# 一位心肌梗塞後心射出分率降低型心臟衰竭 (HFrEF) 的病人有新的依普利酮 (eplerenone) 處方。血鉀為 5.8 mEq/L，肌酸酐清除率為 28 mL/min。護理師應採取何種行動？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522063&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位心肌梗塞後心射出分率降低型心臟衰竭 (HFrEF) 的病人有新的依普利酮 (eplerenone) 處方。血鉀為 5.8 mEq/L，肌酸酐清除率為 28 mL/min。護理師應採取何種行動？

## 選項

1. 首次劑量與鉀補充劑一起給予
2. 給予一半劑量並在 1 個月後重新檢查
3. 暫停給藥並立即釐清處方 **✔ 正確答案**
4. 給予藥物，因為依普利酮會降低血鉀

**正確答案: 3**

## 解析

當血鉀超過 5.5 mEq/L 或肌酸酐清除率為 30 mL/min 或更低時，依普利酮在起始階段是禁忌的。

## 深入解析

快速解答
暫停給藥並釐清，因為同時存在高血鉀和腎功能不全的禁忌症。

為何此選項正確
依普利酮阻斷礦物皮質素作用並可能升高血鉀。目前的藥物標示要求進行基準血鉀和腎功能評估，並將這些數值列為禁忌症。

簡單類比或心像
此藥物關閉了鉀的排出途徑；在首次給藥前，高血鉀和低清除率會使情況變得不安全。

記憶點
依普利酮起始：血鉀 5.5 或更低，肌酸酐清除率 (CrCl) 高於 30。

NCLEX 決策規則
在考慮心臟衰竭的益處之前，請檢查明確的禁忌症閾值。

為何其他選項錯誤
劑量減少或延遲監測並不能凌駕於兩項起始禁忌症之上，且鉀補充劑會加劇風險。References
1DailyMed: Eplerenone鉀和腎臟禁忌症、監測以及心肌梗塞後心射出分率降低型心臟衰竭 (HFrEF) 治療

## 臨床情境

礦物皮質素拮抗劑檢查
確認血鉀、肌酸酐清除率、ACE 抑制劑或 ARB 使用情況、非類固醇消炎止痛藥 (NSAIDs)、補充劑、CYP3A 抑制劑、血壓和監測日期。

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