— 降低風險 · HARD · MCQ —
護理師準備對一位有癲癇病史的病人給藥。若病人出現突發性的意識混亂，護理師應最擔憂下列哪項藥物的影響？
A nurse is preparing to administer medications to a client with a history of seizures. Which medication should the nurse be most concerned about if the client experiences sudden confusion?
- AGabapentin加巴噴丁 (Gabapentin)
- BLevetiracetam左乙拉西坦 (Levetiracetam)
- CPhenytoin✓ 正解苯妥英 (Phenytoin)
- DValproate丙戊酸鹽 (Valproate)
— Explanation · 中文詳解 —
苯妥英鈉（Phenytoin）的治療濃度窗窄，極易發生中毒。其神經毒性常見表徵包含意識混亂、眼球震顫、共濟失調及語言不清。其他選項雖然也可能引起副作用，但 Phenytoin 的中毒風險與臨床病徵在癲癇病人中具高度警示意義。
Phenytoin has a narrow therapeutic window and is highly prone to toxicity. Common manifestations of its neurotoxicity include confusion, nystagmus, ataxia, and slurred speech. Although the other options may also cause adverse effects, the risk of phenytoin toxicity and the associated clinical signs are particularly important warning signs in patients with epilepsy.
✦ 台美臨床差異
美國醫院藥局常會自動監測 Phenytoin 血中濃度並通知護理團隊；台灣則多由醫師或藥師評估濃度後調整。