# 一位病人正在接受伊立替康治療。請根據其支持的藥物安全決策，對每個發現進行分類。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522583&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位病人正在接受伊立替康治療。請根據其支持的藥物安全決策，對每個發現進行分類。

|  | 早期膽鹼能模式 | 晚期腹瀉模式 | 緊急併發症升級處理 |
| --- | --- | --- | --- |
| 輸注期間開始出現腹部絞痛和腹瀉 |  |  |  |
| 輸注反應伴有出汗和流淚 |  |  |  |
| 治療後 36 小時開始出現大量水樣腹瀉 |  |  |  |
| 晚期腹瀉伴有姿勢性低血壓 |  |  |  |
| 體溫 38.5 C 伴嚴重嗜中性白血球低下和腹瀉 |  |  |  |
| 腹脹伴腸蠕動音消失 |  |  |  |

## 解析

輸注期間伴有出汗、絞痛和流淚的腹瀉是早期膽鹼能模式；超過 24 小時後開始的腹瀉是晚期毒性；脫水、發燒、腸阻塞或嗜中性白血球低下需要緊急升級處理。

## 深入解析

快速答案
區分早期膽鹼能症狀、晚期腹瀉和高風險併發症。

為什麼這是正確的
早期症狀可能對授權的阿托品有反應，而晚期腹瀉則需要及時的止瀉治療、體液和電解質支持，以及針對發燒、腸阻塞或嚴重嗜中性白血球低下的升級處理。

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: Irinotecan Hydrochloride Injection早期膽鹼能腹瀉、晚期可能危及生命的腹瀉、阿托品、洛哌丁胺、體液和升級處理

## 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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