一位病人安排接受需使用靜脈含碘顯影劑的檢查。護理師應預期在檢查後的 48 小時內暫停使用哪種藥物？
A client is scheduled for a procedure involving intravenous iodinated contrast media. Which medication should the nurse expect to withhold for 48 hours after the procedure?
- AMetformin✓ 正解Metformin（二甲雙胍）
- BAmlodipineAmlodipine（氨氯地平）
- CAtorvastatinAtorvastatin（阿托伐他汀）
- DFurosemideFurosemide（呋塞米）
Metformin（雙胍類降血糖藥）與含碘顯影劑之間存在嚴重的交互作用風險。含碘顯影劑具有潛在的腎毒性，可能導致急性腎功能損傷（AKI）。如果病人在腎功能受損的情況下繼續服用 Metformin，該藥物會在體內蓄積，進而引發致命的「乳酸中毒」（Lactic acidosis）。因此，標準護理程序要求在接受顯影劑檢查前 24-48 小時暫停 Metformin，並在檢查後至少持續暫停 48 小時，直到確認腎功能（肌酸酐）恢復正常後方可重新開始服用。D、C、B 選項雖然也可能與腎灌流或藥物代謝有關，但皆不會像 Metformin 那樣引發高死亡率的乳酸中毒。這題測驗護理師對「預防藥物併發症」的關鍵知識。
There is a serious interaction between metformin (a biguanide oral hypoglycemic) and iodinated contrast media. Iodinated contrast carries the potential for nephrotoxicity and can cause acute kidney injury (AKI). If the client continues taking metformin while renal function is impaired, the drug accumulates in the body and may precipitate fatal lactic acidosis. Standard nursing practice therefore requires holding metformin 24 to 48 hours before contrast administration and continuing to hold it for at least 48 hours after the procedure, until renal function (creatinine) is confirmed to have returned to baseline. Options D, C, and B, although they may be related to renal perfusion or drug metabolism, do not carry the same high-mortality risk of lactic acidosis. This question tests the nurse's key knowledge of preventing medication-related complications.
美國醫學界與放射科醫學會對於 Metformin 停藥時機有明確的實證指引（Guidelines）。台灣多數大型醫院也有類似流程，但有時在門診檢查中，護理師的衛教內容可能偏重於「多喝水」，對於 Metformin 具體的停藥天數及原因有時解釋不夠詳盡。