[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-115-2-basic-medicine-031":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":34,"lastmod":64},"基礎醫學","basic-medicine","基礎醫學(包括解剖學、生理學、病理學、藥理學、微生物學與免疫學)",{"id":8,"webId":9,"year":10,"session":11,"subject":4,"number":12,"stem":13,"options":14,"answer":19,"answerNote":20,"images":21,"explanation":22,"explanationDeep":23,"topics":24,"freq":27},"nurse-115-2-基礎醫學-031","nurse-115-2-basic-medicine-031",115,2,31,"藥物代謝過程中，經由加入葡萄糖醛酸（glucuronide）、硫酸、醋酸或胺基酸等之接合反應（conjugation reaction），其主要目的為何？",{"A":15,"B":16,"C":17,"D":18},"增加水溶性","增加藥效","促進吸收","增加藥物在體內之時間","A",null,[],"本題考點是藥物代謝第二相接合反應的生化目的。依藥物代謝分相原理,第一相反應(氧化、還原、水解)先產生帶有反應性官能基的代謝物,第二相接合反應再把葡萄糖醛酸、硫酸、醋酸或胺基酸等高極性基團接上去,使分子極性與水溶性大幅提高,便於經腎臟隨尿液或經膽汁排除,故主要目的是增加水溶性,選 A。選項 B 錯在方向,接合後多數代謝物藥理活性下降而非增強。選項 C 錯在階段,吸收發生於給藥後進入血流之前,接合反應屬排除前的代謝步驟。選項 D 也相反,水溶性提高使排除加快,藥物停留體內的時間縮短。","第二相酵素家族值得整組記:UGT(葡萄糖醛酸接合,量最大)、SULT(硫酸接合)、GST(麩胺基硫接合)、NAT(乙醯化)、甲基轉移酶。臨床意義的經典例子有三個。第一,新生兒 UGT 活性不足,膽紅素接合能力低,是生理性黃疸與 Crigler-Najjar 症候群的機轉基礎。第二,乙醯胺酚在治療劑量下大部分走接合途徑解毒,過量時接合能力飽和,毒性代謝物 NAPQI 累積而耗盡麩胺基硫,造成肝細胞壞死,解毒劑 N-acetylcysteine 正是補充麩胺基硫前驅物。第三,少數接合產物反而毒性更強(如嗎啡的 6-glucuronide 仍具活性),說明「第二相必等於解毒」是過度簡化。記憶方向:第一相「開門」(暴露官能基)、第二相「貼標籤」(接上極性基團好被丟出去)。可連結複習:首渡效應、腸肝循環中葡萄糖醛酸代謝物被腸道菌解離後再吸收。",[25,28,30,32],{"term":26,"count":27},"第二相接合反應",1,{"term":29,"count":27},"葡萄糖醛酸化",{"term":31,"count":27},"水溶性與排除",{"term":33,"count":27},"藥物代謝分相",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":10,"session":11},"nurse-115-2-basic-medicine-032","下列藥物中，何者無法用於治療廣角性青光眼？",32,{"webId":40,"stem":41,"number":42,"year":43,"session":27},"nurse-106-1-basic-medicine-078","病毒感染是藉由病毒套膜的糖蛋白 VAP 和細胞受器（receptor）結合而決定其感染細胞的專一性。下列何者是錯誤的結合？",78,106,{"webId":45,"stem":46,"number":47,"year":48,"session":27},"nurse-107-1-basic-medicine-012","下列何者供應闌尾的血液？",12,107,{"webId":50,"stem":51,"number":52,"year":53,"session":27},"nurse-108-1-basic-medicine-050","下列何種抗癲癇藥物，其結構類似 GABA？",50,108,{"webId":55,"stem":56,"number":57,"year":58,"session":11},"nurse-109-2-basic-medicine-014","下列有關腮腺的敘述，何者錯誤？",14,109,{"webId":60,"stem":61,"number":62,"year":63,"session":11},"nurse-110-2-basic-medicine-048","下列那一種關節炎是好發於年輕男性的薦腸骨關節及 HLA-B27 呈陽性？",48,110,"2026-08-06",1787299017674]