【評論主題】3 依據Young’s rule 計算兒童用藥劑量，若成人之劑量為5 毫克，則一位3 歲兒童應給予幾毫克藥物？(A)1 毫克(B)3 毫克(C)5 毫克(D)7 毫克
【評論內容】Young’s Rule: Dose_Child = .....看完整詳解
【評論主題】57.林小妹6歲，因綠膿桿菌引起之尿道感染，醫師開立口服levofloxacin，藥師建議為何？(A)價格低廉，故建議使用(B)不可使用於兒童(C)用於此情況弊多於利，不建議使用(D)用於此情況利多於
【評論內容】
UpToDate 舊的分類裡面，nosocomial UTI 的確是complicated UTI，而Pseudo 也的確是nosocomial UTI 最常見的致病菌；不過complicated UTI 主要是根據是否上行到腎臟、是否有結構異常、是否有其他易引起complication 的危險因子 (immunosuppresion、DM、pregnancy、nosocomial infection、catheter 等等)，不是直接看致病菌。現在的分類則主要是看症狀。
另外，如果其他選項都是注射治療的話，FDA核准cipro PO 用在小兒UTI，但是levo 沒有。
在這題目沒有描述清楚的情況下，以complicated UTI 來進行治療也是可以的；不過在醫師開口服的情況下，大概是在門診而且醫師評估沒有太嚴重的症狀 (如果都收住院了還開levo PO 我也是醉了)，住院一個禮拜注射...
【評論主題】57.林小妹6歲，因綠膿桿菌引起之尿道感染，醫師開立口服levofloxacin，藥師建議為何？(A)價格低廉，故建議使用(B)不可使用於兒童(C)用於此情況弊多於利，不建議使用(D)用於此情況利多於
【評論內容】
回樓上，uncomplicated UTI 建議口服治療，只有cipro 跟levo 可以抗Pseudo 又可以口服
【評論主題】27 下列何藥用於治療便秘及肝臟疾病引起之腦病變？(A) Castor oil (B) Lactulose (C) Mineral oil (D) Sorbitol
【評論內容】刺激型瀉劑：Castor oil高滲透壓型瀉劑：Lact.....看完整詳解
【評論主題】75.王先生有長期飲酒習慣，對warfarin治療效果影響之敘述，下列何者正確？(A)alcohol會增加warfarin之代謝(B)alcohol會減少warfarin之代謝(C)warfarin會
【評論內容】
Cirrhosis / regularly consume ethanol -> increased clearance of warfarin.
Social consumption of ethanol with food, in patients with normal hepatic function, does not appear to interfere with warfarin therapy
Micromedex DDI: warfarin & ethanol
Udall, 1970; O'Reilly, 1979; O'Reilly, 1981; Kater et al, 1969
【評論主題】75 已知某藥在體內之排除可用 Michaelis-Menten 動力學描述，而其給藥速率 R（mg/hr）與穩定狀態血中濃度 Css（mg/L）間之關係可以下圖方式表示。請問此藥在體內之最大排除速率
【評論內容】當藥物濃度達到穩定狀態時，給藥速率=排除速率
【評論主題】79 已知某藥在體內之排除可用Michaelis-Menten動力學描述，而其給藥速率R(mg/hr)與穩定狀態血中濃度Css(mg/L)間之關係可以下圖表示。請問此藥在體內之最大排除速率Vmax (
【評論內容】當藥物濃度達到穩定狀態時，給藥速率=排除速率
【評論主題】51 對於一室模式的藥物，於靜脈注射後，收集的尿中藥物排泄總量 Du，當以 dDu/dt 對時間 t 作半對數圖，則圖上 y 軸的截距代表下列那一項？(A)最初的藥物排泄量 (B)最初的體內藥量(C)
【評論內容】Excretion Rate Method: log (dD.....看完整詳解
【評論主題】29 違反藥物廣告規定者，除受處罰鍰外，對情節重大者，下列何者處罰錯誤？(A)廢止該藥物許可證(B)原品名二年內不得申請使用(C)移送地檢署偵辦(D)責令業者限期在原傳播媒體同一時段及相同篇幅刊播，聲
【評論內容】藥事法 第 96 條違反規定之藥物廣告，...
