# 情境 60歲膝關節炎個案使用acetaminophen 650 mg q6h，詢問睡前加用Tylenol PM與含acetaminophen的綜合感冒藥是否安全。護理師最適當的回應為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375130&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 60歲膝關節炎個案使用acetaminophen 650 mg q6h，詢問睡前加用Tylenol PM與含acetaminophen的綜合感冒藥是否安全。護理師最適當的回應為何?

## 選項

1. 既然您要停止每6小時服用650毫克的常規acetaminophen，那麼在睡前服用Tylenol PM和感冒藥是安全的；這些產品中的acetaminophen是不同的，不會增加您每日的總量。
2. 您可以在繼續規律服用acetaminophen的同時，每晚安全地添加Tylenol PM，因為夜間劑量在睡眠期間的代謝方式不同，不會影響您每日acetaminophen的總量。
3. 全部來源合計24小時不超過4 g(若有肝病或定期飲酒則3 g)；許多OTC含有隱藏acetaminophen，務必逐一閱讀標示。 **✔ 正確答案**
4. 您可以同時服用這三種藥物，因為acetaminophen沒有真正的最大劑量；它由肝臟安全代謝，多餘的部分會被排出而不會造成傷害，除非您有嚴重的肝病。

**正確答案: 3**

## 解析

Acetaminophen為美國急性肝衰竭最常見原因，多由複方產品意外過量造成。成人上限：短期使用各來源合計24小時4 g；慢性使用、飲酒、營養不良或肝病者24小時2~3 g。兒科：75 mg/kg/day且不超過成人上限。Acetaminophen常隱藏於多項OTC：感冒-流感複方(DayQuil、NyQuil、Theraflu)、鴉片類複方(Percocet、Norco、Vicodin)、Tylenol PM(acetaminophen加diphenhydramine)、多種偏頭痛與經痛產品。教學：(1) 統計所有來源每日總量；(2) 閱讀OTC與處方標示尋找acetaminophen、APAP、paracetamol；(3) 不可重覆服用；(4) 避免飲酒；(5) 黃疸、濃尿、右上腹痛、持續噁心嘔吐須回報；(6) 肝毒性為雙相 — 24小時內N/V/倦怠，無症狀期，24~72小時RUQ壓痛與AST/ALT升高，72~96小時腦病變與凝血異常。

## 深入解析

隱藏acetaminophen警示加上4 g(肝/飲酒3 g)上限為NCLEX的核心教學。要永遠加總所有來源。

## 重要概念

- **acetaminophen** — 鎮痛退燒藥，肝代謝，NAPQI為毒性代謝物，需glutathione解毒
- **hidden acetaminophen** — OTC感冒藥、鴉片類複方、Tylenol PM均含隱藏acetaminophen，過量風險
- **hepatotoxicity timeline** — 0-24h N/V、24-72h右上腹加酶升、72-96h腦病變/凝血異常

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