# 一位個案因MRSA菌血症接受靜脈注射vancomycin 1 g每12小時。在下一次給藥前，護理師檢視最近的檢驗數值。哪項發現最令護理師擔憂，並需要暫停給藥及通知醫師？ > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw > language: zh-TW > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## 題目 一位個案因MRSA菌血症接受靜脈注射vancomycin 1 g每12小時。在下一次給藥前，護理師檢視最近的檢驗數值。哪項發現最令護理師擔憂，並需要暫停給藥及通知醫師？ ## 選項 1. 血中尿素氮（BUN）為18 mg/dL，與使用vancomycin治療前的基礎值相比沒有改變 2. Trough 24 mcg/mL、血清肌酸酐由0.8升至1.6 mg/dL **✔ 正確答案** 3. 個案主訴在最近一次vancomycin輸注後，發生一次輕微的噁心 4. vancomycin的谷濃度為15 mcg/mL，且血清肌酸酐持續穩定在0.9 mg/dL **正確答案: 2** ## 解析 Vancomycin腎毒性與劑量和谷濃度相關。當谷濃度高於20 mcg/mL且血清肌酸酐倍增時，符合KDIGO的急性腎損傷標準。護理師必須暫停給藥並通知醫師，以檢討藥物濃度或調整劑量。谷濃度12 mcg/mL為次治療濃度但無腎毒性。BUN 18 mg/dL在正常範圍內。輕微噁心為常見的腸胃道副作用，不須暫停給藥。 ## 深入解析 臨床判斷 Vancomycin需治療性藥物濃度監測以平衡療效與腎安全。重症MRSA治療trough: 15-20 mcg/mL。毒性指標: trough >20 mcg/mL 併肌酸酐升高。肌酸酐倍升符合KDIGO Stage 1 AKI。 記憶口訣 Vanco trough >20 + 肌酸酐倍升 = 暫停並報告 韓 vs 美 美國推薦AUC/MIC(目標400-600);trough 15-20亦可。臺灣醫學中心已採AUC,區域醫院多用trough。 ## 臨床情境 臨床指引 2020 IDSA/ASHP/SIDP/PIDS聯合指引建議重症MRSA採AUC/MIC(AUC 400-600 mg·h/L)。Trough 15-20 mcg/mL亦可。trough >20 mcg/mL 或肌酸酐較基準升高 >0.5 mg/dL 即暫停或調整。 注意 併用腎毒性藥物(aminoglycoside、NSAID、顯影劑、piperacillin-tazobactam)會加重vancomycin腎損傷。治療期間每48-72小時複測肌酸酐。 ## 重要概念 - **Vancomycin trough** — 下次給藥前30分鐘抽取的血清vancomycin濃度。重症MRSA治療範圍: 15-20 mcg/mL。>20 mcg/mL有毒性風險;需複查肌酸酐並評估調整劑量。 - **急性腎損傷 (KDIGO)** — KDIGO Stage 1 AKI: 48小時內血清肌酸酐升0.3 mg/dL,或7天內為基準1.5~1.9倍,或6-12小時尿量 - **治療性藥物監測 (TDM)** — 治療指數窄的藥物採實驗室導引劑量調整。Vancomycin、aminoglycoside、lithium、digoxin、phenytoin、theophylline皆需。Trough於給藥前30分鐘、peak於分布期後抽血。 ## 相同主題題目 - [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=zh-tw) - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=zh-tw) - [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw) - [An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During mornin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372686&lang=zh-tw) - [A 38-year-old female with rheumatoid arthritis is being discharged with a new prescription…](https://mymerci.kr/pages/nclex_q.php?qn_id=372687&lang=zh-tw) - [A 62-year-old patient is being discharged after a deep vein thrombosis and will continue e…](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_