用戶貓點評問題和點評內容

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

【評論主題】4.造成penicillin產生抗藥性的原因，下列何者錯誤？(A)β–lactamase的存在 (B)無法結合到penicillin結合蛋白 (C)增進penicillin排除 (D)在格蘭氏陽性菌株

【評論內容】D.敘述中的G+改成G-，此選項就是合理★===...

【評論主題】56.下列何項藥品之適應症兼具抗憂鬱症及戒菸？(A)buprenorphine (B)bupropion (C)buspirone (D)butorphanol

【評論內容】A. Buprenorphine(Temgesic* SL tab; Transtec* TDDS): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ antagonist用途: 管制止痛藥、鴉片類沉癮治療(Buprenorphine/Naloxone; Suboxone*, Desud* plus)B. Bupropion(Wellbutrin*; Zyban*; Buporin*): DNRI(DA/NE reuptake inhibitor)機轉: 抑制DA/NE reuptake用途: 抗憂鬱藥(MDD, unipolar; sesonal affective disorder)，戒菸輔助藥C. Buspirone(Sepirone*; Busron*): antianxiety agent機轉: 結合在5-HT1A和5-HT2 receptor (中度結合力:D2 receptor)用途: 抗焦慮D. Butorphanol(Butaro* Nasal spray): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ agonist用途: 管制性止痛藥

【評論主題】45.有關topiramate的敘述，下列何者正確？(A)不會造成認知障礙 (B)可能會造成腎結石 (C)沒有藥品交互作用 (D)為微弱的carbonic anhydrase促進劑

【評論內容】

A. 會造成認知障礙(eg.認知衰退、疲勞、困惑)B. 可能會造成腎結石C. 有DDI(和其他AED併用大部分是影響Topiramate自身濃度; 會減少避孕藥(含Estradiol)的濃度)D. 為微弱的Carbonic anhydrase inhibitor(故和acetazolamide併用，加成CAI效果，增加腎結石風險)Topiramate(Topamax*)1.機轉:-Θ電位依賴Na+通道-Θ高電位依賴 L-type Ca2+通道-增強GABA的抑制活性-降低kainate(卡莫酸)在glutamate receptor的興奮活性2.臨床使用:-partial and generalized tonic-clonic seizures(monotherapy)-LGS(lennox-Gastaut syndrome)-infantile spasms(嬰兒痙攣)-absence seizure(失神性發作)-偏頭痛3.常見副作用:通常發生在服用後4週內嗜睡、疲勞、頭暈、認知衰退、感覺異常、麻木感、困惑、腎結石若發生急性近視或青光眼，必須立即停藥4.PK:abs: F(oral):80%exc:urine(primary)=>腎結石t1/2:20-30hr=>XR 劑型可以QD

【評論主題】63.陳先生59歲，有冠狀動脈心臟疾病，最近LDL 200 mg/dL、HDL 42 mg/dL、TG 180 mg/dL。下列何者為首選用藥？ (A)gemfibrozil (B)atorvasta

【評論內容】

病人為59歲男性，過去病史有CADLDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<S> 59 y/o male<O>PI: DyslipidemiaPMH: CADAllergy: NDAcurrent medication: unknowncurrent lab data(lipid panel):LDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<A>1. Dyslipidemia:clinical ASCVD + not at very high risk註(1 ASCVD event +LDL>100mg/dl; <75 y/o)goal: LDL<70mg/dl, TG:<150mg/dl(ref of LDL Goal: 2022 TW lipid guidelines for high risk pt: CAD, PAD and ischemic stroke)→recommend high-intensity statin tx (eg. Atorvastatin 40-80mg, Rosuvastatin20-40mg)→recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd註: 以台灣治療指引條件劃定2. Secondary prevention of ACS: (omit)1. Recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd for dyslipidemia with CAD.Please recheck lipid panel 4 to 12 weeks after initiating therapy and every 3 to 12 months thereafter.(If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.)Consider add Ezetimibe if is still unable to acheive optimal LDL goal.Routine monitoring of hepatic function and CK levels is not recommend unless pt has signs of suggestive of hepatic or muscle injury. Monitor closely for myopathy/rhabdomyolysis.故選(B)作為降血脂首選用藥，且Atorvastatin的劑量必須為40-80mg，作為高強度statin txcf:Atorvastatin 10-20mg為中強度statin tx===2022 TW lipid guideline:CAD:1. LDL goal: <70mg/dl2. LDL goal at very high risk*: <55mg/dl*diabetes, those with recent MI (<12 months), 2 prior MIs, multivessel CAD, or concomitant PAD (including extremity or carotid artery)

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】31.下列何者可抑制xanthine oxidase，用在痛風治療？(A)allopurinol (B)colchicine (C)sulfinpyrazone (D)indomethacin

【評論內容】

A. allopurinol: Xanthine oxidase inhibitor，同類的還有febuxostatB. colchicine: anti-inflammatory，結合在tubulin，抑制leukocyte的migration和phagocytosis→急性痛風發作和預防抗發炎都有其角色地位→作為降尿酸治療的長期抗發炎預防用藥(0.5-0.6mg bid)，比口服NSAID更適合長期預防C. sulfinpyrazone: uricosurics排尿酸劑，同類的還有probenecid、lesinurad→不能用在有腎結石病史的病人→須從最低劑量開始調整，以避免腎結石的發生D. indomethacin: NSAID，抗發炎止痛

【評論主題】26.兒茶酚胺（catecholamine）再回收抑制劑臨床應用廣泛，下列敘述何者錯誤？(A)reboxetine可用於治療重度憂鬱 (B)sibutramine可降低食慾 (C)milnacipra

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

【評論主題】4.造成penicillin產生抗藥性的原因，下列何者錯誤？(A)β–lactamase的存在 (B)無法結合到penicillin結合蛋白 (C)增進penicillin排除 (D)在格蘭氏陽性菌株

【評論內容】D.敘述中的G+改成G-，此選項就是合理★===...