【評論主題】65.併用digoxin與erythromycin產生藥品交互作用時，最主要的原因為何？(A)改變腸胃道的pH值(B)增加藥品的代謝(C)競爭藥品受體的結合點(D)改變腸胃道內細菌的含量
【評論內容】
兩個機轉：1. macrolide 抑制p-gp，使digoxin 無法排除而累積
2. macrolide 清除可以代謝digoxin 的細菌，使更多的digoxin 被吸收
Macrolide inhibition of P-glycoprotein (P-gp) mediated transport of cardiac glycosides could theoretically lead to increases in glycoside bioavailability and/or decreases in renal clearance. Several macrolides inhibit P-glycoprotein (P-gp) mediated transport of digoxin and digitoxin to some extent in vitro with telithromycin showing the greatest inhibitory potency, followed by clarithromycin, followed by azithromycin and erythromycin.
A second theory, which has not been the su...
【評論主題】27.Cisplatin注射劑適當的稀釋劑為下列何者？(A)注射用水(B)dextrose 5% in water(C)sodium chloride 0.9%(D)fructose
【評論內容】
cis: D5W in >=0.33% NaCl or NS, 25'C (勿冷藏), 避光, 稀釋後72 hr (w/ mannitol 24 hr), 前後要hydration
carbo: 25'C, 避光, D5W 稀釋後24 hr, NS 稀釋後8 hr
oxali: D5W, <25'C, 稀釋後24 hr
Pretreatment hydration with 1 to 2 L of fluid is recommended prior to cisplatin administration; adequate post hydration and urinary output (>100 mL/hour) should be maintained for 24 hours after administration.
UpToDate Cisplatin: Drug information
【評論主題】68.下列藥品與服藥時間的配對，何者正確？(A)Atorvastatin必須睡前服藥效果較好(B)同劑量lovastatin每天服藥一次比每天服藥兩次降血脂效果較好(C)Rosuvastatin半衰期
【評論內容】
food interaction:
increased abs: lovastatin
decreased abs: pitavastatin, pravastatin
optimal time of administration:
evening: fluvastatin IR, lovastatin IR, simvastatin
UpToDate Properties of statins
【評論主題】66.有關使用niacin（nicotinic acid）治療血脂異常的敘述，下列何者錯誤？(A)適合單一藥物治療，或合併膽酸清除劑，用於治療原發性高膽固醇血症（primary hypercholes
【評論內容】
(A) Niacin 目前只建議用在 TG>500 但常規治療無效或無法耐受常規治療者
(B) Niacin 可能引發新診斷的糖尿病或使既有的糖尿病惡化
(C) Niacin 潮紅的副作用可以aspirin 或NSAID 預防
(D) Niacin + laropiprant 顯著增加糖尿病相關的副作用，其他顯著增加的副作用還有GI、musculoskeletal、skin、infection、bleeding
Niacin is no longer recommended, except in specific clinical situations (eg, high triglyceride levels [>500 mg/dL], if not able to achieve desired response, or intolerance to other therapies) (ACC [Lloyd-Jones 2017]; Boden 2014; Garg 2017; Landray 2014; Wierzbicki 2014).
To attenuate flushing symptoms, m...
【評論主題】25.有關aspirin及clopidogrel的臨床使用時機，下列何者錯誤？(A)心導管手術前應併用一個劑量(B)心導管手術後的病人應終生以低劑量併用(C)心導管手術後裝置金屬支架的病人應至少併用一
【評論內容】
DAPT in CAD 2017 ESC & EACTS
doi:10.1093/eurheartj/ehx419
【評論主題】34.根除Helicobacter pylori 感染之最佳bismuth-based 四合一療法之組合為何？(A)Omeprazole 20 mg 一天一次＋bismuth subsalicylat
【評論內容】
PPI: rabe 20 QD, esome 40 QD / 20 BID, ome 20 BID, lanso 30 BID, panto 40 BID
【評論主題】65.併用digoxin與erythromycin產生藥品交互作用時，最主要的原因為何？(A)改變腸胃道的pH值(B)增加藥品的代謝(C)競爭藥品受體的結合點(D)改變腸胃道內細菌的含量
【評論內容】
兩個機轉：1. macrolide 抑制p-gp，使digoxin 無法排除而累積
2. macrolide 清除可以代謝digoxin 的細菌，使更多的digoxin 被吸收
Macrolide inhibition of P-glycoprotein (P-gp) mediated transport of cardiac glycosides could theoretically lead to increases in glycoside bioavailability and/or decreases in renal clearance. Several macrolides inhibit P-glycoprotein (P-gp) mediated transport of digoxin and digitoxin to some extent in vitro with telithromycin showing the greatest inhibitory potency, followed by clarithromycin, followed by azithromycin and erythromycin.
