【評論主題】65.有關levothyroxine用於治療甲狀腺功能低下的劑量,下列敘述何者正確? (A)一般成人建議劑量為1.6~1.7 μg\\/kg\\/day (B)孕婦所需劑量較一般建議劑量調降30~5

【評論內容】各選項解題 + 10th koda & kimble p.1112 & TABLE 52-4(B)、(C)、(D)應改成(B)孕婦所需劑量較一般建議劑量調30~50%(C)老年人的劑量要降低!50mcg/day (半顆開始),有CHD病史者,initial dose更應該是從25mcg/day (四分之一顆)開始。大概每三到六個星期緩慢增加劑量,一次劑量可增加25mcg/day(四分之一顆)(D)3~6 months嬰兒建議劑量為10-15  μg/kg/day(A)The signs and symptoms of hypothyroidism can be easily corrected in most patients by the administration of l-thyroxine on an empty stomach at an oral replacement dosage of 1.6 to 1.7 mcg/kg/day(B)Most women with hypothyroidism who are taking oral thyroid hormones before pregnancy, similarto S.C., will require an increase in their dosage by about 30% to 50% throughout their pregnancy

【評論主題】55.下列何者鎮靜效果最少? (A)chlorpromazine (B)haloperidol (C)olanzapine (D)quetiapine

【評論內容】10th koda & kimble applied  table 82-7 & 考點統整表格Relative Incidence of Antipsychotic Drug Adverse Effects各選項鎮靜程度選項鎮靜程度(A) chlorpromazine++++(B) haloperidol+(C) olanzapine+++(D) quetiapine+++【考點統整表格】(from pharmabook 王瑞賢藥治統整本 11.0)

【評論主題】65.有關levothyroxine用於治療甲狀腺功能低下的劑量,下列敘述何者正確? (A)一般成人建議劑量為1.6~1.7 μg\\/kg\\/day (B)孕婦所需劑量較一般建議劑量調降30~5

【評論內容】各選項解題 + 10th koda & kimble p.1112 & TABLE 52-4(B)、(C)、(D)應改成(B)孕婦所需劑量較一般建議劑量調30~50%(C)老年人的劑量要降低!50mcg/day (半顆開始),有CHD病史者,initial dose更應該是從25mcg/day (四分之一顆)開始。大概每三到六個星期緩慢增加劑量,一次劑量可增加25mcg/day(四分之一顆)(D)3~6 months嬰兒建議劑量為10-15  μg/kg/day(A)The signs and symptoms of hypothyroidism can be easily corrected in most patients by the administration of l-thyroxine on an empty stomach at an oral replacement dosage of 1.6 to 1.7 mcg/kg/day(B)Most women with hypothyroidism who are taking oral thyroid hormones before pregnancy, similarto S.C., will require an increase in their dosage by about 30% to 50% throughout their pregnancy

【評論主題】55.下列何者鎮靜效果最少? (A)chlorpromazine (B)haloperidol (C)olanzapine (D)quetiapine

【評論內容】10th koda & kimble applied  table 82-7 & 考點統整表格Relative Incidence of Antipsychotic Drug Adverse Effects各選項鎮靜程度選項鎮靜程度(A) chlorpromazine++++(B) haloperidol+(C) olanzapine+++(D) quetiapine+++【考點統整表格】(from pharmabook 王瑞賢藥治統整本 11.0)

【評論主題】65.有關levothyroxine用於治療甲狀腺功能低下的劑量,下列敘述何者正確? (A)一般成人建議劑量為1.6~1.7 μg\\/kg\\/day (B)孕婦所需劑量較一般建議劑量調降30~5

【評論內容】各選項解題 + 10th koda & kimble p.1112 & TABLE 52-4(B)、(C)、(D)應改成(B)孕婦所需劑量較一般建議劑量調30~50%(C)老年人的劑量要降低!50mcg/day (半顆開始),有CHD病史者,initial dose更應該是從25mcg/day (四分之一顆)開始。大概每三到六個星期緩慢增加劑量,一次劑量可增加25mcg/day(四分之一顆)(D)3~6 months嬰兒建議劑量為10-15  μg/kg/day(A)The signs and symptoms of hypothyroidism can be easily corrected in most patients by the administration of l-thyroxine on an empty stomach at an oral replacement dosage of 1.6 to 1.7 mcg/kg/day(B)Most women with hypothyroidism who are taking oral thyroid hormones before pregnancy, similarto S.C., will require an increase in their dosage by about 30% to 50% throughout their pregnancy

