# 一名服用 cinacalcet 的透析病人，其校正鈣值為 7.3 mg/dL，出現手部痙攣和 QT 間期延長。哪項措施最佳？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522081&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一名服用 cinacalcet 的透析病人，其校正鈣值為 7.3 mg/dL，出現手部痙攣和 QT 間期延長。哪項措施最佳？

## 選項

1. 隨餐給予 cinacalcet，並在下次每月透析評估時重複檢測鈣值。
2. 暫停 cinacalcet，並緊急取得低血鈣治療和持續心律監測醫囑。 **✔ 正確答案**
3. 給予 cinacalcet，同時減少鈣攝取以預防次發性副甲狀腺功能亢進。
4. 等待下次排定的實驗室檢查，因為 QT 變化不會改變用藥計畫。

**正確答案: 2**

## 解析

有症狀的低血鈣（低於 7.5 mg/dL）伴隨 QT 間期延長，需要暫停 cinacalcet 並緊急治療和監測。

## 深入解析

快速解答
預防低血鈣相關心律不整和手足搐慉。

為何這是正確的
Cinacalcet 會降低鈣質；藥品說明書描述了手足搐慉、癲癇、QT 間期延長和心室性心律不整，並指示在嚴重或持續性有症狀的低血鈣情況下應暫停使用。

簡單類比或心像
將藥物安全視為一個控制面板：識別危險信號，調整正確的控制，並驗證反應。

記憶點
線索、行動、反應、再評估。

NCLEX 決策規則
選擇能預防最即時藥物相關危害的措施，同時保留持續的適應症。

為何其他選項是錯誤的
延遲升級、忽略禁忌症或未經授權更改治療的選項，都無法完成安全循環。參考資料
1DailyMed: Cinacalcet低血鈣、QT 間期延長、心室性心律不整、症狀和暫停用藥閾值

## 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、授權行動和可衡量的後續追蹤。

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