【評論主題】56.下列何項藥品之適應症兼具抗憂鬱症及戒菸？(A)buprenorphine (B)bupropion (C)buspirone (D)butorphanol

【評論內容】A. Buprenorphine(Temgesic* SL tab; Transtec* TDDS): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ antagonist用途: 管制止痛藥、鴉片類沉癮治療(Buprenorphine/Naloxone; Suboxone*, Desud* plus)B. Bupropion(Wellbutrin*; Zyban*; Buporin*): DNRI(DA/NE reuptake inhibitor)機轉: 抑制DA/NE reuptake用途: 抗憂鬱藥(MDD, unipolar; sesonal affective disorder)，戒菸輔助藥C. Buspirone(Sepirone*; Busron*): antianxiety agent機轉: 結合在5-HT1A和5-HT2 receptor (中度結合力:D2 receptor)用途: 抗焦慮D. Butorphanol(Butaro* Nasal spray): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ agonist用途: 管制性止痛藥

【評論主題】45.有關topiramate的敘述，下列何者正確？(A)不會造成認知障礙 (B)可能會造成腎結石 (C)沒有藥品交互作用 (D)為微弱的carbonic anhydrase促進劑

【評論內容】

A. 會造成認知障礙(eg.認知衰退、疲勞、困惑)B. 可能會造成腎結石C. 有DDI(和其他AED併用大部分是影響Topiramate自身濃度; 會減少避孕藥(含Estradiol)的濃度)D. 為微弱的Carbonic anhydrase inhibitor(故和acetazolamide併用，加成CAI效果，增加腎結石風險)Topiramate(Topamax*)1.機轉:-Θ電位依賴Na+通道-Θ高電位依賴 L-type Ca2+通道-增強GABA的抑制活性-降低kainate(卡莫酸)在glutamate receptor的興奮活性2.臨床使用:-partial and generalized tonic-clonic seizures(monotherapy)-LGS(lennox-Gastaut syndrome)-infantile spasms(嬰兒痙攣)-absence seizure(失神性發作)-偏頭痛3.常見副作用:通常發生在服用後4週內嗜睡、疲勞、頭暈、認知衰退、感覺異常、麻木感、困惑、腎結石若發生急性近視或青光眼，必須立即停藥4.PK:abs: F(oral):80%exc:urine(primary)=>腎結石t1/2:20-30hr=>XR 劑型可以QD

【評論主題】63.陳先生59歲，有冠狀動脈心臟疾病，最近LDL 200 mg/dL、HDL 42 mg/dL、TG 180 mg/dL。下列何者為首選用藥？ (A)gemfibrozil (B)atorvasta

【評論內容】

病人為59歲男性，過去病史有CADLDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<S> 59 y/o male<O>PI: DyslipidemiaPMH: CADAllergy: NDAcurrent medication: unknowncurrent lab data(lipid panel):LDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<A>1. Dyslipidemia:clinical ASCVD + not at very high risk註(1 ASCVD event +LDL>100mg/dl; <75 y/o)goal: LDL<70mg/dl, TG:<150mg/dl(ref of LDL Goal: 2022 TW lipid guidelines for high risk pt: CAD, PAD and ischemic stroke)→recommend high-intensity statin tx (eg. Atorvastatin 40-80mg, Rosuvastatin20-40mg)→recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd註: 以台灣治療指引條件劃定2. Secondary prevention of ACS: (omit)1. Recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd for dyslipidemia with CAD.Please recheck lipid panel 4 to 12 weeks after initiating therapy and every 3 to 12 months thereafter.(If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.)Consider add Ezetimibe if is still unable to acheive optimal LDL goal.Routine monitoring of hepatic function and CK levels is not recommend unless pt has signs of suggestive of hepatic or muscle injury. Monitor closely for myopathy/rhabdomyolysis.故選(B)作為降血脂首選用藥，且Atorvastatin的劑量必須為40-80mg，作為高強度statin txcf:Atorvastatin 10-20mg為中強度statin tx===2022 TW lipid guideline:CAD:1. LDL goal: <70mg/dl2. LDL goal at very high risk*: <55mg/dl*diabetes, those with recent MI (<12 months), 2 prior MIs, multivessel CAD, or concomitant PAD (including extremity or carotid artery)

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】26.兒茶酚胺（catecholamine）再回收抑制劑臨床應用廣泛，下列敘述何者錯誤？(A)reboxetine可用於治療重度憂鬱 (B)sibutramine可降低食慾 (C)milnacipra

