# 一名因雙相情緒障礙開始lamotrigine的病人，在第18天來電表示胸部與手臂出現新的廣泛斑丘疹，並有輕微口腔黏膜疼痛。護理師的優先行動是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391747&lang=zh-tw  
> language: zh-TW  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## 題目

一名因雙相情緒障礙開始lamotrigine的病人，在第18天來電表示胸部與手臂出現新的廣泛斑丘疹，並有輕微口腔黏膜疼痛。護理師的優先行動是什麼？

## 選項

1. 服用diphenhydramine並48小時後再評估
2. 告知輕微皮疹很常見，請她繼續服藥
3. 指示她立即停止lamotrigine並前往急診，因為使用lamotrigine時任何皮疹都需緊急評估Stevens-Johnson症候群 **✔ 正確答案**
4. 塗抹hydrocortisone乳膏並繼續治療

**正確答案: 3**

## 解析

正解 (2): Lamotrigine有SJS/TEN黑框警告；風險在前8週最高，快速加量或合併valproate時更高。使用lamotrigine期間任何皮疹都應先視為SJS直到排除，需停藥並緊急評估。黏膜侵犯尤其危險。(1,3,4) 延誤可能進展為高死亡率TEN。

## 深入解析

記憶提示 Lamotrigine = “Lamo-Slow”，必須慢速加量。Rash + Lamotrigine = STOP + ED。CPG 慢速加量可降低但不能消除SJS風險。

## 臨床情境

情境 35歲女性，因雙相I型障礙按標準慢速加量使用lamotrigine第18天。現出現胸部與手臂新的廣泛皮疹，並有口腔疼痛。

## 重要概念

- **Lamotrigine加量** — 為降低SJS風險而需以數週緩慢增加劑量；快速加量禁忌。
- **Stevens-Johnson症候群** — 伴隨表皮剝離的嚴重黏膜皮膚反應；可進展為高死亡率TEN。
- **藥物誘發皮疹** — 使用lamotrigine時任何皮疹都需立即停藥並急診評估。

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