藥理學(xué)課件22 腎素-血管緊張素系統(tǒng)抑制藥

第22章腎素－血管緊張素系統(tǒng)抑制藥Renin-AngiotensinSystemInhibitors江西醫(yī)科大學(xué)何明Therenin-angiotensinsystem,animportantendocrinesystem,participatessignificantlyinthepathophysiologyofseveralhighlyprevalentdiseases,whichhasledtoanenormousefforttoexploreallaspectsoftherenin-angiotensinsystemandtodevisenewapproachesforinhibitingitsactions.腎素－血管緊張素系統(tǒng)

Rennin-AngiotensinSystem

angiotensinogenreninPD123319angiotrnsinⅡangiotrnsinⅠinactivepeptidesvasoconstrictionsympatheticstimulationcellularhypertrophyrenovasculareffectsnitricoxideprostacyclinbradykininbradykininreceptorsACE(kinaseⅡ)???ACEIcaptopril－－＋－＋＋AT1receptorantagonistlosartan＋＋AT2AT1angiotensinogenreninPD123319angiotrnsinⅡangiotrnsinⅠinactivepeptidesvasoconstrictionsympatheticstimulationcellularhypertrophyrenovasculareffectsnitricoxideprostacyclinbradykininbradykininreceptorsACE(kinaseⅡ)???ACEIcaptopril－－＋－＋＋AT1receptorantagonistlosartan＋＋AT2AT1Themolecularpathwayoftherennin-angiotensinandthemajorsitesofACEinhibitors.（一）對血管、血壓的影響（二）對心臟的影響（三）對腎臟的影響（四）對腎上腺素的影響腎素－血管緊張素系統(tǒng)的功能作用于腎素－血管緊張素系統(tǒng)的藥物血管緊張素轉(zhuǎn)化酶抑制藥血管緊張素II受體阻斷藥

Drugsusedtoinhibittheactionsoftherenin-angiotensinsystemincludeangiotensinconvertingenzyme(ACE)inhibitorsandAT1receptorblockers.

血管緊張素轉(zhuǎn)化酶抑制藥Angiotensin-convertingenzymeinhibitorsACEinhibitorsarethemostsuccessfulexampleofdrugsinthisfieldinrecentyearsandarewidelyusedinpatientswithhypertension,congestiveheartfailure,andmyocardialinfarction.Therepresentativedruginthisclassiscaptopril.

血管緊張素轉(zhuǎn)化酶抑制藥一、ACE抑制藥的藥理作用

1.降壓作用。2.對血流動力學(xué)的影響。3.抑制和逆轉(zhuǎn)心血管重構(gòu)。4.保護(hù)血管內(nèi)皮細(xì)胞。5.對腎臟的保護(hù)作用。6.對抗動脈粥樣硬化作用。ACE抑制藥的作用機(jī)制（一）抑制循環(huán)及局部組織中的ACE（二）減少bradykinin的降解（三）抑制交感神經(jīng)遞質(zhì)的釋放（四）自由基清除作用ACE抑制藥的分類及常用藥物一、含有巰基（SH）如卡托普利(captoril)二、含有羧基（COO－）如賴諾普利(lisinopril)三、含有磷酸基（POO－）如福辛普利(fosinopril)卡托普利Captopril一、藥理作用:

1.在體內(nèi)和體外均能抑制ACE。除阻礙AngI轉(zhuǎn)化為AngII外，也減少b