一位25歲的男性在家中沙發上被家屬發現失去反應，身旁散落數個已被清空的處方強效鴉片類止痛藥 (Oxycodone) 藥瓶，隨後被緊急送往急診。護理師進行快速評估，發現個案陷入重度昏迷、發紺發紫，並展現出明顯的針孔狀瞳孔。他的呼吸速率勉強只剩每分鐘 4 次，且血氧 SpO2 正直線下降至 82%。護理師必須緊急準備哪一種特定的藥理學解毒劑，以立刻逆轉這個致命狀態？
A 25-year-old male is rushed to the emergency department by his family after being found unresponsive on the couch next to several empty bottles of prescribed Oxycodone (a heavy opioid analgesic). The nurse conducts a rapid assessment and finds the client deeply comatose, cyanotic, and exhibiting distinct pinpoint pupils. His respiratory rate is barely 4 breaths per minute, and his SpO2 is plummeting to 82%. Which specific pharmacological antidote must the nurse urgently prepare to immediately reverse this lethal state?
- ANaloxone (Narcan)✓ 正解納洛酮 (Narcan)
- BProtamine Sulfate硫酸魚精蛋白
- CFlumazenil (Romazicon)氟馬西尼 (Romazicon)
- DEpinephrine (Adrenalin)腎上腺素 (Adrenalin)
本題測驗藥物過量（Overdose）的經典急救解毒劑（Antidotes）。病患服用過量的 Oxycodone，這是一種中樞神經抑制極強的『鴉片類藥物（Opioids）』。鴉片類中毒具有不可錯認的致命三合一徵象：「嚴重昏迷（Coma）、針孔狀瞳孔（Pinpoint pupils）、以及最致命的呼吸抑制（Respiratory depression，本例掉至 4下/分）」。若不立刻逆轉，病患將於幾分鐘內死於缺氧與窒息。要解開鎖在大腦上的鴉片受體，唯一且高度專一性的救命解毒劑是「Naloxone (Narcan)」（選項A正確）。它通常經由靜脈注射或鼻內噴霧給予，能在幾秒到幾分鐘內戲劇性地喚醒病患並恢復呼吸驅動力。選項C的 Flumazenil 是用來解救「苯二氮平類藥物（Benzodiazepines 型安眠鎮靜藥物如 Valium/Xanax）」中毒的。選項B的 Protamine Sulfate 是用來解救「肝素（Heparin）抗凝血劑」過量導致大出血的。選項D的 Epinephrine（腎上腺素）是用在嚴重心血管休克或致命的「全身性過敏性休克（Anaphylaxis）」上的急救藥物。
This item tests the classic emergency antidote for drug overdose. The client has taken an overdose of Oxycodone, a potent opioid with profound central nervous system depressant effects. Opioid toxicity produces an unmistakable lethal triad: severe coma, pinpoint pupils, and—most lethal—respiratory depression (here dropping to 4 breaths/min). Without immediate reversal, the client will die within minutes from hypoxia and asphyxiation. The only highly specific, life-saving antidote that can release opioids from cerebral receptors is Naloxone (Narcan) (option A is correct). It is typically administered intravenously or as an intranasal spray and can dramatically arouse the client and restore the respiratory drive within seconds to minutes. Option C, Flumazenil, is used to reverse benzodiazepine overdose (sedative-hypnotics such as Valium/Xanax). Option B, Protamine sulfate, is used to reverse major bleeding from Heparin (an anticoagulant) overdose. Option D, Epinephrine (Adrenalin), is an emergency drug used for severe cardiovascular shock or fatal anaphylaxis.
「Opioid v.s Naloxone (Narcan)」是從急救員到重症病房醫師人人都必須直覺反射的第一級救命專利。連一般美國街頭警察身上都配有 Narcan 鼻噴劑，這是世界公用的常識。