# 一名CKD第5期個案因高磷血症服用sevelamer。哪一項給藥指導最重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391825&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名CKD第5期個案因高磷血症服用sevelamer。哪一項給藥指導最重要？

## 選項

1. 每餐隨餐服用以結合飲食中的磷；其他藥物至少在sevelamer前1小時或後3小時服用 **✔ 正確答案**
2. 只有出現症狀時才服用
3. 飯後2小時服用
4. 空腹服用

**正確答案: 1**

## 解析

正確（2）：Sevelamer會結合飲食中的磷，必須隨餐服用才有效。其他藥物，特別是ciprofloxacin、levothyroxine、mycophenolate、tacrolimus，需間隔至少前1小時或後3小時。常見便祕、消化不良。（1、3）降低效果。（4）應按時服用。

## 深入解析

記憶提示 磷結合劑要隨餐。Sevelamer是不含鈣的選擇；calcium acetate便宜但增加鈣負荷，lanthanum與ferric citrate也是替代選項。

## 臨床情境

情境 58歲男性CKD第5期，使用sevelamer 800 mg PO TID。門診衛教。

## 重要概念

- **Sevelamer 磷結合劑** — 用於CKD高磷血症的不含鈣磷結合劑；需與交互作用藥物錯開。
- **高磷血症** — CKD第4-5期常見，屬骨礦物質代謝異常。
- **磷結合劑** — 包括sevelamer、calcium acetate/carbonate、lanthanum、ferric citrate、sucroferric oxyhydroxide。

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