[{"data":1,"prerenderedAt":66},["ShallowReactive",2],{"q-nurse-115-2-basic-medicine-037":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":35,"lastmod":65},"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":11},"nurse-115-2-基礎醫學-037","nurse-115-2-basic-medicine-037",115,2,37,"下列抗心律不整藥物中，何者於臨床上亦可作為局部麻醉劑使用？",{"A":15,"B":16,"C":17,"D":18},"lidocaine","mexiletine","amiodarone","sotalol","A",null,[],"本題考點是鈉離子通道阻斷藥在抗心律不整與局部麻醉兩種用途上的重疊。Lidocaine 屬 Vaughan Williams 分類第一 B 類抗心律不整藥,阻斷心肌鈉離子通道並縮短動作電位時程;它同時是 amide 類局部麻醉劑的代表,以阻斷周邊感覺神經的電壓閘控鈉離子通道抑制動作電位傳導而止痛,兩種用途共用同一個鈉通道機轉,故選 A。選項 B 的 mexiletine 雖與 lidocaine 同屬第一 B 類、結構近似且可口服,但臨床不作局部麻醉使用。選項 C 的 amiodarone 屬第三類,主要阻斷鉀離子通道。選項 D 的 sotalol 兼具第三類鉀通道阻斷與 β 受體阻斷作用,兩者機轉都與局部麻醉無關。","Vaughan Williams 分類必須背成骨架:第一類鈉通道阻斷(IA quinidine、procainamide 中度阻斷並延長動作電位;IB lidocaine、mexiletine 弱阻斷並縮短動作電位,對缺血心肌與心室性心律不整最有效;IC flecainide、propafenone 強阻斷、不改變動作電位時程,致心律不整風險最高)、第二類 β 受體阻斷、第三類鉀通道阻斷(amiodarone、sotalol、ibutilide,延長 QT)、第四類鈣通道阻斷(verapamil、diltiazem)。Lidocaine 走靜脈注射而不口服的原因是首渡效應極強,口服幾乎全被肝臟代謝掉。局部麻醉劑另有 ester 類(procaine、tetracaine,由血漿膽鹼酯酶水解,過敏較多)與 amide 類(lidocaine、bupivacaine,由肝臟代謝),記憶訣竅是「名稱中出現兩個 i 者為 amide 類」。局部麻醉劑全身毒性依序表現為口周麻木、耳鳴、抽搐、意識喪失,再進展到心臟毒性,bupivacaine 的心臟毒性最高。可連結複習:amiodarone 的多系統副作用(肺纖維化、甲狀腺功能異常、角膜沉積)。",[25,27,30,32,33],{"term":26,"count":11},"鈉離子通道阻斷",{"term":28,"count":29},"Vaughan Williams 分類",1,{"term":31,"count":29},"第一 B 類抗心律不整藥",{"term":15,"count":29},{"term":34,"count":29},"amide 類局部麻醉劑",[36,40,45,50,55,60],{"webId":37,"stem":38,"number":39,"year":10,"session":11},"nurse-115-2-basic-medicine-038","下列何者無法用於治療發炎性腸道疾病（inflammatory bowel disease）？",38,{"webId":41,"stem":42,"number":43,"year":44,"session":11},"nurse-106-2-basic-medicine-004","下列頭顱骨骼，何者負責與頸椎形成關節？",4,106,{"webId":46,"stem":47,"number":48,"year":49,"session":29},"nurse-107-1-basic-medicine-018","骨骼肌收縮時的鈣離子是從那種鈣通道釋放出來？",18,107,{"webId":51,"stem":52,"number":53,"year":54,"session":29},"nurse-108-1-basic-medicine-056","下列何者為 pilocarpine 的拮抗劑？",56,108,{"webId":56,"stem":57,"number":58,"year":59,"session":11},"nurse-109-2-basic-medicine-020","第一心音發生在下列何時？",20,109,{"webId":61,"stem":62,"number":63,"year":64,"session":11},"nurse-110-2-basic-medicine-054","如果一個藥物的半衰期為 10 小時，以靜脈輸注此藥物後，在血液中達到穩定濃度所需的時間約多久？",54,110,"2026-08-06",1787299017726]