# 52歲男性,因重度憂鬱症已口服venlafaxine 75 mg每日兩次共6週,4週前增量為150 mg每日兩次。目前主訴持續頭痛與耳鳴。今日血壓為156/96 mmHg(基準124/78)。護理師應採取的行動為何? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375257&lang=zh-tw > language: zh-TW > subject: Medical Emergencies > category: PA ## 題目 52歲男性,因重度憂鬱症已口服venlafaxine 75 mg每日兩次共6週,4週前增量為150 mg每日兩次。目前主訴持續頭痛與耳鳴。今日血壓為156/96 mmHg(基準124/78)。護理師應採取的行動為何? ## 選項 1. 將劑量相關的血壓上升通報處方醫師,持續監測BP並檢視其他升壓藥物使用。 **✔ 正確答案** 2. 將 venlafaxine 劑量增加至 225 mg 每日兩次，監測情緒改善情況，並告知個案頭痛和耳鳴是常見的副作用。 3. 指示個案立即停用 venlafaxine，並安排一週後回診重新評估症狀。 4. 指示個案減少咖啡因和飲食中的鈉攝取，每週在家監測血壓，並在三個月後回診。 **正確答案: 1** ## 解析 Venlafaxine因正腎上腺素作用會造成劑量依賴性血壓上升,特別在150 mg/日以上明顯。頭痛、耳鳴與相對基準的測得BP上升是實際藥物作用,並非單純生活型態。應立即通報處方醫師檢視劑量、BP監測頻率與其他升壓暴露(NSAID、感冒鼻塞藥、興奮劑)。增量會使高血壓惡化、延後就診忽略副作用、自行停藥則會引發嚴重SNRI戒斷(暈眩、電擊樣感覺、流感樣症狀)。 ## 深入解析 SNRI需有基準BP並於每次調整劑量時重測 — venlafaxine升壓風險最大,duloxetine較輕但仍需監測。 ## 臨床情境 情境 52歲男性,MDD,6週前開始venlafaxine,目前150 mg每日兩次已4週。每日頭痛、耳鳴。BP 156/96 mmHg、HR 88規律;基準BP 124/78。無發燒或胸痛。家中用藥:venlafaxine 150 mg BID、atorvastatin 20 mg、綜合維他命。無使用NSAID、感冒鼻塞藥或興奮劑。 ## 重要概念 - **SNRI** — 血清素—正腎上腺素再吸收抑制劑 — venlafaxine、desvenlafaxine、duloxetine、levomilnacipran。用於憂鬱、焦慮、神經痛、纖維肌痛。共有副作用:噁心、BP上升(venlafaxine最明顯)、出汗、性功能障礙。 - **SNRI戒斷症候群** — 尤以半衰期短的venlafaxine突然停藥後24〜48小時出現暈眩、眩暈、電擊樣感、流感樣、焦慮與腸胃症狀。需2〜4週以上漸減,嚴重者可能需fluoxetine橋接。 - **Venlafaxine BP監測** — 基準BP與每次加量後再測,特別於150 mg/日以上。持續上升時應減量、改用duloxetine或加上降壓治療。 ## 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=375257&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375257&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375257&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375257&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375257&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。_