# 一位患有慢性腎臟病礦物質和骨骼疾病的透析客戶，預定接受地舒單抗 (denosumab) 治療，並報告出現新的口周刺痛和肌肉痙攣。哪項措施是最好的？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522078&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位患有慢性腎臟病礦物質和骨骼疾病的透析客戶，預定接受地舒單抗 (denosumab) 治療，並報告出現新的口周刺痛和肌肉痙攣。哪項措施是最好的？

## 選項

1. 立即給予地舒單抗，並將下次鈣質檢查安排在常規年度訪視時。
2. 繼續進行，因為定期透析可預防臨床上重要的治療相關低血鈣症。
3. 暫停地舒單抗，並與授權團隊緊急評估鈣質和慢性腎臟病礦物質骨骼計畫。 **✔ 正確答案**
4. 請客戶在透析後自行額外服用一劑地舒單抗。

**正確答案: 3**

## 解析

晚期慢性腎臟病和慢性腎臟病礦物質骨骼疾病會增加地舒單抗相關嚴重低血鈣症的風險；症狀需要在給藥前緊急評估。

## 深入解析

快速解答
將症狀視為晚期慢性腎臟病中可能發生的嚴重低血鈣症進行處理。

為什麼這是正確的
FDA 增加了黑框警語，因為地舒單抗可能導致晚期慢性腎臟病患者出現嚴重、有時甚至危及生命的低血鈣症，特別是伴有慢性腎臟病礦物質骨骼疾病者。

簡單類比或心像
將藥物安全想像成一個控制面板：識別危險信號，改變正確的控制，並驗證反應。

記憶點
線索、行動、反應、重新評估。

NCLEX 決策規則
選擇能預防最直接藥物相關危害的行動，同時保留持續的適應症。

為什麼其他選項是錯誤的
延遲升級、忽略禁忌症或未經授權改變治療的選項，並未關閉安全循環。References
1FDA Drug Safety Communication: Prolia and Advanced CKDBoxed warning for severe hypocalcemia, CKD-mineral bone disorder assessment, supplementation, and monitoring

## 臨床情境

藥物安全審查
驗證適應症、當前評估、實驗室趨勢、時機、交互作用、授權行動和可測量的後續追蹤。

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