# 一位病人最近開始服用lamotrigine，同時也在服用valproate，現在出現擴散性皮疹、發燒和口腔潰瘍疼痛。哪項措施最好？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522096&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位病人最近開始服用lamotrigine，同時也在服用valproate，現在出現擴散性皮疹、發燒和口腔潰瘍疼痛。哪項措施最好？

## 選項

1. 塗抹保濕劑並服用下一劑藥物，因為早期皮疹總是良性的。
2. 暫停lamotrigine並尋求緊急評估，以處理嚴重的皮膚反應。 **✔ 正確答案**
3. 在報告皮疹之前，將lamotrigine劑量加倍以預防戒斷性癲癇發作。
4. 等待下次例行訪視，除非皮疹變得發癢。

**正確答案: 2**

## 解析

新出現的皮疹伴隨發燒和黏膜受累，可能代表危及生命的lamotrigine反應，且與valproate併用會增加額外風險。

## 深入解析

快速解答
將皮疹加上全身性症狀視為嚴重的lamotrigine緊急情況。

為什麼這是正確的
藥品黑框警語指示，除非皮疹明顯與藥物無關，否則在出現皮疹的第一個跡象時應停藥，因為良性和危及生命的皮疹無法可靠地預測。

簡單類比或心像
將藥物安全視為呼吸道檢傷分類：識別威脅、中斷暴露、支持生理功能，並確認持久的反應。

記憶點
線索、風險、行動、反應、復發檢查。

NCLEX決策規則
選擇能預防最即時藥物相關危害的措施，同時保留重新評估和升級的空間。

為什麼其他選項是錯誤的
將惡化正常化、增加相互作用藥物或延遲救援的選項，會使安全循環中斷。References
1DailyMed: LAMICTAL (lamotrigine)Boxed warning for serious skin rash, risk with valproate and rapid escalation, and immediate discontinuation unless clearly unrelated

## 臨床情境

藥物安全審查
核實適應症、當前評估、呼吸和神經系統狀態、藥物相互作用、授權的救援措施以及可測量的後續追蹤。

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