【評論主題】55.下列何者鎮靜效果最少? (A)chlorpromazine (B)haloperidol (C)olanzapine (D)quetiapine

【評論內容】10th koda & kimble applied  table 82-7 & 考點統整表格Relative Incidence of Antipsychotic Drug Adverse Effects各選項鎮靜程度選項鎮靜程度(A) chlorpromazine++++(B) haloperidol+(C) olanzapine+++(D) quetiapine+++【考點統整表格】(from pharmabook 王瑞賢藥治統整本 11.0)

【評論主題】65.有關levothyroxine用於治療甲狀腺功能低下的劑量,下列敘述何者正確? (A)一般成人建議劑量為1.6~1.7 μg\\/kg\\/day (B)孕婦所需劑量較一般建議劑量調降30~5

【評論內容】各選項解題 + 10th koda & kimble p.1112 & TABLE 52-4(B)、(C)、(D)應改成(B)孕婦所需劑量較一般建議劑量調30~50%(C)老年人的劑量要降低!50mcg/day (半顆開始),有CHD病史者,initial dose更應該是從25mcg/day (四分之一顆)開始。大概每三到六個星期緩慢增加劑量,一次劑量可增加25mcg/day(四分之一顆)(D)3~6 months嬰兒建議劑量為10-15  μg/kg/day(A)The signs and symptoms of hypothyroidism can be easily corrected in most patients by the administration of l-thyroxine on an empty stomach at an oral replacement dosage of 1.6 to 1.7 mcg/kg/day(B)Most women with hypothyroidism who are taking oral thyroid hormones before pregnancy, similarto S.C., will require an increase in their dosage by about 30% to 50% throughout their pregnancy

【評論主題】55.下列何者鎮靜效果最少? (A)chlorpromazine (B)haloperidol (C)olanzapine (D)quetiapine

【評論內容】10th koda & kimble applied  table 82-7 & 考點統整表格Relative Incidence of Antipsychotic Drug Adverse Effects各選項鎮靜程度選項鎮靜程度(A) chlorpromazine++++(B) haloperidol+(C) olanzapine+++(D) quetiapine+++【考點統整表格】(from pharmabook 王瑞賢藥治統整本 11.0)

【評論主題】76.下列何者是 artemisinin 抑制寄生蟲生長之最重要基團? (A)nitro group (B)quinone ring (C)arsenic group (D)trioxane rin

【評論內容】統整Artemisinin考點75 下列何者為抗瘧藥 artemisinin 主要的構造特徵?

【評論主題】70.下列有關臨床上使用 omeprazole 的敘述,何者最正確? (A)結構不具有手性中心(chiral chiral center)

【評論內容】補充1112類似題(A)選項應改成Omeprazole 仍具有chiral center (在S)These sulfoxides have a chiral sulfur atom, and recent work has been reported on the effects of stereochemistry on pharmacologic and dispositional characteristics. (B)Esomeprazole是omeprazole  單一(S)-form 立體異構物【1112】 The marketed single enantiomer, esomeprazole, provides greater bioavailability in CYP2C19 extensive metabolizers and less interindividualEsomeprazole, the S-(−)-enantiomer of omeprazole, has been marketed.(D)Omeprazole為由R-form、S-form 依照1:1組成的消旋混合物(racemic mixture)而Omeprazole經CYP2C19的催化,...

【評論主題】68.下列何者為 hydrocortisone 之結構骨架? (A)exemestane (B)cholestane (C)estrane (D)pregnane

【評論內容】8th FOEY hyd☆☆☆☆☆☆☆☆☆☆☆21★...

【評論主題】61.血管張力素(angiotensin)轉換酶切割基質之位置(如下圖)為何?(A)A (B)B (C)C (D)D

【評論內容】要注意renin 與 ACE酵素切的地方不同!!

【評論主題】60.下列那個選項中的粗體部分,是 eptifibatide 活性展現的重要結構? (A)(B)(C)(D)

【評論內容】Eptifibatide的 活性★★ ★★☆☆☆-...

【評論主題】59.下列何者為 digoxin 結構中 C-17 位的取代基? (A)(B)(C) (D)

【評論內容】補充Digoxin vs dig☆☆☆☆☆☆ ☆☆☆☆ ...