A second theory, which has not been the su...
【評論主題】27.Cisplatin注射劑適當的稀釋劑為下列何者？(A)注射用水(B)dextrose 5% in water(C)sodium chloride 0.9%(D)fructose
【評論內容】
cis: D5W in >=0.33% NaCl or NS, 25'C (勿冷藏), 避光, 稀釋後72 hr (w/ mannitol 24 hr), 前後要hydration
carbo: 25'C, 避光, D5W 稀釋後24 hr, NS 稀釋後8 hr
oxali: D5W, <25'C, 稀釋後24 hr
Pretreatment hydration with 1 to 2 L of fluid is recommended prior to cisplatin administration; adequate post hydration and urinary output (>100 mL/hour) should be maintained for 24 hours after administration.
UpToDate Cisplatin: Drug information
【評論主題】68.下列藥品與服藥時間的配對，何者正確？(A)Atorvastatin必須睡前服藥效果較好(B)同劑量lovastatin每天服藥一次比每天服藥兩次降血脂效果較好(C)Rosuvastatin半衰期
【評論內容】
food interaction:
increased abs: lovastatin
decreased abs: pitavastatin, pravastatin
optimal time of administration:
evening: fluvastatin IR, lovastatin IR, simvastatin
UpToDate Properties of statins
【評論主題】66.有關使用niacin（nicotinic acid）治療血脂異常的敘述，下列何者錯誤？(A)適合單一藥物治療，或合併膽酸清除劑，用於治療原發性高膽固醇血症（primary hypercholes
【評論內容】
(A) Niacin 目前只建議用在 TG>500 但常規治療無效或無法耐受常規治療者
(B) Niacin 可能引發新診斷的糖尿病或使既有的糖尿病惡化
(C) Niacin 潮紅的副作用可以aspirin 或NSAID 預防
(D) Niacin + laropiprant 顯著增加糖尿病相關的副作用，其他顯著增加的副作用還有GI、musculoskeletal、skin、infection、bleeding
Niacin is no longer recommended, except in specific clinical situations (eg, high triglyceride levels [>500 mg/dL], if not able to achieve desired response, or intolerance to other therapies) (ACC [Lloyd-Jones 2017]; Boden 2014; Garg 2017; Landray 2014; Wierzbicki 2014).
To attenuate flushing symptoms, m...
【評論主題】25.有關aspirin及clopidogrel的臨床使用時機，下列何者錯誤？(A)心導管手術前應併用一個劑量(B)心導管手術後的病人應終生以低劑量併用(C)心導管手術後裝置金屬支架的病人應至少併用一
【評論內容】
DAPT in CAD 2017 ESC & EACTS
doi:10.1093/eurheartj/ehx419
【評論主題】34.根除Helicobacter pylori 感染之最佳bismuth-based 四合一療法之組合為何？(A)Omeprazole 20 mg 一天一次＋bismuth subsalicylat
【評論內容】
PPI: rabe 20 QD, esome 40 QD / 20 BID, ome 20 BID, lanso 30 BID, panto 40 BID
【評論主題】30.下列何者為selective endothelin receptor antagonist，能顯著降低血壓？(A)Clevidipine(B)Darusentan(C)Nebivolol(D)A
【評論內容】
臨床試驗顯示ET antagonist 對HFrEF 沒效，darusentan 就是其中一個失敗的案例
The effect of selective ET-A receptor blockade was evaluated in the EARTH trial, in which 642 patients with HF (79 percent NYHA class III) and an ejection fraction less than or equal to 35 percent were randomly assigned to one of five doses of darusentan or placebo. At 24 weeks, the primary end point (magnetic resonance measured left ventricular end systolic volume) did not change significantly with any dose of darusentan compared to placebo. There were also no significant changes in symptoms, neurohormone concentrations,...
