[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-115-2-basic-medicine-041":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-041","nurse-115-2-basic-medicine-041",115,2,41,"細菌對青黴素（penicillin）產生抗藥性，其最主要的機轉為何？",{"A":15,"B":16,"C":17,"D":18},"細菌產生對胺基苯甲酸（PABA），干擾葉酸的合成","細菌產生 β-內醯胺酶（β-lactamase），水解藥物的化學結構","細菌改變細胞膜的通透性，使之無法進入","細菌進入對數生長期（Log phase），對抗生素產生天然抗性","B",null,[],"本題考點是細菌對盤尼西林(青黴素)產生抗藥性的主要機轉。盤尼西林的作用是以 β-內醯胺環結合並抑制細菌的轉肽酶,阻斷細胞壁胜肽聚糖交聯;細菌最主要的反擊方式就是製造 β-內醯胺酶,水解該環結構使藥物失去活性,故選 B。選項 A 描述的是細菌大量產生對胺基苯甲酸以競爭性對抗磺胺類藥物的機轉,與盤尼西林的作用標的無關。選項 C 的通透性改變確實存在,但屬於次要機轉,且主要見於革蘭氏陰性菌外膜孔蛋白改變。選項 D 的說法方向相反,細菌處於對數生長期時細胞壁合成最活躍,對盤尼西林反而最敏感,不會因此獲得天然抗性。","抗藥性四大機轉整組背最有效率:酵素破壞藥物(β-內醯胺酶、胺基醣類修飾酶)、標的改變(MRSA 取得 mecA 基因表現 PBP2a,對 β-內醯胺類親和力極低;肺炎鏈球菌 PBP 突變)、通透性下降或排出泵增強(綠膿桿菌孔蛋白減少加 efflux pump)、代謝繞道(如取得替代葉酸合成路徑)。針對 β-內醯胺酶的藥物設計對策有兩條:改造側鏈使酵素無法接近(methicillin、oxacillin、nafcillin 這類抗葡萄球菌盤尼西林),或加入 β-內醯胺酶抑制劑(clavulanic acid、tazobactam、sulbactam,自身抗菌力弱但可當自殺型受質)。重點觀念是 MRSA 的抗藥並非來自 β-內醯胺酶,而是標的 PBP 改變,所以加酵素抑制劑無效,必須改用 vancomycin 或 linezolid,這個區別是國考高頻陷阱。可連結複習:β-內醯胺類四大家族(盤尼西林、頭孢子素、carbapenem、monobactam)的抗菌譜擴展邏輯,以及 ESBL 與 carbapenemase 造成的多重抗藥問題。",[25,28,30,32],{"term":26,"count":27},"β-內醯胺酶",1,{"term":29,"count":27},"盤尼西林作用機轉",{"term":31,"count":27},"細菌抗藥性機轉",{"term":33,"count":27},"胜肽聚糖交聯",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":10,"session":11},"nurse-115-2-basic-medicine-042","下列有關抗體的敘述何者錯誤？",42,{"webId":40,"stem":41,"number":42,"year":43,"session":11},"nurse-106-2-basic-medicine-008","下列有關男性生殖器官的敘述，何者錯誤？",8,106,{"webId":45,"stem":46,"number":47,"year":48,"session":27},"nurse-107-1-basic-medicine-022","終板電位（end-plate potential）屬於下列何種電位？",22,107,{"webId":50,"stem":51,"number":52,"year":53,"session":27},"nurse-108-1-basic-medicine-060","Beta 腎上腺素受體拮抗劑用於治療心律不整，主要的藥理機轉為何？",60,108,{"webId":55,"stem":56,"number":57,"year":58,"session":11},"nurse-109-2-basic-medicine-024","下列何種類型的病人，會有促腎上腺皮質素（ACTH）大量分泌的情況？",24,109,{"webId":60,"stem":61,"number":62,"year":63,"session":11},"nurse-110-2-basic-medicine-058","Propranolol 治療甲狀腺亢奮引起之震顫及心悸，但病人有下列何種疾病時，不宜使用？",58,110,"2026-08-06",1787299017772]