# 一名女性接受aprepitant作為cisplatin化療止吐預防，且使用複合口服避孕藥。哪一項衛教最正確？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391810&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名女性接受aprepitant作為cisplatin化療止吐預防，且使用複合口服避孕藥。哪一項衛教最正確？

## 選項

1. 每天完全同一時間服用兩種藥
2. 預期沒有交互作用；只需繼續OC
3. 永久停用OC
4. Aprepitant短期抑制CYP3A4，但也會透過酵素誘導降低OC效果；治療期間與之後1個月使用非荷爾蒙或備用方法 **✔ 正確答案**

**正確答案: 4**

## 解析

正確 (2)：Aprepitant會依劑量調節CYP3A4，短期輕度抑制，隨時間也會誘導，因此會降低荷爾蒙避孕效果。治療期間及治療後1個月需使用非荷爾蒙或備用避孕方式。(1) 確有交互作用。(3) 不需永久停用。(4) 同時間服用無法解決代謝問題。

## 深入解析

記憶提示 NK1拮抗劑（aprepitant、fosaprepitant、rolapitant）使用時，不要完全信賴口服避孕藥。育齡女性都要衛教備用避孕。

## 臨床情境

情境 34歲女性，使用aprepitant預防cisplatin引起的噁心。正在使用複合口服避孕藥。討論交互作用。

## 重要概念

- **NK1受體拮抗劑** — Aprepitant、fosaprepitant、rolapitant；抑制substance P以治療化療誘發噁心。
- **CYP3A4調節** — Aprepitant急性期抑制，長期則誘導；會降低口服避孕藥效果。
- **三藥止吐療法** — 高致吐性化療使用NK1 + 5-HT3 + dexamethasone。

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