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】31.下列何者可抑制xanthine oxidase，用在痛風治療？(A)allopurinol (B)colchicine (C)sulfinpyrazone (D)indomethacin

【評論內容】

A. allopurinol: Xanthine oxidase inhibitor，同類的還有febuxostatB. colchicine: anti-inflammatory，結合在tubulin，抑制leukocyte的migration和phagocytosis→急性痛風發作和預防抗發炎都有其角色地位→作為降尿酸治療的長期抗發炎預防用藥(0.5-0.6mg bid)，比口服NSAID更適合長期預防C. sulfinpyrazone: uricosurics排尿酸劑，同類的還有probenecid、lesinurad→不能用在有腎結石病史的病人→須從最低劑量開始調整，以避免腎結石的發生D. indomethacin: NSAID，抗發炎止痛

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

【評論主題】4.造成penicillin產生抗藥性的原因，下列何者錯誤？(A)β–lactamase的存在 (B)無法結合到penicillin結合蛋白 (C)增進penicillin排除 (D)在格蘭氏陽性菌株

【評論內容】D.敘述中的G+改成G-，此選項就是合理★===...

【評論主題】45.有關topiramate的敘述，下列何者正確？(A)不會造成認知障礙 (B)可能會造成腎結石 (C)沒有藥品交互作用 (D)為微弱的carbonic anhydrase促進劑

【評論內容】

A. 會造成認知障礙(eg.認知衰退、疲勞、困惑)B. 可能會造成腎結石C. 有DDI(和其他AED併用大部分是影響Topiramate自身濃度; 會減少避孕藥(含Estradiol)的濃度)D. 為微弱的Carbonic anhydrase inhibitor(故和acetazolamide併用，加成CAI效果，增加腎結石風險)Topiramate(Topamax*)1.機轉:-Θ電位依賴Na+通道-Θ高電位依賴 L-type Ca2+通道-增強GABA的抑制活性-降低kainate(卡莫酸)在glutamate receptor的興奮活性2.臨床使用:-partial and generalized tonic-clonic seizures(monotherapy)-LGS(lennox-Gastaut syndrome)-infantile spasms(嬰兒痙攣)-absence seizure(失神性發作)-偏頭痛3.常見副作用:通常發生在服用後4週內嗜睡、疲勞、頭暈、認知衰退、感覺異常、麻木感、困惑、腎結石若發生急性近視或青光眼，必須立即停藥4.PK:abs: F(oral):80%exc:urine(primary)=>腎結石t1/2:20-30hr=>XR 劑型可以QD

【評論主題】56.下列何項藥品之適應症兼具抗憂鬱症及戒菸？(A)buprenorphine (B)bupropion (C)buspirone (D)butorphanol

【評論內容】A. Buprenorphine(Temgesic* SL tab; Transtec* TDDS): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ antagonist用途: 管制止痛藥、鴉片類沉癮治療(Buprenorphine/Naloxone; Suboxone*, Desud* plus)B. Bupropion(Wellbutrin*; Zyban*; Buporin*): DNRI(DA/NE reuptake inhibitor)機轉: 抑制DA/NE reuptake用途: 抗憂鬱藥(MDD, unipolar; sesonal affective disorder)，戒菸輔助藥C. Buspirone(Sepirone*; Busron*): antianxiety agent機轉: 結合在5-HT1A和5-HT2 receptor (中度結合力:D2 receptor)用途: 抗焦慮D. Butorphanol(Butaro* Nasal spray): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ agonist用途: 管制性止痛藥

【評論主題】63.陳先生59歲，有冠狀動脈心臟疾病，最近LDL 200 mg/dL、HDL 42 mg/dL、TG 180 mg/dL。下列何者為首選用藥？ (A)gemfibrozil (B)atorvasta

【評論內容】

病人為59歲男性，過去病史有CADLDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<S> 59 y/o male<O>PI: DyslipidemiaPMH: CADAllergy: NDAcurrent medication: unknowncurrent lab data(lipid panel):LDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<A>1. Dyslipidemia:clinical ASCVD + not at very high risk註(1 ASCVD event +LDL>100mg/dl; <75 y/o)goal: LDL<70mg/dl, TG:<150mg/dl(ref of LDL Goal: 2022 TW lipid guidelines for high risk pt: CAD, PAD and ischemic stroke)→recommend high-intensity statin tx (eg. Atorvastatin 40-80mg, Rosuvastatin20-40mg)→recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd註: 以台灣治療指引條件劃定2. Secondary prevention of ACS: (omit)1. Recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd for dyslipidemia with CAD.Please recheck lipid panel 4 to 12 weeks after initiating therapy and every 3 to 12 months thereafter.(If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.)Consider add Ezetimibe if is still unable to acheive optimal LDL goal.Routine monitoring of hepatic function and CK levels is not recommend unless pt has signs of suggestive of hepatic or muscle injury. Monitor closely for myopathy/rhabdomyolysis.故選(B)作為降血脂首選用藥，且Atorvastatin的劑量必須為40-80mg，作為高強度statin txcf:Atorvastatin 10-20mg為中強度statin tx===2022 TW lipid guideline:CAD:1. LDL goal: <70mg/dl2. LDL goal at very high risk*: <55mg/dl*diabetes, those with recent MI (<12 months), 2 prior MIs, multivessel CAD, or concomitant PAD (including extremity or carotid artery)

