# 一名Parkinson病人服用levodopa-carbidopa 5年，表示藥效「沒有以前持久」，且下一次服藥前1-2小時會出現嚴重僵硬。護理師最佳解釋是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名Parkinson病人服用levodopa-carbidopa 5年，表示藥效「沒有以前持久」，且下一次服藥前1-2小時會出現嚴重僵硬。護理師最佳解釋是什麼？

## 選項

1. 這是長期levodopa治療常見的wearing-off現象，可能需要縮短給藥間隔或加入COMT抑制劑 **✔ 正確答案**
2. 藥物已達最大效益，應改用非藥物治療
3. 這表示疾病已治癒，可以停藥
4. 僵硬回來時應立即服用雙倍劑量

**正確答案: 1**

## 解析

正解 (2): Wearing-off現象是下一次預定劑量前1-2小時Parkinson症狀可預測地回來。原因是疾病進展與多年後藥效時間縮短。處置包括縮短給藥間隔、緩釋levodopa、加入COMT抑制劑（entacapone）、MAO-B抑制劑或dopamine agonist。(1) 不是治癒。(3) 雙倍劑量可造成dyskinesia。(4) 藥物調整仍有幫助。

## 深入解析

Memory Tip Levodopa長期併發症 = wearing-off（可預測） vs on-off fluctuations（不可預測） vs dyskinesias（不自主動作）。CPG 避免在服藥附近吃高蛋白餐，因胺基酸會競爭levodopa吸收。

## 臨床情境

Scenario 68歲男性Parkinson病人，使用levodopa-carbidopa 25/100 mg PO QID 5年。回報兩次給藥間出現「wearing off」，最後1-2小時有bradykinesia與僵硬。

## 重要概念

- **Wearing-off現象** — Parkinson症狀在劑量末端可預測地回來；可用縮短間隔或加入COMT/MAO-B抑制劑處理。
- **On-off波動** — 活動與不能活動之間不可預測的突然轉換；屬後期levodopa併發症。
- **COMT抑制劑** — Entacapone、tolcapone，可阻斷周邊levodopa代謝，延長作用時間。

## 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=391754&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&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。_