【評論主題】48.下列血清胺(serotonin)受體作用藥物,何者不具 indole 結構? (A)rizatriptan (B)zolmitriptan (C)granisetron (D)sumatrip

【評論內容】5-HT1 ago☆☆☆☆ (☆☆☆☆☆☆☆☆) +5-...

【評論主題】55.將氯原子取代在下圖化合物結構的何者位置,可產生最佳之抗焦慮活性?(A)1 (B)2 (C)3 (D)4

【評論內容】BZD SAR考點統整+補充類似國考題★1...

【評論主題】49.下列有關 barbiturate 類鎮靜安眠藥的敘述,何者錯誤? (A)親脂性越大,作用時限(duration of action)越長 (B)親脂性越大,作用起始(onset)時間越快 (C

【評論內容】Barbiturate 考點統整表格(A)選項應該要改成作用時間較「短」因為脂溶性高,更容易被氧化代謝脂溶性、親和力↑、活性↑、onset 易被氧化代謝,作用時間較

【評論主題】47.下列有關 thiazide 利尿劑基本結構(如下圖)之描述,何者錯誤? (A)第 6 位取代基通常為拉電子基團 (B)如第 7 位導入 sulfonamide 基團,其基團之酸性為此結構最強者

【評論內容】8th Foey + SAR 考點統整(B)選項要改成2號N上的H才是酸性最強的基團,因為靠近強拉電子基sulfone甚至比C7導入Sulfonamide更酸The hydrogen atom at the 2-N is the most acidic because of the electron-withdrawing effects of the neighboring sulfone groupThe sulfonamide group that is substituted at C-7 provides an additional point of acidity in the molecule but is less acidic than the 2-N proton(A)第 6 位取代基通常為拉電子基團(CF3、Cl),也是利尿活性的必要基團,若被H或推電子基(CH3/OCH3)取代,則利尿活性下降An electron-withdrawing group is necessary at position 6 for diuretic activity. Little diuretic activity...

【評論主題】43.R-tetrazole 可視為下列何者之生物類性體(bioisostere)? (A)R-NH2 (B)R-SH (C)R-CHO (D)R-COOH

【評論內容】

1.首先由Langmuir提出化★★★★★★...

【評論主題】36.有關鎮靜-安眠(sedative-hypnotic)藥物的敘述,下列何者錯誤? (A)使用越高劑量的藥物時,其眼球快動型睡眠(rapid eye movement)的期間越長 (B)對於有長期

【評論內容】14th basic 鎮靜安眠單元,4選項解析 (A)選項應該要改成「縮短」快動型睡眠(rapid eye movement)的期間 BZD對睡眠周期的影響: 1.改變睡眠周期【1042/1062】2.增加第二期淺睡期3.縮短入睡時間4.抑制熟睡期5.縮短【1131】快速動眼期→快入眠、睡得久(拉長淺睡縮短熟睡期)→品質差  (B)GABA的神經傳導受阻,常常是造成tolerance的原因有證據表明,長期接觸酒精會下調 GABAA 的反應,進而導致耐受性 It is important to recognize that partial cross-tolerance occurs between the sedativehypnotics described here and also with ethanol GABA neurotransmission is believed to play a significant role in toleranc...

【評論主題】37.下列有關全身麻醉劑的敘述,何者錯誤? (A)脂溶性越高的麻醉劑,其產生麻醉作用所需要的濃度越低 (B)麻醉劑的效價(potency)與最低肺泡麻醉濃度(minimum alveolar ane

【評論內容】【誘導速率考點統整表格+96年後國考題彙整】(C) λ(blood/gas)↑,血中溶解度大→越不易分配到肺泡→On set慢→誘導慢→恢復慢(恢復期長)71 使用下列那一種全身性麻醉劑所需要的誘導期間最短,且其恢復也最快?(A) Sevoflurane(B) Methoxyflurane(C) Halothane(D) Isoflurane專技 - 藥理學與藥物化學 -96年 - 96-2 專技高考_藥師:藥理學#10041 答案:A統計:A(268), B(47), C(68), D(38), E(0) #418257難度:簡單36 下列全身麻醉劑中,何者之誘導期間最短,且其恢復作用也最快?(A) methoxyflurane(B) halothane(C) isoflurane(D) sevoflurane專技 - 藥理學與藥物化學 -98年 - 98-1...