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】26.兒茶酚胺（catecholamine）再回收抑制劑臨床應用廣泛，下列敘述何者錯誤？(A)reboxetine可用於治療重度憂鬱 (B)sibutramine可降低食慾 (C)milnacipra

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】31.下列何者可抑制xanthine oxidase，用在痛風治療？(A)allopurinol (B)colchicine (C)sulfinpyrazone (D)indomethacin

【評論內容】

A. allopurinol: Xanthine oxidase inhibitor，同類的還有febuxostatB. colchicine: anti-inflammatory，結合在tubulin，抑制leukocyte的migration和phagocytosis→急性痛風發作和預防抗發炎都有其角色地位→作為降尿酸治療的長期抗發炎預防用藥(0.5-0.6mg bid)，比口服NSAID更適合長期預防C. sulfinpyrazone: uricosurics排尿酸劑，同類的還有probenecid、lesinurad→不能用在有腎結石病史的病人→須從最低劑量開始調整，以避免腎結石的發生D. indomethacin: NSAID，抗發炎止痛

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

【評論主題】4.造成penicillin產生抗藥性的原因，下列何者錯誤？(A)β–lactamase的存在 (B)無法結合到penicillin結合蛋白 (C)增進penicillin排除 (D)在格蘭氏陽性菌株

【評論內容】D.敘述中的G+改成G-，此選項就是合理★===...

【評論主題】45.有關topiramate的敘述，下列何者正確？(A)不會造成認知障礙 (B)可能會造成腎結石 (C)沒有藥品交互作用 (D)為微弱的carbonic anhydrase促進劑

【評論內容】

A. 會造成認知障礙(eg.認知衰退、疲勞、困惑)B. 可能會造成腎結石C. 有DDI(和其他AED併用大部分是影響Topiramate自身濃度; 會減少避孕藥(含Estradiol)的濃度)D. 為微弱的Carbonic anhydrase inhibitor(故和acetazolamide併用，加成CAI效果，增加腎結石風險)Topiramate(Topamax*)1.機轉:-Θ電位依賴Na+通道-Θ高電位依賴 L-type Ca2+通道-增強GABA的抑制活性-降低kainate(卡莫酸)在glutamate receptor的興奮活性2.臨床使用:-partial and generalized tonic-clonic seizures(monotherapy)-LGS(lennox-Gastaut syndrome)-infantile spasms(嬰兒痙攣)-absence seizure(失神性發作)-偏頭痛3.常見副作用:通常發生在服用後4週內嗜睡、疲勞、頭暈、認知衰退、感覺異常、麻木感、困惑、腎結石若發生急性近視或青光眼，必須立即停藥4.PK:abs: F(oral):80%exc:urine(primary)=>腎結石t1/2:20-30hr=>XR 劑型可以QD

【評論主題】63.陳先生59歲，有冠狀動脈心臟疾病，最近LDL 200 mg/dL、HDL 42 mg/dL、TG 180 mg/dL。下列何者為首選用藥？ (A)gemfibrozil (B)atorvasta

【評論內容】

病人為59歲男性，過去病史有CADLDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<S> 59 y/o male<O>PI: DyslipidemiaPMH: CADAllergy: NDAcurrent medication: unknowncurrent lab data(lipid panel):LDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<A>1. Dyslipidemia:clinical ASCVD + not at very high risk註(1 ASCVD event +LDL>100mg/dl; <75 y/o)goal: LDL<70mg/dl, TG:<150mg/dl(ref of LDL Goal: 2022 TW lipid guidelines for high risk pt: CAD, PAD and ischemic stroke)→recommend high-intensity statin tx (eg. Atorvastatin 40-80mg, Rosuvastatin20-40mg)→recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd註: 以台灣治療指引條件劃定2. Secondary prevention of ACS: (omit)1. Recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd for dyslipidemia with CAD.Please recheck lipid panel 4 to 12 weeks after initiating therapy and every 3 to 12 months thereafter.(If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.)Consider add Ezetimibe if is still unable to acheive optimal LDL goal.Routine monitoring of hepatic function and CK levels is not recommend unless pt has signs of suggestive of hepatic or muscle injury. Monitor closely for myopathy/rhabdomyolysis.故選(B)作為降血脂首選用藥，且Atorvastatin的劑量必須為40-80mg，作為高強度statin txcf:Atorvastatin 10-20mg為中強度statin tx===2022 TW lipid guideline:CAD:1. LDL goal: <70mg/dl2. LDL goal at very high risk*: <55mg/dl*diabetes, those with recent MI (<12 months), 2 prior MIs, multivessel CAD, or concomitant PAD (including extremity or carotid artery)

【評論主題】56.下列何項藥品之適應症兼具抗憂鬱症及戒菸？(A)buprenorphine (B)bupropion (C)buspirone (D)butorphanol

