# 情境 55歲類風濕關節炎個案出院長期使用prednisone 20 mg PO每天早晨。最重要的出院衛教為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375100&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 55歲類風濕關節炎個案出院長期使用prednisone 20 mg PO每天早晨。最重要的出院衛教為何?

## 選項

1. 早上空腹服用，如果錯過一次劑量則加倍服用，症狀減輕時停藥。
2. 睡前服用以減少早晨僵硬，在一個星期內逐漸停藥，並避免佩戴醫療警示手環。
3. 早晨配食物服用、不可突然停藥、依處方逐量減量計畫服用。 **✔ 正確答案**
4. 疼痛改善時停藥，睡前服用以減少噁心感，並避免服用鈣補充劑。

**正確答案: 3**

## 解析

長期口服皮質類固醇會抑制下視丘-腦下垂體-腎上腺(HPA)軸。突然停藥導致腎上腺功能不全並可能進展為腎上腺危機(低血壓、低血糖、高鉀、倦怠、嘔吐、休克)。慢性prednisone教學要點：(1) 早晨配食物服用，配合天然皮質醇高峰並減少胃腸不適；(2) 不可突然停藥，依處方漸減；(3) 類固醇會掩蓋感染徵象並影響癒合，須回報發燒、咽痛、排尿不適等感染徵象；(4) 自我監測高血糖、體重增加或水腫、情緒及睡眠變化、易瘀青、白內障與青光眼；(5) 預防骨質疏鬆攝取鈣1000~1200 mg、維生素D 800~1000 IU、負重運動並監測骨密度；(6) 配戴醫療警示手環標示類固醇依賴；(7) 攜帶sick day計畫、重大病症/手術/創傷時補充壓力劑量；(8) 漏服勿加倍，照下一次原定時間服用。提早停藥及加倍均為直接禁忌。

## 深入解析

最致命的教學要點為HPA抑制的不可突然停藥原則。與早晨配食物服用一起記憶以兼顧吸收與生理時鐘。

## 重要概念

- **prednisone** — 口服皮質類固醇、抗炎、免疫抑制、HPA抑制、需漸減
- **corticosteroid taper** — 長期類固醇逐量減藥計畫，保護HPA恢復，禁止突然停藥
- **medical alert bracelet** — 緊急時告知類固醇依賴的醫療識別手環

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