【評論主題】33.王先生67歲，7年前腎臟移植，長期服用cyclosporine。2週前不明原因發燒，使用ceftriaxone及imipenem/cilastatin治療無效。血液培養出Candida trop
【評論內容】
Initial Tx for candidemia in non-neutropenic adult
1. echinocandin
2. fluconazole, if not critically ill and not fluconazole-resistant (glabrata or krusei)
3. amphotericin B lipid formulation
UpToDate Treatment of candidemia and invasive candidiasis in adults
ketoconazole black box warning: Because ketoconazole tablets have been associated with serious adverse effects, ketoconazole tablets are not indicated for the treatment of onychomycosis, cutaneous dermatophyte infections, or Candida infections. Use ketoconazole only when other effective antifungal therapy is not available or tolerated an...
【評論主題】下列何者可與cidofovir併用，【題組】77.做為cidofovir之輔助治療？(A)amitriptyline(B)benztropine mesylate(C)penicillin(D)pro
【評論內容】
probenecid 可以抑制腎小管表皮細胞再吸收cidofovir，進而預防cidofovir 的腎毒性；同時又可以抑制細胞主動分泌cidofovir、減緩排除，進而增加cidofovir 的濃度
The most important toxicity of the drug is renal which can be reduced by coadministration with saline and probenecid; probenecid blocks active renal tubular secretion (see below). Dosing probenecid prior to, two hours after, and eight hours after cidofovir infusion may result in the doubling of serum concentrations. The fact that probenecid protects against nephrotoxicity and yet decreases renal clearance of the drug, may seem paradoxical. However...
【評論主題】66.下列何者最適合用於預防成人cisplatin引起之腎毒性？(A)給與2～3 L normal saline(B)給與aluminum salt(C)furosemide IV q4h till
【評論內容】
特別容易爆腎的病人才需要mannitol
Mannitol is frequently used to induce diuresis, although there is no evidence that this is required. It may be appropriate in select patients, such as those treated with high-dose cisplatin (≥100 mg/m2) and/or those with preexisting hypertension. The addition of furosemide is generally not required, unless there is evidence of fluid overload.
UpToDate Cisplatin nephrotoxicity
【評論主題】36.下列何者符合代謝性鹼中毒的表現？①pH＜7.35 ②pH＞7.45 ③ PaCO2上升 ④HCO3-上升 ⑤ PaCO2下降⑥HCO3-下降(A)②③④(B)②③⑥(C)①④⑤(D)①③⑥
【評論內容】
1. pH 看酸鹼
2. pH 和 PaCO2 / HCO3- 同向或反向，同向代謝、反向呼吸
【評論主題】33.王先生67歲，7年前腎臟移植，長期服用cyclosporine。2週前不明原因發燒，使用ceftriaxone及imipenem/cilastatin治療無效。血液培養出Candida trop
【評論內容】
Initial Tx for candidemia in non-neutropenic adult
1. echinocandin
2. fluconazole, if not critically ill and not fluconazole-resistant (glabrata or krusei)
3. amphotericin B lipid formulation
UpToDate Treatment of candidemia and invasive candidiasis in adults
ketoconazole black box warning: Because ketoconazole tablets have been associated with serious adverse effects, ketoconazole tablets are not indicated for the treatment of onychomycosis, cutaneous dermatophyte infections, or Candida infections. Use ketoconazole only when other effective antifungal therapy is not available or tolerated an...
【評論主題】【題組】76.承上題，藥師應給予什麼用藥指導？(A)先喝一杯牛奶，再吃四環黴素(B)先吃一顆Strocain®，再吃四環黴素(C)可不吃藥，採用補充水分、電解質之支持性療法(D)四環黴素可隨餐服用
【評論內容】
tetra 空腹, doxy 不一定, mino 都可以
tetracycline: Take on an empty stomach 1 hour before or 2 hours after meals to increase total absorption.
doxycycline: Administer Doryx and Doryx MPC without regard to meals. Administer Oracea and doxycycline 20 mg tablet on an empty stomach 1 hour before or 2 hours after meals.
minocycline: Administer without regard to food.