【評論主題】34.關於 phenytoin 的敘述,下列何者正確? (A)具有抗癲癇的效用,也可產生抗心律不整作用 (B)主要用於治療失神性癲癇(absence seizures) (C)carbamazepi

【評論內容】補充不同類型癲癇治療

類型

特色

治療藥

單純性局部性癲癇 (Simple Partial)

不影響意識

Carbamazepine【1091】Phenytoin

Valproic acid

複雜性局部性癲癇 (Complex Partial)

全身性發作(Generalized)☆意識喪失

僵直性-陣攣性

[大發作](Tonic-clonic)

最常見、最戲劇化、失去意識+全身抽搐

Carbamazepine【1091】 Phenytoin【1131】、 Valproic acid

失神性       

 [小發作]

(Absence)

T-type Ca2+異常、spike-wave

Ethosuximide【1112】、 

Clonazepam

Lamotrigine★ 

Valproic acid【1112】

癲癇重積症/持續性癲癇 (Status epilepticus)

連續發作>30分鐘

Diazepam【1122】、 Lorazepam、 M...

【評論主題】30.肉毒桿菌毒素(botulinum toxin)除了可用於消除皺紋外,尚有許多其他的臨床用途,下列何者不是肉毒桿 菌毒素的臨床適應症? (A)膀胱過動(overactive bladder)引

【評論內容】補充肉毒桿菌國考題33.下列關於肉毒桿菌毒素(botulinum toxin)的敘述,何者錯誤?(A) 是一種蛋白質水解酵素(B) 局部注射可以治療腦性麻痺(cerebral palsy),急性偏頭痛(acute migraine)(C) 可以治療膀胱過度活性之尿失禁(incontinence due to overactive bladder)(D) 可能的副作用為肌肉無力、疼痛專技 - 藥理學與藥物化學 -110年 - 110-2 專技高考_藥師(一):藥理學與藥物化學#100430 答案:B統計:A(597), B(1214), C(524), D(183), E(0) #2756057難度:適中23.下列藥物中,何者可抑制副交感神經元進行胞吐作用(exocytosis),減少乙醯膽鹼(acetylcholine)之釋出?(A) cocaine(B) botulinum toxi...

【評論主題】16.關於心衰竭治療劑之藥理特性,下列何者正確? (A)強心配醣體(cardiac glycosides)能直接增加心臟收縮力,主要經由肝臟代謝,原型藥物不會經由尿液排 出 (B)bipyridi

【評論內容】14th basic 國考指定原文書 +levosimendan 原文書重點統整(C)選項應該要改成Levosimendan藉由增加細胞內鈣離子與心肌的troponin C結合之敏感度而導致心臟收縮"強"心藥物: Levosimendan (Inotropic Agent: Levosimendan).. - NEJS【Levosimendan】原文書重點整理:Levosimendan is a  recent example of a drug that increases calcium sensitivity (it may  also inhibit phosphodiesterase) and reduces symptoms in models of heart failureLevosimendan, a drug that sensitizes the troponin system to calcium, also appears to inhibit phosphodiesterase and to cause some  vasodilation in addition to its inotropic effects. Som...

【評論主題】70.關於topical corticosteroid之效價(potency),下列敘述何者錯誤? (A)主成分及劑型相同時,濃度越高效價就越高 (B)基劑添加propylene glycol可提升

【評論內容】10th applied p.934 各選項解析 + 補充考過國考題(C)選項應該要改成主成分及濃度相同時,gel and ointment的效價高於 creams and lotionsWhen equal amounts of a corticosteroid are incorporated into ointments, gels, creams, and lotion bases, the gel and ointment preparations are generallymore active than creams and lotions(A) 主成分及劑型相同時,濃度越高效價就越高(B) 基劑添加propylene glycol或petrolatum 可提升效價Activity of corticosteroids may be enhanced by the use of a more occlusive vehicle, the addition ofpenetration-enhancing substances (i.e., petrolatum, propylene glycol)(D)主成分結構含fluorine的製劑(加F到C9),可預防類固醇的環被代謝,效價比結構不含fluorine者高The addition of a fluorine atom at the 9 position protects the steroid ring from metabolic conversion, resulting in more potent activity. 64 下列何種類固醇藥膏最適合嬰幼兒使用?

【評論主題】52.併用下列何種藥品時,可能引起lithium濃度上升? (A)ibuprofen (B)acetazolamide (C)theophylline (D)caffeine

【評論內容】此題是有考過的考古題!調劑學1012的類似考題補充11th applied 常考表格與lithium 交互作用 考點統整併用ibuprofen與lithium產生交互作用,主要是因抑制腎臟的排除71.併用ibuprofen與lithium產生交互作用時,最主要的原因為何?

