# 一位 eGFR 22 毫升/分/1.73 平方公尺的病人服用秋水仙素，並於 3 天前開始服用克拉黴素。病人現在出現嚴重腹瀉、全身無力和深色尿液。哪項措施是優先事項？ > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=zh-tw > language: zh-TW > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## 題目 一位 eGFR 22 毫升/分/1.73 平方公尺的病人服用秋水仙素，並於 3 天前開始服用克拉黴素。病人現在出現嚴重腹瀉、全身無力和深色尿液。哪項措施是優先事項？ History Vitals Labs Orders Notes 第 4 期慢性腎臟病和痛風；每日服用秋水仙素 (데이터 없음) (데이터 없음) (데이터 없음) (데이터 없음) 1 隨餐給予下一劑秋水仙素。 ✕ 2 暫停秋水仙素和克拉黴素，啟動秋水仙素毒性的緊急評估，並取得腎臟、血球計數、肌肉、肝臟和心律評估。 ✕ 3 使用非處方止瀉藥治療腹瀉，並於下週再評估。 ✕ 4 增加秋水仙素劑量，因為深色尿液表示痛風治療不足。 ✕ ## 解析 腎功能不全加上強效 CYP3A4 和 P-gp 抑制劑可能導致致命的秋水仙素累積。早期胃腸道症狀可能先於神經肌肉、骨髓、肝臟、腎臟和心血管衰竭。 ## 深入解析 快速解答 將腎功能不全病人使用秋水仙素加上克拉黴素視為潛在致命的交互作用，並升級處理。 為何這是正確的 此交互作用在腎功能或肝功能不全病人中是禁忌，因為秋水仙素暴露量可能急劇升高，且沒有解毒劑能使持續給藥安全。 簡單類比或心像 建立藥物安全鏈：識別新的線索，將其與藥物作用機制或標示限制連結，停止可預防的暴露，穩定病人，並驗證可測量的反應。 記憶點 藥物、緊急線索、保護性措施和再評估終點。 NCLEX 決策規則 選擇能預防最即刻藥物相關危害的措施，同時保留指示治療和所需監測。 為何其他選項是錯誤的 繼續可疑暴露、將標示的危險線索正常化、替代未經授權的劑量或延遲升級的選項會使病人處於危險之中。References 1DailyMed: Colchicine TabletsFatal interactions with P-gp or strong CYP3A4 inhibitors in renal impairment and recognition of multisystem toxicity ## 臨床情境 藥物安全審查 確認適應症、當前評估、劑量和途徑、器官功能、交互作用、緊急毒性線索、授權行動和可測量的後續追蹤。 ## 相同主題題目 - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=zh-tw) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw) - [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw) - [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=zh-tw) - [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=zh-tw) - [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_