# 一名長期使用茶鹼的個案，因泌尿道感染新開立ciprofloxacin。護理師的優先處置為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391784&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名長期使用茶鹼的個案，因泌尿道感染新開立ciprofloxacin。護理師的優先處置為何？

## 選項

1. 將ciprofloxacin與制酸劑一起服用以改善吸收
2. 依醫囑同時給予兩種藥物
3. 通知開立者 — ciprofloxacin是強效CYP1A2抑制劑，會增加茶鹼濃度；需要替代抗生素或調整茶鹼劑量 **✔ 正確答案**
4. 永久停止茶鹼

**正確答案: 3**

## 解析

正確 (2)：Ciprofloxacin是強效CYP1A2抑制劑，會使茶鹼濃度升至毒性範圍，造成癲癇與心律不整。需改用非quinolone或不抑制1A2的抗生素，或降低茶鹼劑量並密切監測濃度。(1) 危險。(3) 制酸劑會降低ciprofloxacin吸收。(4) 無適應症不可永久停用茶鹼。

## 深入解析

記憶提示 茶鹼 + ciprofloxacin = 濃度上升。其他1A2抑制劑包括erythromycin、fluvoxamine、口服避孕藥（較輕微）。加入交互作用藥物時一定要重新確認濃度。

## 臨床情境

情境 60歲女性，因氣喘穩定使用茶鹼200 mg BID。急診醫師因UTI開立ciprofloxacin 500 mg PO BID，共7天。

## 重要概念

- **CYP1A2抑制劑** — 會減慢CYP1A2代謝的藥物，如ciprofloxacin、erythromycin、fluvoxamine。
- **茶鹼藥物交互作用** — CYP1A2抑制劑會使濃度上升，誘導劑會使濃度下降；改變後5-7天檢測濃度。
- **抗生素替代選擇** — 若交互作用風險高於效益，應選替代藥；UTI可考慮nitrofurantoin或cephalexin。

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