Barrons R W
Department of Clinical Pharmacy, Xavier University of Louisiana, New Orleans 70125, USA.
Pharmacotherapy. 1997 Nov-Dec;17(6):1220-32.
Myasthenia gravis is an uncommon disorder of the neuromuscular junction resulting in weakness of all striated voluntary muscles. Therapeutic advances have increased patients' age and survival. Older patients with myasthenia gravis may have additional medication needs. Numerous drugs have experimental and clinical evidence of neuromuscular blockade. A MEDLINE search of the English literature from 1966 to the present pertinent to drug-induced myasthenia gravis was performed. Additional literature was obtained from reference citations of relevant articles. Drugs with several reports of neuromuscular blockade were assessed for causality by a recognized probability scale. Prednisone was most commonly implicated as aggravating myasthenia gravis, and D-penicillamine was most commonly associated with myasthenic syndrome. The greatest frequency of drug-induced neuromuscular blockade was seen with aminoglycoside-induced postoperative respiratory depression. However, drugs most likely to impact myasthenic patients negatively are those used in the treatment of the disease. These include overuse of anticholinesterase drugs, high-dose prednisone, and anesthesia and neuromuscular blockers for thymectomy.
重症肌无力是一种罕见的神经肌肉接头疾病，可导致所有横纹肌随意肌出现无力症状。治疗进展提高了患者的年龄和生存率。老年重症肌无力患者可能有额外的用药需求。许多药物具有神经肌肉阻滞的实验和临床证据。对1966年至目前与药物性重症肌无力相关的英文文献进行了MEDLINE检索。通过相关文章的参考文献获取了更多文献。对有几例神经肌肉阻滞报告的药物，根据公认的概率量表评估其因果关系。泼尼松最常被认为会加重重症肌无力，而青霉胺最常与肌无力综合征相关。氨基糖苷类药物引起的术后呼吸抑制导致药物性神经肌肉阻滞的发生率最高。然而，最有可能对重症肌无力患者产生负面影响的药物是用于治疗该疾病的药物。这些包括抗胆碱酯酶药物的过度使用、高剂量泼尼松以及胸腺切除术时使用的麻醉药和神经肌肉阻滞剂。