UpToDate Tetracycline: Drug information
UpToDate Doxycycline: Drug information
UpToDate Minocycline: Drug informatio...
【評論主題】下列何者可與cidofovir併用，【題組】77.做為cidofovir之輔助治療？(A)amitriptyline(B)benztropine mesylate(C)penicillin(D)pro
【評論內容】
probenecid 可以抑制腎小管表皮細胞再吸收cidofovir，進而預防cidofovir 的腎毒性；同時又可以抑制細胞主動分泌cidofovir、減緩排除，進而增加cidofovir 的濃度
The most important toxicity of the drug is renal which can be reduced by coadministration with saline and probenecid; probenecid blocks active renal tubular secretion (see below). Dosing probenecid prior to, two hours after, and eight hours after cidofovir infusion may result in the doubling of serum concentrations. The fact that probenecid protects against nephrotoxicity and yet decreases renal clearance of the drug, may seem paradoxical. However...
【評論主題】68.吳小姐入院治療，做過必要的檢驗後，下列那種用藥最適宜？(A)filgrastim SC＋vancomycin PO＋cefepime IV(B)vancomycin PO＋cefepime IV
【評論內容】
Neutropenic fever: bactericidal, broad spectrum, anti-pseudomonas
High risk (ANC <500 *7 d): IV cefepime, meropenem, imipenem/cilastatin, piperacillin/tazobactam
Low risk: PO ciprofloxacin/levofloxacin + amoxicillin/clavulanate (PCN allergy: clindamycin, cefixime)
UpToDate Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complicationsUpToDate Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients...【評論主題】66.下列何者最適合用於預防成人cisplatin引起之腎毒性？(A)給與2～3 L normal saline(B)給與aluminum salt(C)furosemide IV q4h till
【評論內容】
特別容易爆腎的病人才需要mannitol
Mannitol is frequently used to induce diuresis, although there is no evidence that this is required. It may be appropriate in select patients, such as those treated with high-dose cisplatin (≥100 mg/m2) and/or those with preexisting hypertension. The addition of furosemide is generally not required, unless there is evidence of fluid overload.
UpToDate Cisplatin nephrotoxicity
【評論主題】33.High-flux透析膜孔徑較大，可增加毒素的排除，但也可能導致下列何種藥品的移除增加？(A)amiodarone(B)digoxin(C)phenytoin(D)vancomycin
【評論內容】
amiodarone, digoxin, phenytoin 都是high protein-binding，就算high-flux 也洗不出去
【評論主題】36.下列何者符合代謝性鹼中毒的表現？①pH＜7.35 ②pH＞7.45 ③ PaCO2上升 ④HCO3-上升 ⑤ PaCO2下降⑥HCO3-下降(A)②③④(B)②③⑥(C)①④⑤(D)①③⑥
【評論內容】
1. pH 看酸鹼
2. pH 和 PaCO2 / HCO3- 同向或反向，同向代謝、反向呼吸
【評論主題】69.口服避孕藥與抗生素併用時，透過何種機制產生藥品交互作用？(A)改變腸道的菌叢(B)改變尿液的酸鹼值(C)改變腸胃道的酸鹼值(D)改變腸胃道的蠕動速度
【評論內容】
避孕藥被腸道菌叢水解後才能被再吸收並進入腸肝循環
A proposed (yet otherwise unproven) mechanism for this potential interaction is based on the antibiotic's ability to reduce gut bacteria which are important for hydrolysis of conjugated estrogen, which subsequently permits the reabsorption of the estrogen (ie, enterohepatic circulation is interrupted, resulting in lower serum concentrations of the estrogen).
UpToDate Lexicomp Estrogen Derivatives (Contraceptive) / Penicillins
【評論主題】【題組】78.承上題，該藥品須降低劑量的原因為下列何種酵素被抑制？(A) CYP3A4(B) monoamine oxidase(C) xanthine oxidase(D) aldehyde deh
【評論內容】
AZA代謝途徑包括XO，與allopurinol 並用會增加AZA 濃度
the metabolism of mercaptopurine (MP), or its prodrug azathioprine (AZA), occurs via 3 primary pathways: oxidation to inactive thiouric acid catalyzed by xanthine oxidase (XO); methylation to inactive methyl-mercaptopurine catalyzed by thiopurine S-methyl transferase (TPMT); and activation to thioguanine nucleotides in a process initiated by hypoxanthine-guanine phosphoribosyl transferase.
