— 藥理與非經腸給藥 · HARD · SATA —
病人接受 Vancomycin 治療，哪些評估發現應警覺毒性反應？（選所有適合的）
Which assessment findings should alert the nurse to potential toxicity in a client receiving Vancomycin? (Select all that apply.)
- ATinnitus or hearing loss✓ 正解耳鳴或聽力喪失
- BIncreased serum creatinine levels✓ 正解血清肌酸酐值升高
- CDevelopment of a facial rash (Red Man Syndrome)出現面部皮疹（紅人症）
- DDecreased urine output✓ 正解尿量減少
- EIncreased white blood cell count白血球計數增加
— Explanation · 中文詳解 —
Vancomycin 具有耳毒性（耳鳴、聽力喪失）與腎毒性（肌酸酐上升、尿量減少）。Red Man Syndrome（C）雖與藥物有關，但屬於輸注速度過快引起的過敏樣反應，並非藥物累積代謝後的毒性累積。WBC 上升通常表示感染尚未控制，而非藥物毒性。
Ototoxicity, manifested as tinnitus or hearing loss, and nephrotoicity, indicated by increased serum creatinine and decreased urine output, are major dose-related toxicities of vancomycin. Red Man Syndrome is an infusion-related reaction caused by rapid administration rather than systemic toxicity. An increased white blood cell count typically reflects uncontrolled infection rather than drug toxicity.
✦ 台美臨床差異
美國醫院藥師會進行嚴格的 TDM（治療藥物監測）；台灣醫學中心亦執行，但護理師對 Vancomycin trough level 的追蹤更為嚴謹。