【評論主題】60.下列何者最適合作為降血脂起始治療藥品? (A)atorvastatin 40 mg (B)ezetimibe 10 mg (C)fenofibrate 160 mg (D)fluvastati

【評論內容】三步驟解題思路 + 補充 2013 ACC/AHA cholesterol guideline解題思路【步驟一】病人有心肌梗塞→屬於ASCVD病人*Clinical ASCVD includes nonfatal MI, CHD death, and nonfatal and fatal stroke, TIA or peripheral arterial diseasepresumed to be of atherosclerotic origin【步驟二】根據2013年ACC/AHA cholesterol guideline,臨床有ASCVD病人,<75歲用高強度Statin,>75歲或無法耐受高強度statin時用中低強度statin,病人65歲,使用高強度statin【步驟三】找高強度statin(A) atorvastatin 40 mg高強度statin(B) ezetimibe 10 mg非statin類(C) fenofibrate 160 mgfibrate類(D) fluvastatin 20 mg低強度statin故選A補充Statin強度 (from pharmabook 王瑞賢 藥治統整本 11.0)2013 ACC/AHA cholesterol guideline

【評論主題】65.有關levothyroxine用於治療甲狀腺功能低下的劑量,下列敘述何者正確? (A)一般成人建議劑量為1.6~1.7 μg\\/kg\\/day (B)孕婦所需劑量較一般建議劑量調降30~5

【評論內容】各選項解題 + 10th koda & kimble p.1112 & TABLE 52-4(B)、(C)、(D)應改成(B)孕婦所需劑量較一般建議劑量調30~50%(C)老年人的劑量要降低!50mcg/day (半顆開始),有CHD病史者,initial dose更應該是從25mcg/day (四分之一顆)開始。大概每三到六個星期緩慢增加劑量,一次劑量可增加25mcg/day(四分之一顆)(D)3~6 months嬰兒建議劑量為10-15  μg/kg/day(A)The signs and symptoms of hypothyroidism can be easily corrected in most patients by the administration of l-thyroxine on an empty stomach at an oral replacement dosage of 1.6 to 1.7 mcg/kg/day(B)Most women with hypothyroidism who are taking oral thyroid hormones before pregnancy, similarto S.C., will require an increase in their dosage by about 30% to 50% throughout their pregnancy

【評論主題】59.下列何者無法用於緩解hot flushes之症狀? (A)citalopram (B)clonidine (C)gabapentin (D)raloxifene

【評論內容】補充applied 熱潮紅治療流程圖...

【評論主題】54.有關hypnotics之敘述,下列何者錯誤? (A)ramelteon作用於melatonin受體,適合用於入睡困難的病人 (B)病人若半夜服用zaleplon,建議預留至少4小時的睡覺時間

【評論內容】各選項解析 10th applied p.1908(D)選項 ramelteon不是管制藥(A) ramelteon作用於melatonin受體,適合用於入睡困難的病人其他適用於入睡困難的有Triazolam、Zaleplon【1062/1091】、Zolpidem【1062/1082/1091】(B)zaleplon 有更短的半衰期(1.1 hr),建議預留4hr的睡覺時間zaleplon can be taken in the middle of the night as long as the individual has 4 hours left in bed(C) 仿單建議起始劑量:女性為5毫克,男性為5毫克或10毫克。若5毫克劑量無效,劑量可增加至10毫克。每日最高劑量不可超過10毫克。 女性的建議起始劑量與男性不同,是因為zolpidem的清除率,女性較低

【評論主題】51.22歲方小姐抱怨有睡眠障礙,入睡後半夜容易醒來。下列何者對於維持睡眠效果最差? (A)estazolam (B)temazepam (C)zaleplon (D)zolpidem

【評論內容】10th pharmacotherapy p.3153解題+ 失眠考點統整入睡後半夜容易醒來屬於Difficulty Maintaining Sleep (DMS)通常需要中長效的藥物applied 圖表內用於治療DMS的藥物有(D)Zolpidem【1061/1062 Eszopiclone【1052/1062】、 (B)Temazepam Flurazepam【1032】(A) estazolam半衰期12-15hr(C) zaleplon 半衰期僅1hr 通常用於治療不易入睡的Difficulty Falling Asleep (DFA)對降低nighttime awakening的DMS無效Zaleplon has a rapid onset of action and a half-life of 1 hour, and it is metabolized to inactive metabolites.

