作用于血液及造血系统的药物.pptxVIP

作用于血液及造血系统的药物Drugs Affecting Blood ThrombosisPlatelet inhibitor AnticoagulantsThrombolytic agentsTreatment of BleedingTreatment of Anemia 概述 血液的流动性与凝固性的调节：凝血与抗凝机制；纤维蛋白溶解系统与抗纤溶机制。血栓形成与血栓栓塞性疾病：1、静脉血栓形成与栓塞：2、动脉血栓形成与栓塞：3、播散性血管内凝血（DIC）。 血栓形成 Thrombosis心血管内皮细胞的损伤动脉粥样硬化、动脉炎、静脉内膜炎、高脂血、高血压、免疫反应血流状态的改变：静脉血栓血液凝固性增高 Blood hypercoagulability血栓的种类白色血栓 Pale thrombus：动脉混合血栓Mixed thrombus：静脉红色血栓Red thrombus：静脉透明血栓Hyaline thrombus：微循环小血管 抗栓药（Antithrombotic drugs）一、抗血小板药（Antiplatelet drugs）二、抗凝血药（Anticoagulants）三、纤维蛋白溶解药 (Fibrinolytics)一、抗血小板药（Antiplatelet drugs） 环氧酶抑制剂：阿司匹林； 增加血小板内cAMP的药物：双嘧达莫（潘生丁） 抑制ADP活化血小板和GPIIb/IIIa受体干扰药物: 噻氯吡啶 Ticlopidine (抵克立得) 凝血酶抑制剂：水蛭素； 血小板膜GP IIb/IIIa受体拮抗剂：阿昔单抗 前列环素 PGI2二、抗凝血药（Anticoagulants） 肝素 Heparin 水蛭素 Hirudin 香豆素类 Coumarin三、纤维蛋白溶解药 (Fibrinolytics) 链激酶: Streptokinase 尿激酶: Urokinase 组织型纤维蛋白溶酶原激活剂: t-pA, (Human tissue-type plasminogen activator)Fig. Formation of a hemostatic plug1Damage to vessel expose collagen to subendotheliumProthrombin (II)+2Thrombin (IIa)2Platelet adhesion and release of granules3Fibrinogen(I)Fibrin1Activation of coagulation factors in plasma4Chemical mediatorsReleased by plateletsPlatelets cover and adhere to exposed subendothelial surfacePlatelet aggregation and formation of fibrin plug3TXA2 binds to receptors on other platelets thereby initiating release of additional aggregating agents.5-HTADPBalance between levels of PGI2 and TXA2 influences whether platelet aggregates or circulates freelyPlateletTXA2GranulesPGG2, PGH2DAGIP3AspirincAMPATPAADipyridamoleHealthy, intact endothelium releases PGI2 into plasma.PGI2 binds to platelet membrane receptors causing synthesis of cAMP.cAMP inhibits release of granules containing aggregating agents.5`-AMPThrombin, TXA2 and exposed collagen cause release of AA from platelet membrane.TXA2 is synthesized from AA and released from the platelet.This pathway is inhibited by aspirin.PGI2TXA2EndothelialcellsCollagen fibers1. Accumulation of modified lipid2. Endothelial cell activation3. Inflammato