# 護理師指導COPD病人使用霧化ipratropium。預防嚴重不良反應最重要的注意事項是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391777&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

護理師指導COPD病人使用霧化ipratropium。預防嚴重不良反應最重要的注意事項是什麼？

## 選項

1. 使用密合的面罩或咬嘴，避免霧氣接觸眼睛 **✔ 正確答案**
2. 每次給藥前喝2公升水
3. 空腹使用藥物
4. 治療時在胸部冰敷

**正確答案: 1**

## 解析

正解 (2): Ipratropium是抗膽鹼藥（SAMA）；氣霧接觸眼睛可能在易感病人造成瞳孔放大與急性閉角型青光眼。密合面罩或咬嘴可避免藥物進入眼睛。(1) 吸入藥與空腹無關。(3,4) 無關。

## 深入解析

Memory Tip Ipratropium = Atrovent，Atro聯想到atropine樣抗膽鹼作用。避免藥霧接觸眼睛，並教導急性眼痛、光暈、紅眼等青光眼症狀。

## 臨床情境

Scenario 67歲男性COPD，使用ipratropium 500 mcg nebulizer QID。有閉角型青光眼病史。門診衛教中。

## 重要概念

- **短效毒蕈鹼受體拮抗劑（SAMA）** — Ipratropium bromide，四級抗膽鹼藥，全身吸收少，用於COPD。
- **閉角型青光眼** — 抗膽鹼暴露可引發急性閉角風險，造成嚴重眼痛與視力喪失。
- **氣霧眼部保護** — 霧化治療時面罩或咬嘴密合可減少眼部藥物暴露。

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