# 一位護理師教導一位剛開始服用 cinacalcet 以治療慢性腎臟病（CKD）引起的次發性副甲狀腺功能亢進的個案。哪一項監測指導是必要的？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391830&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位護理師教導一位剛開始服用 cinacalcet 以治療慢性腎臟病（CKD）引起的次發性副甲狀腺功能亢進的個案。哪一項監測指導是必要的？

## 選項

1. 不需要監測
2. 定期檢查血鈣；低血鈣是cinacalcet常見不良反應，症狀包括口周麻、肌肉痙攣與癲癇發作 **✔ 正確答案**
3. 只需每日體重
4. 只需每日血壓

**正確答案: 2**

## 解析

正確（2）：Cinacalcet 會活化副甲狀腺的鈣感應受體→降低副甲狀腺素（PTH）並降低血清鈣。需常規監測血鈣；若血鈣＜8.4 mg/dL 或出現症狀則暫停給藥。教導個案回報口周麻木、肌肉痙攣、抽搐（低血鈣症狀）。（1、3、4）不充分。

## 深入解析

記憶提示 Cinacalcet是calcimimetic，模仿鈣來抑制PTH，因此血清Ca會下降。定期追蹤Ca、P、PTH。

## 臨床情境

情境 60歲男性CKD透析中，因PTH升高開始cinacalcet 30 mg PO daily。

## 重要概念

- **Cinacalcet 鈣擬似劑** — 用於次發性副甲狀腺機能亢進的calcimimetic；IV替代藥為etelcalcetide。
- **cinacalcet造成的低血鈣** — 常見不良反應；需監測Ca並教導症狀。
- **CKD-MBD 治療** — 包含維生素D類似物、calcimimetic、磷結合劑與副甲狀腺切除。

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