# 情境 50歲fibromyalgia個案開始pregabalin 75 mg PO BID。護理師最重要監測與回報的評估發現為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375212&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 50歲fibromyalgia個案開始pregabalin 75 mg PO BID。護理師最重要監測與回報的評估發現為何?

## 選項

1. 治療第一週期間出現輕微、短暫的頭暈和白天嗜睡，偶爾口乾但補充水分後可緩解，以及前臂有一小塊瘀傷，是兩天前輕微居家意外造成的。
2. 個案表示工作時感覺稍微「昏沉」且反應不如以往敏銳，但仍能無誤地執行工作職責；過去一個月體重減輕1公斤，個案說偶爾有輕微頭痛，服用acetaminophen後可緩解。
3. 服用pregabalin後開始出現持續的輕微噁心和腹部脹氣，偶爾稀便，一週內體重增加0.5公斤，但個案表示這些症狀尚可忍受，且進食量足夠。
4. 兩週內新出現末梢水腫加3 kg體重增加、視力模糊、暈眩或嗜睡加重、情緒改變或自殺意念，以及提早領藥、反覆要求補方等濫用徵象(pregabalin為Schedule V)。 **✔ 正確答案**

**正確答案: 4**

## 解析

Pregabalin (Lyrica)為fibromyalgia、糖尿病性神經痛、帶狀疱疹後神經痛、脊髓損傷神經疼痛的第一線gabapentinoid，亦作為部分性發作的輔助治療。護理評估與衛教重點：(1) 末梢水腫與體重增加 — 常見且可能誘發或惡化心衰，回報新下肢水腫與快速體重增加；(2) 臨床試驗報告視力模糊，可能改善或持續，需回報；(3) CNS — 暈眩、嗜睡、共濟失調、倦怠，高齡跌倒風險高；(4) 抗癲癇藥類別警示包含情緒變化與自殺意念；(5) 濫用 — pregabalin因可產生欣快感被列Schedule V，物質濫用病史者更需警覺，注意提早領藥、自行加量、處方遺失、合用鴉片；(6) 腎功能調整劑量、停藥需漸減、避免酒精與未許可的CNS抑制藥；(7) 罕見angioedema及嚴重皮膚反應，臉部腫脹立即回報。粉紅色尿可能與藥物相關但非優先監測；口乾輕微；小瘀青屬跌倒評估，非Lyrica特異。

## 深入解析

水腫/體重、視力、情緒、濫用徵象為pregabalin必觀組合。Schedule V是與gabapentin最大差異。

## 重要概念

- **pregabalin Schedule V** — 欣快感可能性，管制藥，需監測提早領藥/濫用徵象
- **fibromyalgia treatment** — pregabalin、duloxetine、milnacipran、運動、CBT，多模式
- **gabapentinoid CHF risk** — 末梢水腫與體重增加可惡化既有心衰，須謹慎使用

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