留學生心絞痛§1BriefIntroductionCoronaryheartdiseaseTeatmentofAnginaPectoris:1、Dilationofbloodvessels2、Reducingbloodlipidlevel3、Reducingbloodglucoselevel4、Antithrombosis5、Anti-pain大家有疑問的，可以詢問和交流可以互相討論下，但要小聲點ContractilityHeartRateCardiacWallTensionPreloadandAfterload1.Beta-Blockers2.Glyceryltrinitrate

3.L-CBAnti-anginapectorisAgentsCoronaryheartdiseaseprescription:NitrateestersAntihypertensiveagentsAntilipemicagents§2NitrateVasodilator

Inbloodvesselwall,GTNproduceNOwiththehelpofmitochondrialaldehydedehydrogenase(mtALDH)NOinducedilationofbloodvesselsOverdose/longtimeadministrationofGTNalsocaninduceactiveoxygenandinducetolerance.BloodvesseldilationmechanismGTN:GlycerylNitratePETN:pentaerythrityltetranitrateISDN:isosorbidedinitrateISMN:isosorbide-5-mononitrateSolubleguanylylcyclase(sGC)istheonlyknownreceptorforNO、Itissoluble,i、e、pletelyintracellular、Itismostnotablyinvolvedinvasodilation、Inhumans,itisencodedbythegenesGUCY1A2,GUCY1A3,andGUCY1B3EffectsofGTNTolowertheoxygendemandoftheheart2.Todilatecoronaryarteryandincreasetheischemiaareabloodirrigation3.Todecreasetheleftventricularendocardialpressure,increasetheendocardialbloodsupplyandimprovetheadaptabilityoftheleftventricle4.Toprotectischemiccardiaccells：

NO-inducedPGI2andcalcitoningene-relatedpeptides(CGRP)5.Anti-arrythmiaandInhibitionofplateletaggregationBeforeGTNAfterGTNIschemiczoneNormalzonePharmacokineticsofGTNHighlipophilicpropertyExtensivefirst-passeffectsforP.O.:Ifsublingualroute,Fis80%,theonsetofactionis1to2minutes,andthedurationofactionis20to30minutes.INDICATIONSOFGTN1.Acuteanginapectorisattack2.ProphylaxisofanginapectorisGTNpatches,ointment3.Acutemyocardialinfarction4.CongestiveheartfailureIsosorbideDinitrate(消心痛）IsosorbideMononitrate（異樂定）AnginaPreventionHeartFailureTreatmentP.O.WeakTolerance醫大一院有大夫:高血壓合并心絞痛,異樂定+福新普利？AdsofGTNPosturalhypotensionReflextachycardiaThrobbingheadacheFlushing,DizzinessHighIntracerebral/IntraocularPressureTolerance目前常用于心絞痛得藥物:異樂定(欣康,硝酸酯類)消心痛(硝酸酯類)心痛定(硝苯地平)圣通平(硝苯地平緩釋)拜新同(硝苯地平控釋)波依定(非洛地平)絡活喜(氨氯地平)司樂平(拉西地平)異搏定(維拉帕米)比索洛爾(Beta1阻滯劑,選擇性最高)貝她樂克(Beta1阻滯劑)阿替洛爾(Beta1阻滯劑)心得安(Beta阻滯劑)蒙諾(ACEI,福新普利),諾迪康(藏藥)萬爽力(新型藥物,改變心肌代謝)Thecurrentmonlyusedinanginamedicine:Xinkang,nitratesIsosorbidedinitrate(nitrate)NifedipineNifedipine(slow-release)Nifedipine(controlled-release)Felodipine)AmlodipineLacidipineVerapamilBisoprolol(Beta1blockers,thehighestselectivity)Betaloc(Beta1blocker)Atenolol(Beta1blocker)Propranolol(Betablocker)Fosinopril(ACEI),Nuodikang(Medicine)Trimetazidine(changesinmyocardialmetabolism)Bisoprolol(Bisoprolol,Beta1blockers,highselectivity)Metoprolol(Beta1blockers)Atenolol(Beta1blockers)Propranolol(Betablockers)§3Beta-RBlockers

{Tolowerheartrate,V-pressureandcontractilityToslowfatdecompositionToincreaseV-volumeTocontractcoronaryarteries(Propranolol)

-blockersiseffectiveagainstthestableanginapectorisnotinvariantanginapectoris.

和硝酸之類的區別？ForAnginaPectoris:BetaBlockers+GTN?ContraindicationsofBeta-Blockers:

AsthmaHeartFailureBradycardiaHyperlipidemiaVariantAngina§4Ca2+ChannelBlockers1.Reductionofmyocardialoxygendemand?2.Dilationofcoronaryvessels3.Protectionofischemicmyocardialcell4.InhibitionofplateletaggregationNifidipine:variantanginaNifedipine+

-blockers?Verapamil,diltiazem:variant,stable,andunstableanginapectoris.Summary1、

Acuteattacksofanginaaretreatedwith:SublingualnitratesNifedipine2、Acuteanginalpainistreatedwithmorphine3、StableanginaistreatedwithLong-lastingnitrates

-adrenergicreceptorblockersCa2+channelblockers4、Unstableanginaistreatedwith:AspirinHeparin

疏血通,金納多等病例高血壓合并心絞痛一職業高中教師,男76歲(退休)。當年45歲時候,患高血壓,主要靠復方降壓片治療。隨著時間得推移,藥物逐漸失效,并患有冠心病。某“地方小醫院”處方卡托普利、復方降壓片(北京0號類似)和心痛定(硝苯地平片)。后來發生腦梗塞,經治療,基本恢復。最近感到頭疼,血壓升高,來到中國醫大一院心血管內科。患者及其家屬,告訴大夫上述降壓藥物已經使用多年,效果不理想,希望換藥。大