# 一位病人最近開始使用美沙拉嗪。請標示出需要立即藥物追蹤的發現。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522581&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位病人最近開始使用美沙拉嗪。請標示出需要立即藥物追蹤的發現。

| 領域 | 發現 |
| --- | --- |
| 胃腸道 | 新發生的嚴重絞痛伴血便增加 |
| 全身性 | 體溫 38.6 C 伴新發頭痛 |
| 皮膚 | 治療開始後出現擴散性紅斑皮疹 |
| 腎臟 | 肌酸酐從 0.8 增加到 1.7 mg/dL |
| 營養 | 病人耐受醫囑早餐 |
| 水合狀態 | 口腔黏膜濕潤 |
| 遵從性 | 藥物清單與處方相符 |
| 可近性 | 病人有預定的追蹤預約 |

## 解析

新發生的嚴重絞痛伴血便、發燒伴頭痛、擴散性皮疹以及肌酸酐升高，可能表示急性不耐受、過敏反應或腎毒性，需要及時評估。

## 深入解析

快速答案
升級處理急性不耐受和腎功能惡化。

為什麼這是正確的
美沙拉嗪的急性不耐受可能類似於潰瘍性結腸炎的急性發作。腎功能在治療前和治療期間會定期評估，若惡化則需要考慮停藥。

簡單類比或心像
使用閉環式藥物安全流程：識別暴露、連結新發現、中斷進一步傷害、支持生理功能，並隨時間驗證反應。

記憶點
暴露、交互作用、毒性模式、立即行動、連續再評估。

NCLEX 決策規則
選擇能降低最直接藥物相關風險，同時保留監測和升級的行動。

為什麼其他選項是錯誤的
繼續暴露、僅治療單一症狀或延遲再評估的選項會使毒性過程持續活躍。References
1DailyMed: Mesalamine Delayed-Release Tablets急性不耐受症候群、腎功能惡化、停藥和定期腎功能監測

## 臨床情境

藥物安全審查
驗證適應症、途徑、交互作用藥物、目前的呼吸道和胃腸道發現、授權行動以及可測量的後續追蹤。

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