用藥安全專題(一): 心血管相關藥物之高危險用藥為恭紀念醫院藥劑部莊惠評藥師常見的心血管疾病HyperlipidemiaIschemicheartdisease(angina,myocardialinfarction)HeartfailureCardiacarrhythmiasHypertension缺血性心臟病病程的發展HTN、DM、HyperlipidemiaAtherosclerosis、oronarythrombosisMyocardiuminfarctionArrhythmia、Lossofmuscle、SuddendeathRemodelingVentriculardilationHeartfailureEnd-stageheartdisease心血管治療用藥LipidloweringagentsNitratesβ-blockersCalciumchannelblockersDiureticsVasodilatorsAngiotensinconvertingenzymeinhibitors(ACE-I)AngiotensinIIreceptor-antagonistsDigitalisAntiplateletsAnticoagulantsThrombolyticagentsAntiarrhythmicdrugsMyocardialinfarction★LipidloweringagentsHMG-CoAReductase-IFibratesBileacidsequestrantresins★Lipidloweringagents學名EffectsonlipidsEffectsonlipoproteinsDosageSideeffectsBileacidsequestrantresinsCholestyramine↓cholesterol↓LDL↑VLDL8mgTID/、D、E、K之吸收FibricacidsGemfibrozilFenofibrate↓TG&cholesterol↓VLDL&LDL↑HDL300-600mgBID/AC,-CoAreductaseinhibitorsSimvastatinAtrovastatin↓cholesterol↓LDL10-20mg/day/Qpm10-80mg/day肌肉病變肝功能異常(建議隔4~6週檢查一次肝功能)Fibrates類與statin類併用時可能會發生橫紋肌溶解症之副作用(5%),應小心併用。劑量增加,發生機率亦增加。若須併用,建議statin類以晚飯後低劑量給予,而fibrates以早上飯前或飯後給予以避免橫紋肌溶解症之副作用產生。itantdiseaseNoneRecentmyocardialinfarctionAsthma,monlyusedintreatinganginaLong-actingnitrateLong-actingnitrateLong-actingnitrateLong-actingnitrateLong-actingnitrateLong-actingnitrateβ-blockersβ-blockersβ-blockersβ1-selectiveblockersβ-blockersCa++channelblockersCa++channelblockersCa++channelblockersCa++channelblockersCa++channelblockers★Nitrates:經體內代謝後會轉變成NO,先擴張靜脈↓preload及afterload,使心臟工作量減低,而大劑量時會使得冠狀動脈舒張,緩解因vasospasm所引起的心絞痛。ClassandagentDosageOnset(mins)mentsSublingualnitroglycerin(避光儲存,若含在口中無辛辣感則表示藥物已無效)--510-30minsHighdosesneededTolerancecanbepreventedbyovernightdoseinterval>8hProtectiveeffectagainstcardiacischemiaPreloadreducingagentsIsosorbibidedinitrate(Isoket,Isodil)5-40mgtid2-7mg/hr,-604-6hrsIsosorbibide5-mononitrate(Ismo)10-20mgbid30-606-8hrs★β-blockers:抑制交感神經對心臟的作用,使心臟收縮力及傳導速率下降
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