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臨床藥理hfppt課件(編輯修改稿)

2026-02-04 04:10 本頁面

　

【文章內容簡介】 opril強。 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。 ? BetaAdrenergic Agonists – dopamine, dobutamine, prenalterol – Levodopa and ibopamine ? Cyclic Nucleotide Phosphodiesterase (PDEIII, cGMPinhibitable PDE) Inhibitors – Bipyridines amrinone and milrinone – imidazolone derivatives enoximone and piroximone BetaBlockers and CHF ? A number of studies beginning in the 1970s have shown that betablockers can improve symptoms and ventricular function in patients with moderate to severe heart failure, and may slow the progression of heart failure in some patients (reviewed in Bristow, Circulation 101:558 (2022)) ? Though betablockers were widely considered to be contraindicated for patients with heart failure only a decade ago, they are now considered fi

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