【評論內容】A. Buprenorphine(Temgesic* SL tab; Transtec* TDDS): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ antagonist用途: 管制止痛藥、鴉片類沉癮治療(Buprenorphine/Naloxone; Suboxone*, Desud* plus)B. Bupropion(Wellbutrin*; Zyban*; Buporin*): DNRI(DA/NE reuptake inhibitor)機轉: 抑制DA/NE reuptake用途: 抗憂鬱藥(MDD, unipolar; sesonal affective disorder)，戒菸輔助藥C. Buspirone(Sepirone*; Busron*): antianxiety agent機轉: 結合在5-HT1A和5-HT2 receptor (中度結合力:D2 receptor)用途: 抗焦慮D. Butorphanol(Butaro* Nasal spray): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ agonist用途: 管制性止痛藥

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

【評論主題】31.下列何者可抑制xanthine oxidase，用在痛風治療？(A)allopurinol (B)colchicine (C)sulfinpyrazone (D)indomethacin

【評論內容】

A. allopurinol: Xanthine oxidase inhibitor，同類的還有febuxostatB. colchicine: anti-inflammatory，結合在tubulin，抑制leukocyte的migration和phagocytosis→急性痛風發作和預防抗發炎都有其角色地位→作為降尿酸治療的長期抗發炎預防用藥(0.5-0.6mg bid)，比口服NSAID更適合長期預防C. sulfinpyrazone: uricosurics排尿酸劑，同類的還有probenecid、lesinurad→不能用在有腎結石病史的病人→須從最低劑量開始調整，以避免腎結石的發生D. indomethacin: NSAID，抗發炎止痛

【評論主題】26.兒茶酚胺（catecholamine）再回收抑制劑臨床應用廣泛，下列敘述何者錯誤？(A)reboxetine可用於治療重度憂鬱 (B)sibutramine可降低食慾 (C)milnacipra

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】4.造成penicillin產生抗藥性的原因，下列何者錯誤？(A)β–lactamase的存在 (B)無法結合到penicillin結合蛋白 (C)增進penicillin排除 (D)在格蘭氏陽性菌株

【評論內容】D.敘述中的G+改成G-，此選項就是合理★===...

【評論主題】45.有關topiramate的敘述，下列何者正確？(A)不會造成認知障礙 (B)可能會造成腎結石 (C)沒有藥品交互作用 (D)為微弱的carbonic anhydrase促進劑

【評論內容】

A. 會造成認知障礙(eg.認知衰退、疲勞、困惑)B. 可能會造成腎結石C. 有DDI(和其他AED併用大部分是影響Topiramate自身濃度; 會減少避孕藥(含Estradiol)的濃度)D. 為微弱的Carbonic anhydrase inhibitor(故和acetazolamide併用，加成CAI效果，增加腎結石風險)Topiramate(Topamax*)1.機轉:-Θ電位依賴Na+通道-Θ高電位依賴 L-type Ca2+通道-增強GABA的抑制活性-降低kainate(卡莫酸)在glutamate receptor的興奮活性2.臨床使用:-partial and generalized tonic-clonic seizures(monotherapy)-LGS(lennox-Gastaut syndrome)-infantile spasms(嬰兒痙攣)-absence seizure(失神性發作)-偏頭痛3.常見副作用:通常發生在服用後4週內嗜睡、疲勞、頭暈、認知衰退、感覺異常、麻木感、困惑、腎結石若發生急性近視或青光眼，必須立即停藥4.PK:abs: F(oral):80%exc:urine(primary)=>腎結石t1/2:20-30hr=>XR 劑型可以QD

【評論主題】56.下列何項藥品之適應症兼具抗憂鬱症及戒菸？(A)buprenorphine (B)bupropion (C)buspirone (D)butorphanol

【評論內容】A. Buprenorphine(Temgesic* SL tab; Transtec* TDDS): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ antagonist用途: 管制止痛藥、鴉片類沉癮治療(Buprenorphine/Naloxone; Suboxone*, Desud* plus)B. Bupropion(Wellbutrin*; Zyban*; Buporin*): DNRI(DA/NE reuptake inhibitor)機轉: 抑制DA/NE reuptake用途: 抗憂鬱藥(MDD, unipolar; sesonal affective disorder)，戒菸輔助藥C. Buspirone(Sepirone*; Busron*): antianxiety agent機轉: 結合在5-HT1A和5-HT2 receptor (中度結合力:D2 receptor)用途: 抗焦慮D. Butorphanol(Butaro* Nasal spray): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ agonist用途: 管制性止痛藥

【評論主題】63.陳先生59歲，有冠狀動脈心臟疾病，最近LDL 200 mg/dL、HDL 42 mg/dL、TG 180 mg/dL。下列何者為首選用藥？ (A)gemfibrozil (B)atorvasta

【評論內容】

病人為59歲男性，過去病史有CADLDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<S> 59 y/o male<O>PI: DyslipidemiaPMH: CADAllergy: NDAcurrent medication: unknowncurrent lab data(lipid panel):LDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<A>1. Dyslipidemia:clinical ASCVD + not at very high risk註(1 ASCVD event +LDL>100mg/dl; <75 y/o)goal: LDL<70mg/dl, TG:<150mg/dl(ref of LDL Goal: 2022 TW lipid guidelines for high risk pt: CAD, PAD and ischemic stroke)→recommend high-intensity statin tx (eg. Atorvastatin 40-80mg, Rosuvastatin20-40mg)→recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd註: 以台灣治療指引條件劃定2. Secondary prevention of ACS: (omit)1. Recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd for dyslipidemia with CAD.Please recheck lipid panel 4 to 12 weeks after initiating therapy and every 3 to 12 months thereafter.(If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.)Consider add Ezetimibe if is still unable to acheive optimal LDL goal.Routine monitoring of hepatic function and CK levels is not recommend unless pt has signs of suggestive of hepatic or muscle injury. Monitor closely for myopathy/rhabdomyolysis.故選(B)作為降血脂首選用藥，且Atorvastatin的劑量必須為40-80mg，作為高強度statin txcf:Atorvastatin 10-20mg為中強度statin tx===2022 TW lipid guideline:CAD:1. LDL goal: <70mg/dl2. LDL goal at very high risk*: <55mg/dl*diabetes, those with recent MI (<12 months), 2 prior MIs, multivessel CAD, or concomitant PAD (including extremity or carotid artery)

