臨床藥理hfppt課件-文庫吧資料
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【正文】 vere heart failure. N Engl J Med 1999。 ? metoprolol ? carvedilol ? bisoprolol ? The adverse effects : worsening of symptoms, hypotension, and bradycardia ? These symptoms can be minimized by initiating therapy with low doses and gradually increasing dosage until tolerable therapeutic doses are reached ? Betablockers are contraindicated in patients with asthma or severe bradycardia Diuretics ? Most pateints with heart failure require treatment with diuretics to relieve symptoms of fluid retention (edema and congestion), but their is no evidence that diuretics slow the progression of the disease or decrease mortality. ? Loop diuretics (furosemide) are the most effective diuretics 多用于 嚴 重水 鈉 潴留和 腎 功能不全 時 。 ARBs angiotensin receptor blockers ? angiotensin receptor antagonists (AT1 Receptor Antagonists) are as effective as ACE inhibitors in treating heart failure, but it appears that therapeutic efficacy may be parable ? losartan, candesartan, valsartan Inotropic Drugs digitalis ? The beneficial effects of cardiac glycosides in the treatment of heart failure have been attributed to a positive inotropic effect on failing myocardium and efficacy in controlling the ventricular rate response to atrial fibrillation. The cardiac glycosides also modulate autonomic nervous system activity, and it is likely that this mechanism contributes substantially to their efficacy in the management of heart failure. ? Positive Inotropic Effect （抑制 Na+,K+ATPase ） ? Electrophysiological Actions （加上增強迷走） ? Regulation of Sympathetic Nervous System Activity – There is evidence that digitalis may act directly to sensitization of baroreceptor response and thereby exert some of its beneficial effects through reduction of sympathetic tone ? The recent Digitalis Investigation Group (DIG) clinical trial indicated digoxin did not reduce overall mortality in patients with heart failure (who were receiving diuretics and ACE inhibitors), but did reduce the rate of hospitalization Other inotropic agents 只適用于急性心衰，長期應用于慢性心衰后，病人死亡率增加。 ?
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