【評論主題】57.下列何者為menopausal hormone therapy的絕對禁忌症? (A)diabetes mellitus (B)obese (C)skin cancer (D)active de

【評論內容】10th pharmacotherapy:TABLE 82-1  FDA-Labeled Indications and Contraindications for Menopausal Hormone Therapy with Estrogens and Progestins(D)active deep vein thrombosis是絕對禁忌症(A)DM 與 (B) 肥胖是相對禁忌症<補充自 pharmabook 王瑞賢 藥治統整本 11.0 >

【評論主題】55.下列何者鎮靜效果最少? (A)chlorpromazine (B)haloperidol (C)olanzapine (D)quetiapine

【評論內容】10th koda & kimble applied  table 82-7 & 考點統整表格Relative Incidence of Antipsychotic Drug Adverse Effects各選項鎮靜程度選項鎮靜程度(A) chlorpromazine++++(B) haloperidol+(C) olanzapine+++(D) quetiapine+++【考點統整表格】(from pharmabook 王瑞賢藥治統整本 11.0)

【評論主題】50.對於Parkinson disease<65歲,早期病人的resting tremor,通常可以優先選擇下列何項藥品? (A)levodopa (B)rotigotine (C)tolcapo

【評論內容】補充applied內抗帕金治療流程圖解題的重點在於resting tremor的治療通常使用抗膽鹼治療resting tremor (且病人<65歲)41.Anticholinergics對於帕金森氏症病人的何種症狀治療效果最佳?

【評論主題】49.關於tension-type headache之治療,下列何者錯誤? (A)NSAIDs為有效治療藥品 (B)relaxation training合併biofeedback為有效非藥物治療

【評論內容】10th pharmacotherapy p.2752 各選項解析+緊縮型頭痛考點統整(C)選項目前沒有研究證實Muscle relaxants對緊縮型頭痛有效果There is no evidence to support the efficacy of muscle relaxants in the management of episodic tension-type headache----------------------------------------------------------------------------------------------------------------------(A)簡單的止痛藥(EX:Acetaminophen, aspirin, diclofenac, ibuprofen, naproxen, ketoprofen, and ketorolac )和NSAIDs對輕-中度緊縮型頭痛有效(B)relaxation training合併biofeedback為有效非藥物治療,甚至是行為治療中最有效的(D)amitriptyline為有效預防藥品Mirtazapine、Venlafaxine也可預防--------------------------------------------------------------------------------------------------------------------(A) Simple analgesics (alone or in combination with caffeine) and NSAIDs are effective for the acutetreatment of most mild to moderate tension-type headaches(B)Psychophysiologic therapy and physical therapy have been used in the management of tension-typeheadache. Behavioral treatments can consist of cognitive-behavioral therapy (ie, stress management),relaxation training, and biofeedback.37 These therapies (alone or in combination withpharmacotherapy) can result in a 33% to 64% reduction in headache activity. Relaxation training combined with biofeedback is more effective than other behavioral therapy options(D)Antidepressant agents (e.g., amitriptyline) are useful for prophylactic treatment of migraine and tension-type headaches.【緊縮型考點統整】 (From pharmabook 王瑞賢 藥治統整本 11.0)

【評論主題】36.醫師處方loperamide 2 mg\\/cap治療急性腹瀉,成人每日極量為多少caps? (A)2 (B)16 (C)4 (D)8

【評論內容】

Loperamide 考點統整

1.可治急性/慢性腹瀉【1062】旅行者腹瀉【1042】2.急性腹瀉【1062】:起始4mg(2)最多16mg/day(8【1131】若症狀超過2未緩解需就醫

3.Irinotecan延遲性腹瀉(>24hr)4 mg PO STAT and followed by 2 mg Q2H 6.有關loperamide之敘述,下列何者錯誤?

