF(1)CHF increase motor increase motor tolerancetolerance decrease mortality decrease mortality(2)Hypertension
17、(2)Hypertension 第15页/共48页3.Adverse effects HypotensionHypotensionCough and angioedemaCough and angioedemaHyperpotassemiaHyperpotassemia Rashes and altered tastesRashes and altered tastesContraindications:Contraindications:pregnancy and pregnancy and stenosis of renal artery stenosis of renal artery
18、B.Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists第16页/共48页AT1 receptor antagonistsCompared with ACEI:Compared with ACEI:Blocking actions of angiotensin Blocking actions of angiotensin II directlyII directlyNot affecting bradykinin Not affecting bradykinin metabolis
19、mmetabolismProtecting renal functionProtecting renal functionUsed for CHF and hypertensionUsed for CHF and hypertension B.Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor antagonists第17页/共48页1.1.Pharmacological effectsPharmacological effects Reduce blood volume by increasing Na
20、Reduce blood volume by increasing Na+and and water excretionwater excretion Reduce NaReduce Na+-Ca-Ca2+2+exchange in vascular smooth exchange in vascular smooth muscle cellsmuscle cells2.2.Clinical uses Clinical uses CHF:CHF:grand I IV(mainly used in II III),grand I IV(mainly used in II III),alone o
21、r combined with other drugs alone or combined with other drugs Edema,hypertension,Edema,hypertension,etc.etc.3.Adverse effects3.Adverse effects imbalance of electrolytes/acid-base;imbalance of electrolytes/acid-base;plasma level of renin plasma level of renin ;hypokalemia;hypokalemia;hyperuricemia;h
22、yperglycemia/hyperlipidemiahyperuricemia;hyperglycemia/hyperlipidemiaC.C.DiureticsDiuretics第18页/共48页Therapeutic effects of Therapeutic effects of diuretics in CHFdiuretics in CHF第19页/共48页Main Main diureticsdiureticsThiazideThiazides sLoop Loop diureticdiuretics sK+K+sparing sparing diureticsdiuretic
23、s第20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
24、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,青光眼脑水肿,青光眼袢利尿药(髓袢袢利尿药(髓袢袢利尿药(髓袢袢利尿药(髓袢升支粗段)升支粗段)升支粗段)升支粗段)1.1.高效能利尿药高效能利尿药高效能利尿药高效能利尿药2.Na2.Na+-K-K+-2C1-2C1同同同同向转运体抑制药向转运体抑制药向转运体抑制药向转运体抑制药抑制抑制抑制抑制NaNa+-K-K+-2C1-2C1同向转运同向转运同向转运同向转运各种严重水肿,各种严重水肿
25、,各种严重水肿,各种严重水肿,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高钙血症,加速高钙血症,加速高钙血症,加速高钙血症,加速毒物排出毒物排出毒物排出毒物排出噻嗪类利尿药噻嗪类利尿药噻嗪类利尿药噻嗪类利尿药(远曲小管)(远曲小管)(远曲小管)(远曲小管)1.1.中效能利尿药中效能利尿药中效能利尿药中效能利尿药2.Na2.Na+-C1-C1同向转同向转同向转同向转运体抑制药运体抑制药运体抑制药运体抑制药抑制抑制抑制抑制NaNa+-C1-C1同向同向同向同向转运转运转运转运各种水肿各种水肿各种水肿各种水肿高血压,高尿钙高血压,高尿钙高血压,高尿钙高血压,高尿钙症,尿崩症症,尿崩症症
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