# 情境 70歲第2型糖尿病(glyburide)、陣發性心房顫動病史(amiodarone與PRN ondansetron)的個案因院內肺炎開始IV levofloxacin。療程前後最適當的整合護理行為為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375231&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## 題目

情境 70歲第2型糖尿病(glyburide)、陣發性心房顫動病史(amiodarone與PRN ondansetron)的個案因院內肺炎開始IV levofloxacin。療程前後最適當的整合護理行為為何?

## 選項

1. 為克服交互作用levofloxacin期間增加glyburide劑量。
2. 取得基線12導程ECG與血鉀血鎂；告知處方者與藥劑師關於QT延長藥物群(levofloxacin、amiodarone、ondansetron)；監測心律與QTc、血糖(磺脲類加fluoroquinolone增加低/高血糖風險)、肌腱與CNS症狀；若baseline QTc已延長考慮替代抗生素。 **✔ 正確答案**
3. 為預防未來嘔吐再加一種QT延長止吐藥。
4. 廣效抗生素緊急，不再確認直接給藥。

**正確答案: 2**

## 解析

Levofloxacin與amiodarone及ondansetron合用造成累積QT延長風險，於高齡、低鉀、低鎂或既有QT延長者尤可能引發torsades de pointes。個案還使用glyburide治療糖尿病 — 與fluoroquinolone的血糖紊亂相加，可有低血糖與高血糖風險，特別是磺脲類有嚴重低血糖案例。整合護理：(1) 用藥前取得基線12導程ECG與含K、Mg的電解質，若低需補充；(2) 將對QT延長群的擔憂告知處方者與藥師，依敏感性可改用ceftriaxone加macrolide或doxycycline等替代，或縮短fluoroquinolone療程；(3) 心電圖遙測並追蹤QTc；(4) 頻繁指尖血糖並衛教個案/家屬，反覆低血糖時暫停或降glyburide劑量；(5) 標準fluoroquinolone監測 — 肌腱、CNS、腸胃、光敏、C. difficile；(6) 補水避免結晶尿；(7) 記錄過敏並檢視所有居家用藥包括OTC與草藥找其他QT延長與CYP交互作用。未經確認給藥、增量glyburide、加用QT延長止吐藥皆不安全。

## 深入解析

QT多重用藥+糖尿病+高齡=高風險levofloxacin病人。基線ECG、電解質、血糖警覺、向團隊溝通。考慮替代藥。

## 重要概念

- **fluoroquinolone QT** — 抗心律不整/抗精神病/抗生素群、低鉀低鎂累積、torsades風險
- **fluoroquinolone glucose** — 低血糖與高血糖雙向，磺脲類合用易嚴重低血糖
- **preemptive review** — 基線ECG、電解質、檢視OTC/草藥、與藥師會診、決定替代藥物

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