【評論主題】43.60歲林先生,ESRD接受血液透析,最近一次檢驗值:Ca 12 mg\\/dL(8.8-10.2)、P 7 mg\\/dL、pH 7.30、 PaCO2 35 mmHg、HCO3- 18 m

【評論內容】(A)使用含Mg的磷結合劑,可能加重高血鎂,不適合用於腎衰竭病人(B)此題的Ca 已超過正常值 ,不建議含鈣的降磷劑 calcium acetate因此(C)、(D)在選pH 7.30、 PaCO2 35 mmHg、HCO3- 18 mEq/L正常值:

arterial blood gas

正常值

PH

7.35–7.45

PaO2

80–105 mm Hg

PaCO2

35–45 mm Hg

HCO3−

22–26 mEq/L

病人PH<7.35→酸中毒HCO3−稍低(減少)、PaCO2稍低→變化方向相同→代謝性病人是代謝性酸中毒sevelamer hydrochloride會降低洗腎病人serum bicarbonate→病人HCO3−稍低(減少)故選擇(C) sevelamer carbonateThe administration of sevelamer hydrochloride to patients on HD is associated with a lowering of serum bicarbonate; this effect should be taken into account when using this agent.

【評論主題】48.有關疼痛之處置,下列何者正確? (A)acute cancer pain crisis應視為急症,須以morphine或等效narcotic analgesics處置 (B)acute can

【評論內容】10th pharmacotherapy p.2692(A)臨床上常用morphine或等效narcotic analgesics來治療acute cancer pain crisis(B)在使用non-opioids治療前,需先看是否有肝腎功能不全的狀況,若有則會考慮opioid類治療(C)雖然Opioids常用於慢性非癌症的疼痛,但長期使用的療效與安全性資料相當有限(D)根據Systematic review 看各類型鴉片劑型對breakthrough pain的療效口頰溶片(buccal film)的fantanyl作為突破性疼痛治療效果最好 ref:Breakthrough Cancer Pain: A Systematic Review of Pharmacologic Management | ONS(A)Opioids are often the next step in the management of acute pain and cancer-related chronic pain(B) The World Health Organization (WHO) recommends a three-step ladder approachusing nonopioids as initial treatment and escalating to either “weak” or “strong” opioids based onmild, moderate, or severe pain intensity ratings, respectively. However, patient specific factors (e.g.,renal or liver dysfunction which may limit nonopioid alternatives), may lead clinicians to initiatetherapy with an opioid to optimize pain relief while minimizing adverse effects.(C)Although opioids continue to be commonly utilized in the management of chronic noncancer pain and can be effective for individual patients, limited data is available supporting the long-term safety and efficacy of these agentsThis medication class may also be an effective treatment option in the management of chronic noncancer pain; however, this continues to be increasingly controversial.(D)Transmucosal immediate-release fentanyl (TIRF) was found to have the most evidence for BtCP.(Breakthrough cancer pain)

【評論主題】42.有關呼吸性鹼中毒,下列何者最正確? (A)ABG呈現CO2 及HCO3 -同時上升 2 3 (B)ABG呈現CO2 上升及HCO3 -下降 (C)易發生於氣喘惡化 (D

【評論內容】11th applied Common Causes of Respiratory Alkalosis 表格整理(AB)ABG呈現CO2 及HCO3 -同時下降(C)氣喘惡化較易發生於呼吸性中毒(D)

【評論主題】41.下列何者是peritoneal dialysis且免疫功能正常之病人發生首次peritonitis,最合理的empirical antibiotics? (A)tigecycline IVF

【評論內容】補充SBP的長考考點統整SBP(Spontaneous Bacterial Peritonitis)原發性腹膜炎

【評論主題】41.下列何者是peritoneal dialysis且免疫功能正常之病人發生首次peritonitis,最合理的empirical antibiotics? (A)tigecycline IVF

【評論內容】10th pharmacotherapy table 114-8 + 考過國考題Guidelines for Empiric Antimicrobial Agents for Intra-Abdominal InfectionsIP(Intraperitoneal)注射【1071】、合併用藥為了同時cover G(+)G(-)的菌種【1071/1121】

【評論主題】32B型肝炎血清學應至少有那幾項,才可評估B型肝炎 reactivation的風險?①HBsAg ②Anti-HBs Ab ③HBeAg ④Anti-HBe Ab ⑤Anti-HBc Ab ⑥Ig

【評論內容】B肝血清學判讀與補充考過考點HBsAg① b肝的表面抗原 判斷是否已感染B肝,感染B肝時,最早出現【1002】指標Anti-HBc⑤B肝表面抗體,判斷是否曾感染B肝,(+)代表曾經感染過B肝【考過考點統整】<節錄自 pharmabook 王瑞賢 藥治統整本 11.0>39.有關HBsAg(-)而anti-HBs(+)的B型肝炎病人,下列敘述何者最正確?

