9.關於神經肌肉阻斷藥物之敘述，下列何者錯誤？
(A)乙醯膽鹼酯酶抑制劑會延長succinylcholine的作用時間
(B)肝臟疾病可能延長succinylcholine的作用時間
(C)Aminoglycosides抗生素具有神經肌肉阻斷作用
(D)Isoflurane不會增強非競爭性神經肌肉阻斷藥的作用

To johnson，你是對的，但題幹在特定解讀下也沒有錯，還請閱以下敘述

引述紅皮(藥理聖經)的內容如下，我隨便翻，原文要看

先說結論，乙醯膽鹼酯酶抑制劑不該延長 succinylcholine 的作用時間，因為 succinylcholine 只被 PChE 分解

但事實是，neostigmine 等乙醯膽鹼酯酶抑制劑也具有抑制 PChE 的作用

也就是說，以乙醯膽鹼酯酶抑制劑來形容它會有過於狹隘之嫌，應為膽鹼酯酶抑制劑 ChE

如果看到A選項會直接聯想到 neostigmine 等藥，並得出敘述正確的判斷，那就是跟出題老師一樣的邏輯，是反射性的但有瑕疵存在

In general, administration of an AChE inhibitor (e.g., edrophonium, neostigmine) will not reverse the effects of depolarizing NMB agents such as succinylcholine and may in fact delay recovery.

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The short duration of action (approximately 6–10 minutes) of succinylcholine is due to its rapid hydrolysis by plasma cholinesterase (psuedocholinesterase, butyrlcholinesterase) to succinylmonocholine and choline.

(前一句說 succinylcholine 的 onset 跟 duration 都超快)，這是因為 PChE 水解 succinylcholine 的速度也很快

Because there is limited plasma cholinesterase activity at the NMJ, the neuromuscular blockade that occurs from succinylcholine is terminated by the drug's diffusion away from the NMJ back into the circulation.

基於 PChE 在神經肌肉接合處的活性有限，succinylcholine 的神經肌肉阻斷效果之所以會結束是因為 Such 從 NMJ 擴散回循環的關係 (而不是 PChE 跑去把它分解了，PChE在血漿呀)

This has important clinical consequences in that the drug is not reversible by AChE inhibitors and factors that decrease plasma cholinesterase activity may prolong recovery. 

這在臨床的重要意義在於 succinylcholine 的作用無法被 AChE 抑制劑逆轉，且 PChE活性減少會讓復原時間延長(如肝病)

succinylcholine 的作用無法靠增加 ACh 來反制，ChE 抑制劑的介入更會延長其作用時間，紅皮也提到

Neostigmine, a cholinesterase inhibitor, potentiated the muscle twitch depression evoked by succinylcholine and prolonged recovery from the effects of this agent.

Neostigmine 會增強 succinylcholine 的肌肉鬆弛作用及延長恢復時間

This synergistic interaction is primarily attributed to the anticholinesterase activity of neostigmine, resulting in decreased biotransformation of both succinylcholine and endogenous ACh.

此協同作用乃 neostigmine 的抗膽鹼酯酶作用使 SuCh 及 ACh 降解減少所致

雖然題幹A選項提的是作用延長，書上說的是作用反轉，但事實是 AChE 跟 succinylcholine 沒有關係，因此兩件事都辦不到

A選項該要是有問題的

感謝j大提出個以前沒想到的問題

Ref.

Veterinary Pharmacology and Therapeutics, 10th Edition, page 203, 205-206.

綠皮page.69

Isoflurane 會增強競爭性神經肌肉阻斷藥的作用，因為他們穩定N_M接合處後膜(或導致過極化)。

SuCh與吸入性麻醉劑共同投藥會誘發增加心搏徐緩、心律不整、竇性停搏及呼吸暫停(由於神經節的阻斷)的發病率。

Heng 抱歉幫你補充個，因為綠皮的中文翻譯有點鬧

Inhalant anesthetics, for example, isoflurane, enhance nondepolarizing neuromuscular blockade since they stabilize the postjunctional membrane.

Concomitant administration of SuCh with inhalation anesthetics may induce increased incidences of bradycardia, arrhythmias, sinus arrest, and apnea (owing to ganglionic blockade).  

引自 Handbook of Veterinary Pharmacology (藍皮)，小弟沒有綠皮原文書