Inhibition of XO by allopurinol may increase systemic MP exposure and toxicity, particularly via inhibition of its presystemic metabolism.
US prescribing in...
【評論主題】【題組】80.欲避免或治療前題之狀況，下列處置何者不適當？(A) sodium bicarbonate tablet 300 mg/tab 3 tablets tid PO(B) normal sal
【評論內容】
NS就有效，bicarb 反而還容易讓 CaP 亂沉澱
The role of urinary alkalinization with either acetazolamide and/or sodium bicarbonate is unclear and controversial. In the past, alkalinization to a urine pH of 6.5 to 7 or even higher was recommended to increase uric acid solubility, thereby diminishing the likelihood of uric acid precipitation in the tubules. However, this approach has fallen out of favor for the following reasons:
●There are no data demonstrating the efficacy of this approach. In addition, the only available experimental study suggested that hydration with saline alone is as effectiv...
【評論主題】18.有關脂肪乳劑使用的敘述，下列何者錯誤？(A)使用時應監測血中總膽固醇的值(B)每公克脂肪可提供9大卡熱量(C)可作為主要熱量來源之一(D)可以預防必需脂肪酸的缺乏
【評論內容】
high TG - pancreatitis
【評論主題】51.下列藥品中，建議應隨餐服用之組合何項最完整？①alendronate tab ②itraconazole cap③nateglinide tab ④orlistat cap(A)僅①②③(B)僅
【評論內容】
nateglinide 120 mg 3 times daily before meals?
UpToDate Nateglinide
【評論主題】43.年齡大於75歲的老年人對降血壓藥品的反應，下列何組之藥品較佳？(A)thiazides和CCBs(B)CCBs和ACEIs(C)ACEIs和β-blockers(D)β-blockers和thi
【評論內容】
老人高血壓：CCB (LA-DHP), thiazide, ACEI/ARB
Among older hypertensive patients who require antihypertensive medication and who do not have an indication for a specific drug, we recommend initial monotherapy with a low-dose thiazide-type diuretic, a long-acting calcium channel blocker, or an angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (Grade 1B). A long-acting dihydropyridine or a thiazide diuretic is generally preferred because of increased blood pressure-lowering efficacy in this population. Among older adult patients in whom there is a reasonable like...
【評論主題】3 依據Young’s rule 計算兒童用藥劑量，若成人之劑量為5 毫克，則一位3 歲兒童應給予幾毫克藥物？(A)1 毫克(B)3 毫克(C)5 毫克(D)7 毫克
【評論內容】Young’s Rule: Dose_Child = Dose_Adult * Age / (Age+12)
【評論主題】57.林小妹6歲，因綠膿桿菌引起之尿道感染，醫師開立口服levofloxacin，藥師建議為何？(A)價格低廉，故建議使用(B)不可使用於兒童(C)用於此情況弊多於利，不建議使用(D)用於此情況利多於
【評論內容】
UpToDate 舊的分類裡面，nosocomial UTI 的確是complicated UTI，而Pseudo 也的確是nosocomial UTI 最常見的致病菌；不過complicated UTI 主要是根據是否上行到腎臟、是否有結構異常、是否有其他易引起complication 的危險因子 (immunosuppresion、DM、pregnancy、nosocomial infection、catheter 等等)，不是直接看致病菌。現在的分類則主要是看症狀。
另外，如果其他選項都是注射治療的話，FDA核准cipro PO 用在小兒UTI，但是levo 沒有。
在這題目沒有描述清楚的情況下，以complicated UTI 來進行治療也是可以的；不過在醫師開口服的情況下，大概是在門診而且醫師評估沒有太嚴重的症狀 (如果都收住院了還開levo PO 我也是醉了)，住院一個禮拜注射...
