# 一名使用levodopa-carbidopa的病人正在接受新發重度憂鬱評估。開始治療前，藥物對照清單中哪一項最需要與醫師討論？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391756&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名使用levodopa-carbidopa的病人正在接受新發重度憂鬱評估。開始治療前，藥物對照清單中哪一項最需要與醫師討論？

## 選項

1. Sertraline（SSRI）
2. 依廠商建議劑量使用Bupropion
3. Mirtazapine（米氮平）
4. Phenelzine（非選擇性MAOI） **✔ 正確答案**

**正確答案: 4**

## 解析

正解 (2): 非選擇性MAOI（phenelzine、tranylcypromine、isocarboxazid）與levodopa禁忌；它們會阻斷周邊dopamine與norepinephrine分解，造成嚴重高血壓危象。前後需14天washout。(1) SSRI需監測但非絕對禁忌。(3) Mirtazapine通常安全。(4) Bupropion需謹慎但非絕對禁忌。

## 深入解析

Memory Tip Levodopa + 非選擇性MAOI = 高血壓危象。Selegiline與rasagiline（選擇性MAO-B）在治療劑量為PD輔助藥；從非選擇性MAOI轉換時，使用levodopa前需14天washout。

## 臨床情境

Scenario 70歲男性Parkinson病人，正在使用levodopa-carbidopa，因新發重度憂鬱接受評估，正在考慮新藥。

## 重要概念

- **非選擇性MAOI** — Phenelzine、tranylcypromine會同時阻斷MAO-A與MAO-B，與levodopa禁忌。
- **高血壓危象** — 單胺類累積造成的嚴重血壓上升，可能致命。
- **MAOI washout** — 使用非選擇性MAOI前後必須保留14天無藥間隔。

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