心脏病学

章节摘录

书摘·Disopyramide (additive effect)．·General anesthetics (negative inotropic effect)．·Lidocaine(unwanted lidocaine effects may be exagger-ated)．    ·MAO inhibitors(increased hypotensive effect)．·NSAIDs(antihypertensive action may be decreased)．·Quinidine(beta blocking effect may be increased)．·Rifampicin(bbta—blocker plasma levels may be reduced)．DosageSeeTable 5．8NONSELECTIVE BETA-BLOCKERS WITHISAAlprenolol，carteolol，oxprenolol，penbutolol，pindol01．Some are lipid—soluble(e．g．，alprenolol，oxprenol01)，aremetabolized extensively by the liver,have relatively shorthalf-lives，and need to be administered in several dailydoses(Tab．5．8)．Advantages·Resting heart Fate is decreased less than after adminis—tration of beta—blockers without ISA．·Cardiac output at rest is depressed to only a minor degree．·In this subgroup resting blood pressure is lowered more by a fall in peripheral resistance than by a decrease in cardiac output．·Exacerbation of anginal symptoms following discontin-uation of treatment is less likely witll beta-blockers hav-ing a moderate／high ISA(no up-regulation of the recep-tor)．·Adverse reactions(e．g．，cold extremities，fatigue)may be less~equent．    ·Increase in serum cholesterol and triglycerides and decrease in HDL cholesterol are less likely．·Little effect on the resting heart rate．therefore．1ess effective in reducing mortality．·Less effective antianginal activity,especially at night(then an increase in heart rate may occur，prolongtng ischemic episodes)．·Ventricular fibrillation threshold lowers(relatively)．See nonselective beta．blockers without ISADosageSee 1．able 5．8SELECTIVE BETA·BLOCKERS WITHOUTISAAtenolol，betaxolol，bisoprolol，esmolol，metoprololOf these(Tab．5．9)，some are relatively lipid soluble(e．g．，metoprol01)．are metabolized by the liver，and have ashort half．1ife．thus requiring special felrmulation foronce-a-day tablets．Others are rather hydrophilic(e．g．．atenol01)，minimally metabolized，excreted by the kid·neys．have longer duration of action，and are sufncient foronce-daily administration．Advantages·The lack of beta，一blocking effects makes beta，vasodi—latation possible，and therefore betal—selective drugs decrease diastolic blood pressure slightly more f3—4 mm Hgl than do non—selective agents．·Lesser impairment of exercise tolerance(beta2-blocking e行ects on muscle glycolytic processes)．·Fewer adverse reactions in patients with a tendency to bronchospasm．diabetes．or peripheral vascular disease．·Esmolol has a rapid onset and a very short half-life(Tab．5．91 and is indicated mainly for fast ventricular-rate con-trol in patients when short-teITn control of the heart rate is necessary(e.g.atrial fibrillation or atrial flutter)．DisadvantagesFall in cardiac output(20·25％)，which remains at theselevels throughout chronic therapy．·Second and third—degree atrioventricular block．·Severe bradycardia(condition may worsen)．·Severe peripheral vascular disease(cardiac output is decreased．which could lead to further worsening)．·Uncontrolled heart failure fmay be exacerbated)．·Severe asthma(may be exacerbated)．·Pregnancy．·Myocardial infarction with bradycardia(further nega-tive chronotropic effect)．·Hypotension(may be exacerbated)．·Epinephrine(sudden hypertension with bradycardia，less likely than with nonselective drugs)．·Antiarrhythmics(Class I：cardiac depression and brady-cardia)．·C：alcium antagonists fespecially diltiazem and vera-pamil：additive negative chronotropic and inotropic action，hypotension)．·Enzyme inhibitors(e．g．，cimetidine may increase plas-ma levels of metabolites)．·Clonidine(rebound hypertension when clonidine is withdrawn．although less likely than wi山nonselective beta．blockers)． ……书摘1……

媒体关注与评论

书评……

书籍目录

Contributors                                 IXForeword                                    XVIIPreface                                    XIXSECTION IBASIC FOUNDATIONSOF CARDIOLOGYChapter IIntroduction: the changing face of cardiology 3Peter SleightChapter 2EpidemiologyPrancois Delahaye, Gay de Gevigney, Jacques DelayeChapter 3Physiology of circulation                Thomas KennerChapter 4Psychologic stress and the heart        Richard L. Verrier, Murray A. MittlemanChapter 5Principles of drug therapy              Lajos MatosChapter 6Rehabilitation                    Catherine MonpereSECTION 2CLINICAL EVALUATIONAND SPECIAL INVESTIGATIONSChapter 7History and symptoms              Jean-Pierre DelahayeChapter 8The physical examination of thecardiovascular system……

 心脏病学下载