【評論主題】57.林小妹6歲，因綠膿桿菌引起之尿道感染，醫師開立口服levofloxacin，藥師建議為何？(A)價格低廉，故建議使用(B)不可使用於兒童(C)用於此情況弊多於利，不建議使用(D)用於此情況利多於
【評論內容】
回樓上，uncomplicated UTI 建議口服治療，只有cipro 跟levo 可以抗Pseudo 又可以口服
【評論主題】8.有關感染症與療程的配對，下列何者正確？(A)急性骨髓炎（acute osteomyelitis）：4~6週(B)術後感染預防性抗生素（surgical prophylaxis）：3~7天(C)急性
【評論內容】
surgical px <24 hr
UpToDate Antimicrobial prophylaxis for prevention of surgical site infection in adults
APN 5-14 d
UpToDate Acute complicated urinary tract infection (including pyelonephritis) in adults
【評論主題】27 下列何藥用於治療便秘及肝臟疾病引起之腦病變？(A) Castor oil (B) Lactulose (C) Mineral oil (D) Sorbitol
【評論內容】刺激型瀉劑：Castor oil高滲透壓型瀉劑：Lactulose、Sorbitol軟便劑：Mineral oil
【評論主題】75.王先生有長期飲酒習慣，對warfarin治療效果影響之敘述，下列何者正確？(A)alcohol會增加warfarin之代謝(B)alcohol會減少warfarin之代謝(C)warfarin會
【評論內容】
Cirrhosis / regularly consume ethanol - increased clearance of warfarin.
Social consumption of ethanol with food, in patients with normal hepatic function, does not appear to interfere with warfarin therapy
Micromedex DDI: warfarin & ethanol
Udall, 1970; O'Reilly, 1979; O'Reilly, 1981; Kater et al, 1969
【評論主題】75 已知某藥在體內之排除可用 Michaelis-Menten 動力學描述，而其給藥速率 R（mg/hr）與穩定狀態血中濃度 Css（mg/L）間之關係可以下圖方式表示。請問此藥在體內之最大排除速率
【評論內容】當藥物濃度達到穩定狀態時，給藥速率=排除速率
【評論主題】79 已知某藥在體內之排除可用Michaelis-Menten動力學描述，而其給藥速率R(mg/hr)與穩定狀態血中濃度Css(mg/L)間之關係可以下圖表示。請問此藥在體內之最大排除速率Vmax (
【評論內容】當藥物濃度達到穩定狀態時，給藥速率=排除速率
【評論主題】74 下列有關吸入劑型產品之敘述，何者最為正確？(A)具良好的生體可用率 (B)吸收速率快(C)首渡效應（first-pass effect）大 (D)全身性毒性大
【評論內容】吸入劑優點：吸收快、Onset快、首度效應小、只作用在肺臟可減少全身性副作用
【評論主題】51 對於一室模式的藥物，於靜脈注射後，收集的尿中藥物排泄總量 Du，當以 dDu/dt 對時間 t 作半對數圖，則圖上 y 軸的截距代表下列那一項？(A)最初的藥物排泄量 (B)最初的體內藥量(C)
【評論內容】Excretion Rate Method: log (dDu/dt) = -kt/2.303 + log (KR*D0)
【評論主題】25.下列何者可作為助懸劑（suspending agent）及親水性稠化劑（hydrophilic thickener）？(A)Benzalkonium chloride(B)Methylparab
【評論內容】Tween (Polysorbate) 80 是親水性乳化劑
【評論主題】22 某化合物（MW=240）之溶液，其濃度為 120 μg/mL，此溶液置於內徑 1cm cell 中，測得其吸光度為0.24，則其吸光率 a（absorptivity）為多少？(A) 4.8×10
【評論內容】
a = A / (L*c)
吸光率 absorptivity, a
吸光度 absorbance, A
光徑 L (cm)
濃度 c (g/L)
A = ε* L * C
吸光度 absorbance, A
克分子吸光度ε
光徑 L (cm)
濃度 C (mole/L)
【評論主題】65.併用digoxin與erythromycin產生藥品交互作用時，最主要的原因為何？(A)改變腸胃道的pH值(B)增加藥品的代謝(C)競爭藥品受體的結合點(D)改變腸胃道內細菌的含量
【評論內容】
兩個機轉：1. macrolide 抑制p-gp，使digoxin 無法排除而累積
2. macrolide 清除可以代謝digoxin 的細菌，使更多的digoxin 被吸收
Macrolide inhibition of P-glycoprotein (P-gp) mediated transport of cardiac glycosides could theoretically lead to increases in glycoside bioavailability and/or decreases in renal clearance. Several macrolides inhibit P-glycoprotein (P-gp) mediated transport of digoxin and digitoxin to some extent in vitro with telithromycin showing the greatest inhibitory potency, followed by clarithromycin, followed by azithromycin and erythromycin.
