表一主要的危險因子 mg/dl 5-10% 8 參臨症狀 6P pain ( ) pallor () pulselessness ( ) paresthesia () paralysis ( ) poikilothe

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1 臨繼續教育 Therapeutics of Clinical Drugs 下肢週邊動脈阻塞疾病馬偕紀念醫院台東分院劑科師張健蓉馮靜修馬偕紀念醫院台東分院神經內科醫師洪國華摘要 (Lower extremity peripheral arterial disease lower extremity PAD) lower extremity peripheral arterial disease lower extremity PAD 壹前言 1 貳病理機轉 2 () THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.3 Sep

disease lower extremity PAD) lower extremity peripheral arterial disease lower extremity

2 表一主要的危險因子 mg/dl 5-10% 8 參臨症狀 6P pain ( ) pallor () pulselessness ( ) paresthesia () paralysis ( ) poikilothermia () 肆嚴重程度評估 Fontaine Stages1954 Dr. René Fontaine Rutherford Categories 4 表二兩種評估嚴重程度的方法 Fontaine Rutherford I 0 0 IIa I 1 IIb I 2 I 3 III II 4 IV III 5 III 6 伍診斷臨 303 Sep 雜誌

paralysis ( ) poikilothermia () 6 8 48 肆嚴重程度評估 Fontaine Stages1954 Dr.

3 臨繼續教育 Therapeutics of Clinical Drugs (femoral artery) (abdominal aortic artery) (popliteal artery) ( ) ( (ankle-brachial index ABI) (toe brachial index TBI) (segmental pressure) ) 陸一減少粥狀動脈硬化的危險因子 ( 一 ) 戒菸 bupropion varenicline (1) (2) 21 mg 14 mg 7 mg 24 (3) 20 12(4) 0.5 mg1 2 (5) Bupropion Varenicline ( 二 ) 降血糖 HbA1c < 7% 6% 10 ( 三 ) 降血壓 < 140/90 mmhg < 130/80 mmhg 9 ACEI 9 ( 四 ) 降血脂 HMG CoA 11 HMG CoA 94 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.3 Sep

15 (1) 10 15 10 15 30 (2) 21 mg 14 mg 7 mg 24 (3) 20 12(4) 0.5 mg1 2 (5) 1 2 20 30 2.Bupropion 1 2 3.

4 LDL C < 100 mg/dl LDL C < 70 mg/dl LDL C TG HDL C fibric acid ( 五 ) 抗血小板品的使用 12 Aspirin mg aspirin clopidogrel 75 mg aspirin clopidogrel ( 六 ) 抗凝血劑的使用 warfarin warfarin warfarin warfarin 13 prasugrel ticagrelor vorapaxar FDA 二改善跛行 14 ( 一 ) 運動復健 "" ( 二 ) 品 1. Cilostazol FDA 100 mg 2 Cilostazol phosphodiesterase type III (PDE3) phosphodiesterase ( milrinone vesnarinone) cilostazol ( EF 40%) Cilostazol 2 4 cytochrome P450 3A4 (CYP3A4) CYP3A4 ketoconazole fluconazole cyclosporine erythromycin diltiazem omeprazole cilostazol 74%20% 臨 303 Sep 雜誌

Cilostazol FDA 100 mg 2 Cilostazol phosphodiesterase type III (PDE3) phosphodiesterase ( milrinone vesnarinone) cilostazol ( EF 40%) Cilostazol 2 4

5 臨繼續教育 Therapeutics of Clinical Drugs 2. Pentoxifylline xanthine FDA cilostazole TASC II Pentoxifylline mg 三侵入性 ABI 9 柒結論 ( ) ABI TBI Therapy for Lower Extremity Peripheral Arterial Disease Chien-Jung Chang 1, Ching-Hsiu Feng 1, Kuo-Hua Hung 2 Department of Pharmacy, Mackay Memorial Hospital Taitung Branch 1 Department of Neurology, Mackay Memorial Hospital Taitung Branch 2 Abstract The major cause of lower extremity peripheral arterial disease (lower extremity PAD) is atherosclerosis. Risk factors for atherosclerosis such as cigarette smoking, hypertension, 96 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.3 Sep

Disease Chien-Jung Chang 1, Ching-Hsiu Feng 1, Kuo-Hua Hung 2 Department of Pharmacy, Mackay Memorial Hospital Taitung Branch 1 Department of Neurology, Mackay

6 臨下肢週邊動脈阻塞疾病 diabetes and dyslipidemia increase the likelihood of developing lower extremity PAD. Lower extremity PAD is a progressive disease. This disease is usually asymptomatic initially and, moreover, it may progress to intermittent claudication, rest pain, or even gangrene and necrosis. Early diagnosis, risk factors modification, exercise therapy and pharmacologic therapy are indispensable for prevention of severe sequelae. 參考資料 Criqui MH, Ninomiya JK, Wingard DL, et al: Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. J Am Coll Cardiol 2008; 52:1736. Joosten MM, Pai JK, Bertoia ML, et al: Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA 2012; 308:1660. Hirsch, AT, Criqui, MH, Treat Jacobson, D, et al: Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286:1317. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31(1 pt 2):S1-S296. Fowkes FG, Housley E, Riemersma RA, et al: Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 1992;135: Hiatt WR, Hoag S, Hamman RF. Effect of diagnostic criteria on the prevalence of peripheral arterial disease. The San Luis Valley Diabetes Study. Circulation 1995; 91: Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985;33: Ingolfsson IO, Sigurdsson G, Sigvaldason H, et al: A marked decline in the prevalence and incidence of intermittent claudication in Icelandic men : a strong relationship to smoking and serum cholesterol-the Reykjavik Study. J Clin Epidemiol 1994;47: Hirsch AT, Haskal ZJ, Hertzer NR, et al: ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)., Circulation. 2006;113: Norgren L, Hiatt WR, Dormandy JA, et al: Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S:S5 Aung PP, Maxwell HG, Jepson RG, et al: Lipid lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev 2007 Wong PF, Chong LY, Mikhailidis DP, et al: Antiplatelet agents for intermittent claudication. Cochrane Database Syst Rev Anand S, Yusuf S, Xie C, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med. 2007;357: Murphy TP, Cutlip DE, Regensteiner JG, et al: Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study. Circulation 2012; 125:130. 第 30 卷第 3 期 Sep 雜誌第120冊 97

Early diagnosis, risk factors modification, exercise therapy and pharmacologic therapy are indispensable for prevention of severe sequelae. 參考資料 1. 2. 3. 4. 5. 6. 7.

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表 一 主 要 的 危 險 因 子 mg/dl 5-10% 8 參 臨 症 狀 6P pain ( ) pallor () pulselessness ( ) paresthesia () paralysis ( ) poikilothe

表一主要的危險因子 mg/dl 5-10% 8 參臨症狀 6P pain ( ) pallor () pulselessness ( ) paresthesia () paralysis ( ) poikilothe