# 情境 28歲個案因活動性結核接受多藥併用療法，開始rifampin。同時使用複合口服避孕藥。最重要的個案衛教為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375249&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 28歲個案因活動性結核接受多藥併用療法，開始rifampin。同時使用複合口服避孕藥。最重要的個案衛教為何?

## 選項

1. 將膠囊磨碎並與食物混合。
2. 若尿液變橘色就停止rifampin。
3. 體液(尿、汗、淚、唾液)會呈橘紅色，為無害現象；軟式隱形眼鏡可能永久染色，建議改戴眼鏡或硬式鏡片；rifampin為強CYP誘導劑，會降低複合口服避孕藥、抗凝劑、抗反轉錄病毒藥、methadone等效果；治療期間及停藥後28天內使用非荷爾蒙備援避孕；完成完整結核療程，出現黃疸或右上腹痛須回報。 **✔ 正確答案**
4. 可以自由飲酒。

**正確答案: 3**

## 解析

Rifampin (Rifadin)為結核多藥併用療法(RIPE: rifampin、isoniazid、pyrazinamide、ethambutol)的核心殺菌藥，亦用於N. meningitidis與H. influenzae接觸者預防。為CYP3A4、CYP2C9、CYP1A2、P-gp等的強效誘導劑，可顯著降低多種藥物血漿濃度。重點衛教：(1) 體液(尿、汗、淚、唾液、母乳)橘紅色變色為預期良性現象，並非黃疸，需先告知個案與家屬以免驚慌；軟式隱形眼鏡可能永久染色，建議改戴眼鏡或硬式鏡片；(2) 降低避孕效果 — 複合口服避孕、貼片、陰道環皆會失效；治療期間及停藥後至少28天使用保險套等非荷爾蒙備援避孕；長期可考慮levonorgestrel IUD或銅IUD；(3) 藥物交互作用 — warfarin(INR下降)、抗反轉錄病毒(特別是HIV protease抑制劑與NNRTI)、tacrolimus與cyclosporine(排斥)、methadone(戒斷)、皮質類固醇、口服降糖藥等 — 由藥師檢視所有居家藥物；(4) 肝毒性 — 黃疸、深色尿、右上腹痛、持續噁心或食慾不振須回報；基線LFT與定期監測；(5) 間歇給藥可能流感樣症候群與血小板減少；(6) 可能時空腹服用以利吸收。因橘色尿停藥、飲酒、磨碎皆為錯誤。

## 深入解析

橘紅體液無害；CYP誘導使OCP與許多藥物濃度降低。停藥後28天備援避孕。橘色淚與隱形眼鏡染色為NCLEX熱門。

## 重要概念

- **rifampin** — 結核RIPE核心殺菌藥，腦膜炎預防，強CYP誘導，體液橘紅，肝毒性，類流感
- **CYP3A4 induction** — 降低基質藥濃度，OCP/warfarin/抗反轉錄病毒/calcineurin/methadone等，停藥後至少28天
- **TB RIPE regimen** — rifampin、isoniazid、pyrazinamide、ethambutol，集中期2個月與維持期4個月

## 相同主題題目

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=zh-tw)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=zh-tw)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=zh-tw)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375249&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375249&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375249&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375249&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375249&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_