Drug Safety 淺 談 酒 精 濫 用 之 風 險 及 戒 酒 藥 物 彰 化 基 督 醫 院 雲 林 分 院 藥 劑 課 藥 師 洪 千 茵 徐 兆 谷 李 敏 齡 摘 要 alcohol abstinence alcohol abuse cessation medication 壹 前 言 2004 4% 1 貳 酒 精 簡 介 一 淺 談 酒 精 ( ) 二 血 中 的 酒 精 濃 度 與 其 影 響 BAC (blood alcohol content) (mg/dl) ( ) 表 一 血 中 酒 精 濃 度 及 其 導 致 之 臨 床 症 狀 BAC (mg/dl) BAC (%) 臨 床 症 狀 50~100 0.05~0.1 100~200 0.1~0.2 200~300 0.2~0.3 300~400 0.3~0.4 >500 >0.5 藥 學 雜 誌 第 110 冊 141
Drug Safety 三 酒 精 代 謝 途 徑 ( ) 90% 7~10 g/hr ( =1 2100) ( ) ( ) ( ) 表 二 酒 精 代 謝 系 統 代 謝 系 統 酵 素 與 產 物 說 明 1.ADH (alcohol dehydrogenase; ) 2.MEOS (microsomal ethanol oxidizing system; ) 3.ALDH (aldehyde dehydrogenase; ) NAD + NADH+ (NADH ) NADPH NADP + + +ROS ( ) NAD + NADH+ +CO 2 ADH ADH MEOS P450 ( ) ( 二 ) 細 胞 膜 訊 息 傳 遞 蛋 白 圖 一 乙 醇 代 謝 途 徑 (http://www.niaaa.nih.gov/resources/graphicsgallery/ METABOLISM/Pages/pathways_alcohol.aspx) 參 酒 精 導 致 的 不 良 反 應 一 急 性 症 狀 ( 一 ) 中 樞 系 統 GABA GABA A IPSP (inhibitory postsynaptic potential) glutamate N M D A ( N - m e t h y l - D - aspartate) 2,3 ( 三 ) 心 血 管 系 統 (>100 mg/dl) 142 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1
二 慢 性 症 狀 ( 一 ) 肝 臟 B C 4 ( 二 ) 腸 胃 道 ( 三 ) 心 血 管 ( 四 ) 體 液 與 電 解 質 的 失 衡 ( 五 ) 免 疫 系 統 T 5 ( 六 ) 神 經 系 統 6 B 1 (Wernicke- Korsakoff syndrome) (delirium tremens) 7 肆 酒 精 中 毒 的 處 理 與 治 療 一 急 性 中 毒 的 處 理 二 戒 除 酒 癮 的 治 療 disulfiram naltrexone acamprosate topiramate baclofen nalmefene 藥 學 雜 誌 第 110 冊 143
Drug Safety ( 一 )Disulfiram ALDH Disulfiram 12 ALDH FDA 125 500 mg ( ) 250 mg disulfiram phenytoin isoniazid disulfiram metronidazole sulfonylurea ( 二 )Naltrexone disulfiram 8 ( 三 )Acamprosate NMDA GABA A 666 disulfiram naltrexone 9 ( 四 )Topiramate G A B A (corticomesolimbic system) (glutaminergic pathways) ( 300 mg/d) 10 ( 五 )Baclofen 2002 Alcohol baclofen 2007 Lancet 11 ( 六 )Nalmefene Nalmefene naltrexone (dose-dependent) nalmefene 12 伍 總 結 144 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1
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