摘要 西園醫院藥劑科藥師黃玉瑩 龔紹龍 (myasthenia gravis) my asthenia gravis (autoimmune) 1 50 7020 40 70 2,3 myasthenia gravis autoimmune acetylcholine 壹 致病機轉 (action potential) (acetylcholine ACh) (postsynaptics) (depolarization) Ach (acetylcholinesterase) 4 Ach Ach 貳 臨床表徵 (diplopia) (blurry vision) (dysphasia) (suction) 5-7 15 20% 6% 藥學雜誌 123 93 臨床藥物治療學肌無力症及藥物治療
Therapeutics of Clinical Drugs 臨床藥物治療學 antibody) (generalized myasthenia) (deep tendon reflex) 參 病情加重的因素 (aminoglycosides) 喹 (quinolone) (class ) quinidine procainamide -blocker (calcium channel blocker) 8 penicillamine ( ) 9 10 9 表一可能加重肌無力症的藥物 steroids aminoglycosides, ciprofloxacin, clindamycin, erythromycin procainamide, quinidine -blocker (propranolol, timolol), calcium channel blockers (verapamil) succinylcholine, curare derivatives, botulinum toxin phenytoin, lithium magnesium sulfate 肆 與肌無力有關的疾病 10 28% (thymoma) 3 15% 4% 2% (CT scan) (rheumatoid factor) (antinuclear 伍 診斷 ( ice pack ) 11 陸 治療 一 胸腺切除 (thymectomy) 60 60 二 抗乙醯膽鹼酶之藥物 (anticholinesterase drugs) Pyridostigmine 11 3 6 15 60 mg 4 6 1 mg/kg (syrup) neostigmine, ambenonium 94 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2
Ach (cholinergic crisis) (muscarinic) cholinergic crisis edrophonium test (tensilon test) 2 mg edrophonium 8 mg cholinergic crisis 11,12 edrophonium test (tensilon test) 三 類固醇 prednisolone (100 mg/day) prednisolone (5 mg/day) 四 免疫抑制劑 藥學雜誌 123 95 臨床藥物治療學chloride Azathioprine (Imuran) 3 8 50 mg 3 50 mg 150 mg 3000/mm 2 Mycophenolate mofetil (Cellcept) IMPDH II (inosine monophosphate dehydrogenase type II) 13 2006 1 9 FDA 1 1.5 g 14 Tacrolimus (Prograf) streptomyces tsukubanesis 13 T T IL-2 T cyclophosphamide cyclosporine azathioprine 五 血漿置換術 (plasmapheresis) Ach
臨床藥Therapeutics of Clinical Drugs 物治療 學 15 柒 預後 (morbidity) (mortality) 參考資料 : 捌 結論 Myasthenia Gravis & Treatment Yu-Ying Huang, Siu-Lung Kung Department of Pharmacy, West Garden Hospital Abstract Myasthenia gravis is a type of disease that affects the neuromuscular junction; it's caused by the lack of acetylcholine (Ach) receptor on the sarcolemma at the junction of the neuro cell synaptic. There is a large variety of clinical symptoms, and the most obvious and common one is the blepharoptosis. Depending on the patient's condition, they'll receive the appropriate treatment to best cure the patient. The treatment of myasthenia gravis includes thymectomy, medicine treatment, and therapeutic hemapheresis. 1. http://www.fmg.org.tw/understand.php?id=1 / 2015.04.08 2. Sanders DB, Andrews PI, Howard JF, et al: Seronegative myasthenia gravis. Neurology. 1997;48 (suppl 5):S40- S45. 3. Phillips LH, Torner JC, Anderson MS, et al: The epidemiology of myasthenia gravis in central and western Virginia. Neurology. 1992;42:1888-1893. 4. Drachman DB. Myasthenia gravis. In: Wilson JD, Braunwald E, Isselbacher KJ, et al: Harrison's principles of internal medicine. 12th ed. New York: McGraw-Hill, 2118-20, 1991. 5. Giagheddu M, Puggioni G, Sanna G, et al: Epidemiological studt of myasthenia gravis in Sardinia, Italy (1958-1986). Acta Neurol Scand. 1989;79:326-333. 6. Oosterhuis HJ. The ocular signs and symptoms of myasthenia gravis. Doc Ophthalmol. 1982;52:363-378. 7. Sneddon J. Myasthenia gravis: the difficult diagnosis. Br Psychiatry. 1980;136:92-93. 8. Wittbrodt ET. Drugs and myasthenia gravis: an update. Arch Intern Med 1997;157:399-408. 9. Johns TR. Long-term corticosteroid treatment of myasthe- 96 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2
10. Sanders DB. Mtasthenia gravis and myasthenic syndromes. Proceedings of American Academy of Neurology Annual Meeting. Boston: American Academy of Neurology, 1-26, 33-40, 1991. 11. Scherer K. Bedlack RS. Simel DL. Does this patient have myasthenia gravis? JAMA. 293(15):1906-14, 2005 Apr 20. 12. Simpson JA. Thomaides T. Treatment of myasthenia gravis: an audit. QJ Med; 10(1):70-82, 1987. (Middle East Respiratory Syndrome MERS) (WHO) 2012 9 ( MERS-CoV) 2003 SARS MERS-CoV 13. Schneider-Gold C. Hartung HP. Gold R. Mycophenolate mofetil and tacrolimus: new therapeutic options in neuroimmunological diseases. Muscle & Nerve. 34(3):284-91, 2006 Sep. 14. Garcia-Carrasco M. Escarcega RO. Fuentes-Alexandro S. et al: Therapeutic options in autoimmune myasthenia gravis. Autoimmunity Reviews. 6(6):373-8, 2007 Jun. 15. Antozzzi C. Gemma M, Regi B, et al: A short plasma exchange protocol is effective in severe myasthenia gravis. J Neurol; 238(2):103-7, 1991. 專有名詞介紹 2-14 (DIC) // 藥學雜誌 123 97 臨床藥物治療學nia gravis. Ann N Y Acad Sci 1987;505:568-583.