A second theory, which has not been the su...
【評論主題】27.Cisplatin注射劑適當的稀釋劑為下列何者？(A)注射用水(B)dextrose 5% in water(C)sodium chloride 0.9%(D)fructose
【評論內容】
cis: D5W in =0.33% NaCl or NS, 25'C (勿冷藏), 避光, 稀釋後72 hr (w/ mannitol 24 hr), 前後要hydration
carbo: 25'C, 避光, D5W 稀釋後24 hr, NS 稀釋後8 hr
oxali: D5W, <25'C, 稀釋後24 hr
Pretreatment hydration with 1 to 2 L of fluid is recommended prior to cisplatin administration; adequate post hydration and urinary output (100 mL/hour) should be maintained for 24 hours after administration.
UpToDate Cisplatin: Drug information
【評論主題】68.下列藥品與服藥時間的配對，何者正確？(A)Atorvastatin必須睡前服藥效果較好(B)同劑量lovastatin每天服藥一次比每天服藥兩次降血脂效果較好(C)Rosuvastatin半衰期
【評論內容】
food interaction:
increased abs: lovastatin
decreased abs: pitavastatin, pravastatin
optimal time of administration:
evening: fluvastatin IR, lovastatin IR, simvastatin
UpToDate Properties of statins
【評論主題】66.有關使用niacin（nicotinic acid）治療血脂異常的敘述，下列何者錯誤？(A)適合單一藥物治療，或合併膽酸清除劑，用於治療原發性高膽固醇血症（primary hypercholes
【評論內容】
(A) Niacin 目前只建議用在 TG500 但常規治療無效或無法耐受常規治療者
(B) Niacin 可能引發新診斷的糖尿病或使既有的糖尿病惡化
(C) Niacin 潮紅的副作用可以aspirin 或NSAID 預防
(D) Niacin + laropiprant 顯著增加糖尿病相關的副作用，其他顯著增加的副作用還有GI、musculoskeletal、skin、infection、bleeding
Niacin is no longer recommended, except in specific clinical situations (eg, high triglyceride levels [500 mg/dL], if not able to achieve desired response, or intolerance to other therapies) (ACC [Lloyd-Jones 2017]; Boden 2014; Garg 2017; Landray 2014; Wierzbicki 2014).
To attenuate flushing symptoms, m...
【評論主題】34.根除Helicobacter pylori 感染之最佳bismuth-based 四合一療法之組合為何？(A)Omeprazole 20 mg 一天一次＋bismuth subsalicylat
【評論內容】
PPI: rabe 20 QD, esome 40 QD / 20 BID, ome 20 BID, lanso 30 BID, panto 40 BID
【評論主題】30.下列何者為selective endothelin receptor antagonist，能顯著降低血壓？(A)Clevidipine(B)Darusentan(C)Nebivolol(D)A
【評論內容】
臨床試驗顯示ET antagonist 對HFrEF 沒效，darusentan 就是其中一個失敗的案例
The effect of selective ET-A receptor blockade was evaluated in the EARTH trial, in which 642 patients with HF (79 percent NYHA class III) and an ejection fraction less than or equal to 35 percent were randomly assigned to one of five doses of darusentan or placebo. At 24 weeks, the primary end point (magnetic resonance measured left ventricular end systolic volume) did not change significantly with any dose of darusentan compared to placebo. There were also no significant changes in symptoms, neurohormone concentrations,...
【評論主題】25.有關aspirin及clopidogrel的臨床使用時機，下列何者錯誤？(A)心導管手術前應併用一個劑量(B)心導管手術後的病人應終生以低劑量併用(C)心導管手術後裝置金屬支架的病人應至少併用一
【評論內容】
DAPT in CAD 2017 ESC & EACTS
doi:10.1093/eurheartj/ehx419