【評論主題】31.急性心肌梗塞病人入院後24小時內,通常不會進行下列那項處置? (A)morphine IV injection,緩解胸痛 (B)nitroglycerin IV infusion,直到胸痛緩解

【評論內容】STEMI 起始治療口訣 & 補充 11th applied STEMI 治療流程圖&考過國考題

【評論主題】28.有關digoxin之敘述,下列何者正確? (A)屬rhythm control抗心律不整藥品 (B)靜脈注射5~10分鐘可發揮抗心律不整作用 (C)腎衰竭病人速效劑量與維持劑量都要降低 (D)

【評論內容】10th koda & kimble applied p.497(A) 選項應改成屬rhythm control抗心律不整藥品→ Rate control(B) IV注射後至少2小時可發揮抗心律不整作用,6-8小時後最大After an intravenous (IV) dose, digoxin will take more than 2 hours for the onset of effect and 6 to 8 hours for the maximal effect, which is markedly slower than other negative dromotropic agents(C)腎衰竭病人速效劑量與維持劑量都要降低If he had significant renal dysfunction, both the loading and the maintenance doses of digoxinwould need to be altered(D)需依照腎功能調整劑量,需進行TDM,對腎衰竭的治療濃度0.5 to 1.0 ng/mL

【評論主題】33.承上題,若病人需要給與抗病毒藥品預防B型肝炎reactivation,下列何者最適當? (A)lamivudine (B)telbivudine (C)entecavir (D)adefovi

【評論內容】10th pharmacotherapy p.1789FDA核准4個選項作為慢性B肝治療用藥其中(B) telbivudine因為高抗藥性與突變性,目前已不被治療指引建議單用於HBV感染(C) entecavir相較於(A) lamivudine、(D) adefovir

【評論主題】29.下列何者不會造成次發性高血壓? (A)licorice (B)pseudoephedrine (C)eplerenone (D)venlafaxine

【評論內容】補充10th koda & kimble applied table 14-3 & 1112考過的類似考題31.下列何者較不會引起次發性高血壓?

【評論主題】26.60歲女性,接受mechanical prosthetic valve replacement,肝腎功能正常,無特殊過敏史,下列何者是 較適當的anticoagulant選擇? (A)dab

【評論內容】NOAC藥物是針對對非瓣膜性心房纖維顫動(non-valvular AF, NVAF)瓣膜性心房纖維顫動(valvular AF)專指1.中度至重度二尖瓣狹窄(moderate to severe mitral stenosis很可能需進行瓣膜手術)2.機械瓣膜(mechanical valve) 置換者這些患者建議需長期使用warfarin 並保持適當的INR以有效預防血管栓塞。而對其中機械瓣膜置換患者(不含生物瓣膜或瓣膜 成形術)特別強調建議使用 #VKA (warfarin) 而非NOAC才能確保有效預防腦梗塞的發生。

【評論主題】24.68歲陳女士,有hypertension、DM、dyslipidemia病史,初診斷有stable ischemic heart disease。目前 BP 148\\/86 mmHg、BW

【評論內容】10th koda & kimble applied table 17-3 與補充考過國考題AHA/ACC建議CAD次級預防與風險因子控制目標(B)選項應更改為LDL cholesterol < 100 mg/dL(C)選項應更改為HbA1C < 7%(D)選項應更改為<130/80mmHg風險因子控制目標備註吸菸戒菸或遠離有菸環境血壓<130/80 (D)有DM/CKD病人血壓目標也是130/80血脂 LDL-C <100 mg/dL(B)若TG >200 mg/dL,non–HDL-C應<130 mg/dL糖尿病Hemoglobin A1c <7% (C)-體重BMI between 18.5 and 24.9 kg/m2Waist circumference, men <40 inchesWaist circumference, women <35 inches46.依據美國NCEP/ATPIII的指導方針,下列何項是被視為冠心症(CHD)的 negative risk factor?

【評論主題】23.70歲謝女士,身高158公分,體重60公斤,有hypertension和dyslipidemia病史。最近3天一直有頭暈和心 悸,心電圖顯示有atrial fibrillation,seru

【評論內容】【解題思路】1.直流電整流術 (Direct current cardioversion, DCC)是Rhythm control,但Rthythm control 通常用於年輕(<65歲)且無心臟疾病(HTN、HF)患者,題幹70歲且有高血壓,較不適合此外DCC容易發生栓塞,DCC前3後4周【1061】仍需給抗凝血劑(warfarin【982/1052】)目標INR2.5