phosphodiesterase – n. 磷酸二酯酶
milrinone – n. 米力农
cAMP -- cyclic adenosine monophosphate
cAMP --环腺苷酸
bisulfite – n. 亚硫酸氢盐
aortic valvular disease – 主动脉瓣膜病
pulmonic valvular disease – 肺瓣膜疾病
diltiazem – n. 地尔硫卓
Cardizem – n. 合心爽
Adalat CC – n. 心痛定CC
Nymalize – n. 【奥】尼莫立治 注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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Phosphodiesterase Inhibitors
磷酸二酯酶抑制剂
The phosphodiesterase inhibitors belong to a second class of drugs that act as cardiotonic agents. The only drug currently available in this class is milrinone.
磷酸二酯酶抑制剂属于起强心作用类药中的二类药。该类药中目前唯一可用是米力农。
The phosphodiesterase inhibitors block the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium levels in the cell. Increased cellular calcium causes a stronger contraction and prolongs the effects of sympathetic stimulation, which can lead to vasodilation, increased oxygen consumption, and arrhythmias. Milrinone is indicated for the short-term treatment of HF that has not responded to digoxin or diuretics alone or that has had a poor response to digoxin, diuretics, and vasodilators.
Phosphodiesterase inhibitors are contraindicated in the presence of allergy to either of these drugs or to bisulfites to avoid hypersensitivity reactions. Milrinone is also contraindicated in the following conditions: Severe aortic or pulmonic valvular disease, which could be exacerbated by increased contraction; acute MI, which could be exacerbated by increased oxygen consumption and increased force of contraction; fluid volume deficit, which could be made worse by increased renal perfusion; and ventricular arrhythmias, which could be exacerbated by this drug.
Caution should be exercised in the elderly, who are more likely to develop adverse effects. There are no adequate studies about the effects of these drugs during pregnancy, and use should be reserved for situations in which the benefit to the mother clearly outweighs the potential risk to the fetus. It is not known whether this drug enters breast milk, so caution should be exercised if the patient is breastfeeding.
1. As a competent nurse, you are aware that vasodilators are used mainly to treat:
A. Diabetes.
B. Hypertension.
C. Atrial fibrillation.
D. Hypotension. 2. Which of the following calcium channel blockers has the most potent peripheral smooth muscle dilator effect?
A. Diltiazem (Cardizem)
B. Nifedipine (Adalat CC)
C. Nimodipine (Nymalize)
D. Verapamil (Calan)
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答案 Answers
1. B. Hypertension. Rationale: Vasodilators are used to treat hypertension. Vasodilators are useful in treating a variety of medical conditions, most commonly systemic hypertension. Other diseases include myocardial infarction (both ST-segment elevation and non-ST-segment elevation), angina, heart failure, stroke, chronic kidney disease, preeclampsia, hypertensive emergency. 2. B. Nifedipine (Adalat CC) Rationale: Nifedipine has the strongest peripheral smooth muscle dilator effect of all the calcium channel blockers. Nifedipine inhibits the entry of calcium ions by blocking these voltage-dependent L-type calcium channels in vascular smooth muscle and myocardial cells. The reduced intracellular calcium, results in a reduction of peripheral arterial vascular resistance and dilatation of coronary arteries, leading to a reduction in systemic blood pressure and increased myocardial oxygen delivery. Other choices have less of a vasodilator effect.
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