# 情境 55歲心房顫動使用warfarin、高血脂使用simvastatin的個案因皮膚感染獲開立erythromycin 500 mg PO QID。護理師應優先處理的藥物交互作用相關回報為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375233&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 55歲心房顫動使用warfarin、高血脂使用simvastatin的個案因皮膚感染獲開立erythromycin 500 mg PO QID。護理師應優先處理的藥物交互作用相關回報為何?

## 選項

1. 休息後緩解的輕微頭痛。
2. 瘀青、出血增加(CYP3A4抑制使warfarin INR上升)、新發肌肉疼痛或無力(simvastatin濃度上升致橫紋肌溶解)，加上erythromycin為motilin受體促效劑造成嚴重腸胃絞痛與噁心；通知處方者，預期INR檢查並暫停statin或改用非CYP3A4抗生素。 **✔ 正確答案**
3. 服藥時輕微金屬味。
4. 一劑後尿略呈粉紅。

**正確答案: 2**

## 解析

Erythromycin為強CYP3A4抑制劑的巨環內酯(clarithromycin亦強、azithromycin則弱)。同時是motilin受體促效劑，造成顯著噁心、嘔吐、腹絞痛與腹瀉，有時低劑量做為腸蠕動促進藥使用。本案臨床優先：(1) warfarin — erythromycin抑制CYP3A4與1A2，INR上升與出血風險增；瘀青與出血為警示徵；預期監測INR；(2) simvastatin — 為強CYP3A4基質；erythromycin顯著提高simvastatin濃度導致肌病與橫紋肌溶解；新發肌肉痛、無力、濃尿須暫停statin並驗CK；(3) 腸胃motilin效應 — 嚴重絞痛、噁心、嘔吐、腹瀉常見可成限制因素；(4) macrolide類別之QT延長；(5) 肝毒性少見但可能；(6) 與carbamazepine、theophylline、cyclosporine及多種其他藥物有交互作用，需藥師審視。護理：通知處方者與藥師，預期INR檢查、必要時暫停statin或改非CYP3A4抑制抗生素，衛教出血與肌病徵象，腸胃副作用支持。

## 深入解析

Erythromycin = 強CYP3A4抑制加motilin促效。warfarin與statin交互最高優先；可行時改用非CYP3A4替代藥。

## 重要概念

- **erythromycin** — 巨環內酯，強CYP3A4抑制，motilin促效，嚴重腸胃，QT，warfarin/statin交互
- **CYP3A4 inhibition** — erythromycin/clarithromycin/葡萄柚等抑制基質藥代謝，提高warfarin/statin/環孢素濃度
- **rhabdomyolysis risk** — statin加上CYP3A4抑制致肌痛、無力、濃尿，需驗CK並暫停藥物

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