# 一名72歲慢性腎臟病病人（eGFR 28 mL/min）因帶狀疱疹後神經痛被開立gabapentin 300 mg口服每日三次。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=391752&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名72歲慢性腎臟病病人（eGFR 28 mL/min）因帶狀疱疹後神經痛被開立gabapentin 300 mg口服每日三次。護理師的優先行動是什麼？

## 選項

1. 暫停給藥並聯絡醫師討論腎功能劑量調整，因gabapentin經腎排除且會在CKD中蓄積 **✔ 正確答案**
2. 依醫囑給藥
3. 將劑量增加到600 mg TID以提高止痛效果
4. 將膠囊壓碎並與蘋果泥混合

**正確答案: 1**

## 解析

正解 (2): Gabapentin為腎臟排除；eGFR 15-29時應減量，例如每日200-700 mg分次給予。未調整會蓄積並造成鎮靜、共濟失調、跌倒與呼吸抑制，對高齡者尤其危險。(1) 標準劑量有毒性風險。(3) 增量會加重傷害。(4) 改變給藥方式無法解決根本問題。

## 深入解析

Memory Tip Gabapentin/Pregabalin = 需要依腎功能減量。開始與每次調整劑量時都要看eGFR。Caution 與opioid或其他CNS抑制藥併用時呼吸抑制風險增加。

## 臨床情境

Scenario 72歲男性，帶狀疱疹後神經痛。CKD第4期（eGFR 28 mL/min）。醫師開立gabapentin 300 mg PO TID。

## 重要概念

- **腎功能劑量調整** — 依eGFR或肌酸酐清除率降低藥物劑量；CKD使用gabapentin時需要。
- **Gabapentinoid鎮靜** — Gabapentin/pregabalin造成的劑量相關CNS抑制；CKD蓄積時更明顯。
- **帶狀疱疹後神經痛** — 帶狀疱疹後的慢性神經病理性疼痛；gabapentin與pregabalin為第一線藥物。

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