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】31.下列何者可抑制xanthine oxidase，用在痛風治療？(A)allopurinol (B)colchicine (C)sulfinpyrazone (D)indomethacin

【評論內容】

A. allopurinol: Xanthine oxidase inhibitor，同類的還有febuxostatB. colchicine: anti-inflammatory，結合在tubulin，抑制leukocyte的migration和phagocytosis→急性痛風發作和預防抗發炎都有其角色地位→作為降尿酸治療的長期抗發炎預防用藥(0.5-0.6mg bid)，比口服NSAID更適合長期預防C. sulfinpyrazone: uricosurics排尿酸劑，同類的還有probenecid、lesinurad→不能用在有腎結石病史的病人→須從最低劑量開始調整，以避免腎結石的發生D. indomethacin: NSAID，抗發炎止痛

【評論主題】26.兒茶酚胺（catecholamine）再回收抑制劑臨床應用廣泛，下列敘述何者錯誤？(A)reboxetine可用於治療重度憂鬱 (B)sibutramine可降低食慾 (C)milnacipra

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

【評論主題】4.造成penicillin產生抗藥性的原因，下列何者錯誤？(A)β–lactamase的存在 (B)無法結合到penicillin結合蛋白 (C)增進penicillin排除 (D)在格蘭氏陽性菌株

【評論內容】D.敘述中的G+改成G-，此選項就是合理★===...

【評論主題】45.有關topiramate的敘述，下列何者正確？(A)不會造成認知障礙 (B)可能會造成腎結石 (C)沒有藥品交互作用 (D)為微弱的carbonic anhydrase促進劑

【評論內容】

A. 會造成認知障礙(eg.認知衰退、疲勞、困惑)B. 可能會造成腎結石C. 有DDI(和其他AED併用大部分是影響Topiramate自身濃度; 會減少避孕藥(含Estradiol)的濃度)D. 為微弱的Carbonic anhydrase inhibitor(故和acetazolamide併用，加成CAI效果，增加腎結石風險)Topiramate(Topamax*)1.機轉:-Θ電位依賴Na+通道-Θ高電位依賴 L-type Ca2+通道-增強GABA的抑制活性-降低kainate(卡莫酸)在glutamate receptor的興奮活性2.臨床使用:-partial and generalized tonic-clonic seizures(monotherapy)-LGS(lennox-Gastaut syndrome)-infantile spasms(嬰兒痙攣)-absence seizure(失神性發作)-偏頭痛3.常見副作用:通常發生在服用後4週內嗜睡、疲勞、頭暈、認知衰退、感覺異常、麻木感、困惑、腎結石若發生急性近視或青光眼，必須立即停藥4.PK:abs: F(oral):80%exc:urine(primary)=>腎結石t1/2:20-30hr=>XR 劑型可以QD

【評論主題】56.下列何項藥品之適應症兼具抗憂鬱症及戒菸？(A)buprenorphine (B)bupropion (C)buspirone (D)butorphanol

【評論內容】A. Buprenorphine(Temgesic* SL tab; Transtec* TDDS): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ antagonist用途: 管制止痛藥、鴉片類沉癮治療(Buprenorphine/Naloxone; Suboxone*, Desud* plus)B. Bupropion(Wellbutrin*; Zyban*; Buporin*): DNRI(DA/NE reuptake inhibitor)機轉: 抑制DA/NE reuptake用途: 抗憂鬱藥(MDD, unipolar; sesonal affective disorder)，戒菸輔助藥C. Buspirone(Sepirone*; Busron*): antianxiety agent機轉: 結合在5-HT1A和5-HT2 receptor (中度結合力:D2 receptor)用途: 抗焦慮D. Butorphanol(Butaro* Nasal spray): mixed opioid agonist-antagoinst機轉: Partial μ agonist, κ agonist用途: 管制性止痛藥

【評論主題】63.陳先生59歲，有冠狀動脈心臟疾病，最近LDL 200 mg/dL、HDL 42 mg/dL、TG 180 mg/dL。下列何者為首選用藥？ (A)gemfibrozil (B)atorvasta

