臨床藥理hfppt課件(已改無錯字)
2023-02-08 04:10:34 本頁面
【正文】 rstline therapy for patients with mild to moderate heart failure ? 現(xiàn)認(rèn)為脂溶性的效果更好。 ? 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(yán) 重水 鈉 潴留和 腎 功能不全 時 。 ? Thiazide diuretics act on the distal loop and are less effective than loop diuretics 用于 輕 度水 鈉 潴留。 ? Concurrent use of two diuretics with different sites of action may be needed in patients who do not respond well to a single oral diuretic ? The most mon adverse effect of diuretic therapy is potassium depletion which can be prevented by use of supplemental potassium, an ACE inhibitor, or a potassiumsparing diuretic (spironolactone or amiloride) ? Aldosterone Antagonists Recent clinical trials indicate that adding spironolactone (螺內(nèi)酯 )to standard treatment can significantly decrease mortality in patients with severe heart failure Effect of spironolactone on survival in patients with moderate or severe congestive heart failure in a randomized doubleblind clinical study. (Reproduced, with permission, from Pitt B et al: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999。341:709 醛固酮受體拮抗劑螺內(nèi)酯 降低充血性心衰病人死亡率 Other Agents with Therapaeutic Potential ? Endothelin1 Antagonists ? The vasoconstrictor peptide, endothelin1, is known to be elevated in heart failure and is a predictor of mortality in patients with heart failure. Animal models of heart failure indicate endotheli
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