導(dǎo)致心衰或加重心衰的藥物

1、導(dǎo)致心衰或加重心衰的藥物—AHA聲明,廣州市紅十字會(huì)心血管醫(yī)學(xué)部 林梓卿,,心衰惡化的原因,心衰惡化原因：病因、生活方式、?？扑幬锾幏?、其他藥物或者保健藥物影響導(dǎo)致和惡化心衰的藥物，包括中草藥,機(jī)理,direct myocardial toxicity, drug-drug interactions, or both.,誘發(fā)程度,強(qiáng)

2、（Major）：危及生命的作用或可導(dǎo)致住院或急診的作用。中（Moderate）：導(dǎo)致額外的就診，改變NYHA功能分級(jí)，心功能變化，或心血管疾病惡化（如高血壓、血脂異常和代謝綜合征）或可導(dǎo)致需要在長期用藥方案中永久改變的癥狀。弱（Minor）：在患者評(píng)估中導(dǎo)致短暫增加的作用或?qū)е滦枰唐谒幬锔淖兊淖饔谩?起效,立即（Immediate）：用藥后1周之內(nèi)出現(xiàn)作用。中（Intermediate）：用藥后幾周至幾月出現(xiàn)作用。延遲（D

3、elayed）：用藥后≥1年出現(xiàn)作用。,證據(jù)級(jí)別,解熱鎮(zhèn)痛藥,舉例—來自塞萊昔布說明書,舉例—來自塞萊昔布說明書,Drug-drug interactions,綜合機(jī)理,使血壓難以控制增加血栓事件風(fēng)險(xiǎn)增加水鈉儲(chǔ)留、腎功能惡化削弱利尿劑作用，削弱RASS抑制劑,臨床實(shí)踐,心衰合并痛風(fēng)、關(guān)節(jié)痛ACS或者介入治療后疼痛的處理和阿司匹林等抗血小板藥物聯(lián)用時(shí)與劑量相關(guān),糖尿病藥物,二甲雙胍說明書,糖尿病藥物—觀察性研究2007BMJ,

4、對(duì)二甲雙胍的不同看法胰島素增加心衰病人全因死亡率噻唑烷二酮增加心衰住院率,新型藥物:沙格列汀說明書,SAVOR-TIMI 53 研究:沙格列汀VS安慰劑心衰住院率 3.5%VS 2.8%（風(fēng)險(xiǎn)比 1.27；p=0.007）危險(xiǎn)因素: 基線BNP水平 /既往合并心衰/慢性腎臟疾病,特點(diǎn),suggesting a possible class effectThe true mechanism of this potent

5、ial increase in HF hospitalization remains unknown.,CCB,證據(jù),多沙唑嗪,CCB,Hematologic Medications,解讀和證據(jù),選擇性磷酸二酯酶III抑制劑: 西洛他唑、米力農(nóng),機(jī)理和建議,西洛他唑說明書,Pulmonary agents:Bosentan , Epoprostenol,and alprostadil,Antimigraine Medications,

6、Valve lesionRight-sided HFLong-term administrationDid not completely resoved on drug discontinuation,Valve lensionLong-term administrationRight-sided HFDid not completely resolve on drug discontinuationThe mechani

7、sm is thought to be related to excess serotonin activity,OTC,Headache, stomached, heartburn, allergies, coughMore than the recommended dose of an OTC product.OTC NSAIDs, high sodium, vasoconstrictor,,Sodium-Containing

8、 Medications,Sodium with HF,<2.0g/day,CAMs With Significant interactions With Cardiovascular Medications Used in Patients With HF,CAMs That increase Bleeding risk With Anticoagulants via Platelet and/or Clotting Facto

9、r Effects,Off-target effects,CAMs That May Be Mechanistically Harmful in Patients With Heart Failure,vitamin E,> vitamin E 400 IU/d may increase the risk of developing new- onset HF; increased risk for hospi- talizat

10、ion for HF compared with placebo, up to a 50% increased risk for developing clinically overt HF,3 specific measures,QT-Prolongjing,antibi- otics, antidepressants, antipsychotics, and antiemetics hypokalemia, hypomagnes

11、emia, bradycardia, genetic predisposition, female sex, HF,Medications That Could Prolong the QT Interval and Induce TdP,others,Antiarrhythmic Medications : Flecainide , sltalol, Dronedarone ,Anesthesia Medications Anti