【評論內容】

病人為59歲男性，過去病史有CADLDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<S> 59 y/o male<O>PI: DyslipidemiaPMH: CADAllergy: NDAcurrent medication: unknowncurrent lab data(lipid panel):LDL: 200mg/dl, HDL:42mg/dl, TG:180mg/dl<A>1. Dyslipidemia:clinical ASCVD + not at very high risk註(1 ASCVD event +LDL>100mg/dl; <75 y/o)goal: LDL<70mg/dl, TG:<150mg/dl(ref of LDL Goal: 2022 TW lipid guidelines for high risk pt: CAD, PAD and ischemic stroke)→recommend high-intensity statin tx (eg. Atorvastatin 40-80mg, Rosuvastatin20-40mg)→recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd註: 以台灣治療指引條件劃定2. Secondary prevention of ACS: (omit)1. Recommend add Lipitor*(20) #2 qd or Tulip*(40) #1 qd or Crestor*(10) #2 qd for dyslipidemia with CAD.Please recheck lipid panel 4 to 12 weeks after initiating therapy and every 3 to 12 months thereafter.(If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.)Consider add Ezetimibe if is still unable to acheive optimal LDL goal.Routine monitoring of hepatic function and CK levels is not recommend unless pt has signs of suggestive of hepatic or muscle injury. Monitor closely for myopathy/rhabdomyolysis.故選(B)作為降血脂首選用藥，且Atorvastatin的劑量必須為40-80mg，作為高強度statin txcf:Atorvastatin 10-20mg為中強度statin tx===2022 TW lipid guideline:CAD:1. LDL goal: <70mg/dl2. LDL goal at very high risk*: <55mg/dl*diabetes, those with recent MI (<12 months), 2 prior MIs, multivessel CAD, or concomitant PAD (including extremity or carotid artery)

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】32.Ibuprofen 是屬於下列那個分類之止痛藥物？(A)propionic acid derivative(B)fenamates(C)indole derivative(D)oxicam

【評論內容】

官能基及範例藥品A. Propinoic acid der. =>IbuprofenB. Fenamates => Mefenamic acidC. Indole der. =>Indomethacin (商品名:Indoy*)D. Oxicam =>Meloxicam (商品名:Mobic*)

【評論主題】22 Etretinate 臨床上可用來治療牛皮癬，它是屬於下列何種維生素之類似物？(A)A(B)D(C)E(D)K

【評論內容】

Etretinate

Vit.A(retinol)

【評論主題】68.下列何者是thiazolidinedione（TZD）類的降血糖藥物？(A) (B) (C) (D)

【評論內容】A. RaloxifeneB. Pioglitazone(最右邊的雜環是thiazolidinedione; 此雜環去掉兩個酮基是thiazolidine)C. Glipizide(右邊有sulfonylurea的骨架; 左邊有pyrimidine)D. Piroxicam (D.的左下角是-oxicam的骨架; 右邊是pyridine)

【評論主題】66.下列何種DPP-IV抑制劑，具有最高的口服生體可用率？(A)saxagliptin (B)sitagliptin (C)alogliptin (D)linagliptin

【評論內容】

這個可以考慮申覆C.Alogliptin

仿單、UpTodate 、micromedex 寫到Alogliptin 生體可用率都是接近100%

【評論主題】53.下列神經肌肉疾病與使用藥物的配對，何者錯誤？(A)Duchenne muscular dystrophy：interferon β-1a(B)multiple sclerosis：dimethy

【評論內容】

D. Amyotrophic lateral sclerosis(ALS)肌萎縮性脊髓側索硬化症(俗稱漸凍人)1.病因: 運動神經元退化，喪失的神經元被膠質增生取代；皮質運動神經元(錐體細胞和Betz細胞)消失，導致逆行性軸突傳輸功能喪失、皮質脊髓束的膠質增生→造成脊髓萎縮→脊髓腹跟變薄、運動神經元喪失大型髓鞘纖維的保護→患部肌肉呈現去神經化(denervation)之萎縮、再神經支配(或稱神經再極化; reinnervation)2.症狀:包含上運動神經元(upper motor neuron)及下運動神經元(lower motor neuron)的相關表徵，肌肉虛弱、痙攣、反射亢進、肌肉萎縮、肌束顫動等3.治療:-症狀支持性療法: (略)-Disease-modifying therapy:1) Riluzole(Rilutek*): 屬於glutamate inhibitor機轉: 抑制glutamic acid釋放、阻斷NMDA Receptor與glutamate結合、去活化voltage-dependent Na+ channel用法用量: PO, 50mg bid2) Edaravone(Radicava*): 屬於Free Radical Scavenger機轉: 預防細胞膜受氧化性壓力破壞，減緩ALS病程惡化3) Idrocilamide(Srilane*): 屬於Skeletal Muscle Relaxant←屬於歐洲藥，美國無藥證機轉: 抑制肌質網(sarcoplasmic reticulum)釋放Ca2+ref: UpToDate, Abialbon Paul et al. (2021) Introduction to Basics of Pharmacology and Toxicology: Volume 2

【評論主題】53.下列神經肌肉疾病與使用藥物的配對，何者錯誤？(A)Duchenne muscular dystrophy：interferon β-1a(B)multiple sclerosis：dimethy

