# 一位 65 歲患有疼痛性糖尿病周邊神經病變的個案，正要開始服用 gabapentin 100 mg 口服一天三次，預計在數週內逐漸調高劑量。哪一項個案衛教最重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375211&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位 65 歲患有疼痛性糖尿病周邊神經病變的個案，正要開始服用 gabapentin 100 mg 口服一天三次，預計在數週內逐漸調高劑量。哪一項個案衛教最重要？

## 選項

1. 一劑內就有止痛效果，若沒有今晚加倍。
2. 只在嚴重疼痛時PRN使用。
3. 若想睡代表沒效，停藥。
4. 依時間服用、預期數週內漸進產生效果、回報暈眩、嗜睡、下肢水腫、情緒變化或自殺意念；避免酒精；不可突然停藥(可能引發抽搐與疼痛反彈)，停藥需漸減；緩慢起身避免跌倒。 **✔ 正確答案**

**正確答案: 4**

## 解析

Gabapentin（Neurontin）及相關藥物 pregabalin（Lyrica）是數種神經病變性疼痛症候群的第一線藥物，包括糖尿病周邊神經病變、帶狀疱疹後神經痛、中樞神經病變性疼痛，亦用於癲癇及纖維肌痛（pregabalin）。藥效開始時間漸進——數天至一週內可出現部分效益，在調高劑量的 2 至 8 週內達到完整效益；劑量需逐步調升以平衡療效與耐受性。重要衛教：(1) 按時服藥（gabapentin 通常一天三次，pregabalin 通常一天兩次），不論疼痛程度如何；(2) 預期藥效漸進，勿自行加倍劑量；(3) 常見副作用——頭暈、嗜睡、步態不穩、周邊水腫及體重增加、視力模糊、疲倦；若惡化應通報；(4) 美國 FDA 對本類藥品有自殺意念的仿單警告；若出現憂鬱、情緒變化或自殺念頭，應立即通報；(5) 未經開方醫師指示，避免併用酒精、鎮靜劑及鴉片類藥物，因會加成中樞神經抑制；已有併用鴉片類致致命性呼吸抑制的案例報告；(6) 應逐步減量而非突然停藥，因驟然停藥可誘發癲癇及反彈性疼痛；(7) 由坐姿或臥姿起身時動作宜緩，以防老年個案發生姿勢性低血壓跌倒；(8) 腎功能不全（肌酸酐清除率下降）時須調整劑量；(9) pregabalin 為第五級管制藥品，因有濫用可能。為疼痛而加倍劑量、因嗜睡而停藥、或需要時才服用，均為不正確的作法。

## 深入解析

漸進效果、留意鎮靜/水腫/情緒、漸減而非突停、避免酒精。自殺意念警示為FDA類別標籤。

## 重要概念

- **gabapentin titration** — 漸進加量平衡療效與耐受性，TID時程，2-8週完全效果，CrCl調整
- **gabapentinoid edema** — 末梢水腫與體重增加，常見副作用，非CHF性水腫
- **suicidal ideation warning** — FDA抗癲癇藥類別警示，情緒、憂鬱、自殺意念立即回報

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