# 一名因慢性氣喘使用zafirlukast的病人表示新出現疲倦、右上腹痛、深色尿與灰白色糞便。優先護理行動是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391781&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名因慢性氣喘使用zafirlukast的病人表示新出現疲倦、右上腹痛、深色尿與灰白色糞便。優先護理行動是什麼？

## 選項

1. 加用cholestyramine binder緩解症狀
2. 安撫病人這些是氣喘常見症狀
3. 暫停zafirlukast並通知處方者；症狀提示肝毒性，需要緊急LFT評估 **✔ 正確答案**
4. 增加zafirlukast劑量以改善控制

**正確答案: 3**

## 解析

正解 (2): Zafirlukast與zileuton有肝毒性警告。疲倦、RUQ痛、黃疸、深色尿、灰白色糞便強烈提示膽汁鬱積性肝損傷。需暫停藥物、通知處方者並緊急檢查LFT（AST/ALT/bilirubin）。(1) 不是氣喘症狀。(3) 加量會惡化肝損傷。(4) 未診斷前使用cholestyramine不適當。

## 深入解析

Memory Tip Zafirlukast/zileuton = 注意LFT。建議基線與定期LFT。Montelukast肝毒性較低，但有神經精神警告。

## 臨床情境

Scenario 45歲女性，因慢性氣喘使用zafirlukast 20 mg PO BID 3個月。現在疲倦、RUQ痛、深色尿、灰白色糞便、鞏膜黃染。

## 重要概念

- **扎魯司特** — Leukotriene receptor antagonist；慢性氣喘第二線用藥，有肝毒性風險。
- **肝毒性徵象** — 疲倦、RUQ痛、黃疸、深色尿、灰白色糞便、AST/ALT上升。
- **LFT監測** — Zafirlukast與zileuton建議基線與定期AST/ALT/bilirubin監測。

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