【評論內容】C. Spinal muscular atrophy(SMA)脊髓性肌肉萎縮症1.病理: 屬於體染色體隱性遺傳疾病，survival motor neuron 1 (SMN1) 運動神經元存活基因缺損，導致脊髓前角細胞(運動神經元)退化，造成肌肉無力及萎縮2.治療:-Supportive therapy(主要): (略)-Disease-modifying therapy:1) Nusinersen(Spinraza*):屬於Antisense Oligonucleotide(反義寡核苷酸)機轉: 修飾SMN2基因剪接藉由結合在SMN2 mRNA transcript的exon 7之內含子下游特定序列，增加正常的SMN protein合成用法用量:DL: 每次IT(intrathecal, 脊髓鞘內)注射施打12mg, q14 day，打3劑；3劑後，距離第3劑30天後打第4劑12mgDM: 12mg q4m2) Onasemnogene abeparvovec(Zolgensma*): 屬於腺病毒載體的基因治療(Gene Therapy, Adeno-Associated Virus)機轉: 利用正常的SMN互補DNA置換病人的突變(缺陷)DNA用法用量:終身只施打一次，IVF(Fusion time 60min)， 1.1 × 1014 vector genomes/kg適應症:只適用於<2歲的SMA病童3) Risdiplam(Evrysdi*): 屬於SMN2-Directed RNA Splicing Modifier的小分子藥物機轉: 藉由結合在SMN2 pre-mRNA的兩處作用位，校正並修剪SMN2的缺陷，使其促進合成正常的SMN protein用法用量: (成人)PO, 5mg/qd

【評論主題】53.下列神經肌肉疾病與使用藥物的配對，何者錯誤？(A)Duchenne muscular dystrophy：interferon β-1a(B)multiple sclerosis：dimethy

【評論內容】A. 的interferon β-1a改成治療multiple sclerosis就合理===A. Duchenne muscular dystrophy(DMD)裘馨氏肌肉失養症; 杜興氏肌肉營養不良症:-病因: 因X染色體上負責製造dystrophin(肌失養蛋白)的DMD基因突變，造成dystrophin不足。Dystrophin缺乏會造成肌纖維膜脆弱無力，經過一段時間的伸展，致使肌纖維膜扯裂並促使肌細胞死亡。-常見症狀: 肌肉無力；步態不穩-目前治療: 1. 以glucocorticoids為主的治療(通常建議predinsone, deflazacort; 有些專家認為delazacort比前者有較佳的副作用)2. 其他基因治療:-exon skipping(增加dystrophin合成): eteplirsen, golodirsen, viltolarsen, casimersen-read-through of premature termination codon: atalurenB. multiple sclerosis多發性硬化症:Disease-modifying therapy治療:1. Mab: natalizumab, ocrelizumab, rituximab, ofatumumab, alemtuzumab2. Oral tx: -fumarates: eg. dimethyl fumarate, diroximel fumarate, monomethyl fumarate-sphingosine 1-phosphate (S1P) receptor modulators : eg. fingolimod, siponimod, ozanimod, ponesimod-teriflunomide, cladribine3. Platform injection therapies: recombinant human interferon beta-1b, recombinant human interferon beta-1a, glatiramer acetate

【評論主題】26.兒茶酚胺（catecholamine）再回收抑制劑臨床應用廣泛，下列敘述何者錯誤？(A)reboxetine可用於治療重度憂鬱 (B)sibutramine可降低食慾 (C)milnacipra

【評論內容】A. Reboxetine(Edronax*): Selective NE reuptake inh→MDD; 國內已註銷此藥證B. Sibutramine(Reductil*;諾美婷*): SNRI→抑制食慾，曾作為減肥藥，但因其會使心跳加快、血壓升高，增加心血管風險，已於2010年下市C. milnacipran(Savella*; Milpran*): SNRI→MDD, fibromyalgia(但國內沒此適應症，其他可用來治療fibromyalgia的SNRI藥品，eg. Duloxetine, Venlafaxine)D. Atomoxetine(Strattera*): Selective NE reuptake inh→ADHD(其他用來治療ADHD的藥品有Methylphenidate)治療姿態性低血壓的藥品:Midodrine(α1 agonist)

【評論主題】31.下列何者可抑制xanthine oxidase，用在痛風治療？(A)allopurinol (B)colchicine (C)sulfinpyrazone (D)indomethacin

【評論內容】

A. allopurinol: Xanthine oxidase inhibitor，同類的還有febuxostatB. colchicine: anti-inflammatory，結合在tubulin，抑制leukocyte的migration和phagocytosis→急性痛風發作和預防抗發炎都有其角色地位→作為降尿酸治療的長期抗發炎預防用藥(0.5-0.6mg bid)，比口服NSAID更適合長期預防C. sulfinpyrazone: uricosurics排尿酸劑，同類的還有probenecid、lesinurad→不能用在有腎結石病史的病人→須從最低劑量開始調整，以避免腎結石的發生D. indomethacin: NSAID，抗發炎止痛

【評論主題】15.下列口服降血糖藥物，何者可以抑制dipeptidyl peptidase 4，使內生性之glucagon-like peptide-1作用時間延長，而增加胰臟insulin釋放量？ (A)can

【評論內容】抑制dipeptidyl peptidase 4(DPP4)，增加glucagon-like peptide 1(GLP-1)作用時間: DPP4i的機轉A. Canagliflozin (Canaglu*): -gliflozin, SGLT2iB. Exenatide (Bydureon*): GLP-1 analogC. Glimepiride (Amaryl*): 2nd SUD. Saxagliptin (Onglyza*): -gliptin, DPP4i

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