阿摩線上測驗
68.某癲癇病人因感染住院，在使用meropenem期間，癲癇復發且抗癲癇藥品血中濃度大幅降
低。此案例之抗癲癇藥品最可能是下列何者？
(A)carbamazepine
(B)levetiracetam
(C)phenytoin
(D)valproic acid
答案：登入後查看
統計： A(1512), B(463), C(752), D(2627), E(0) #1153604
統計： A(1512), B(463), C(752), D(2627), E(0) #1153604
詳解 (共 9 筆)
林榮耀
#1433056
於醫院實習時，「藥物血中濃度監測」有提到Valproic acid與penem類抗生素之特殊交互作用。原因不明，背起來就好。
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仁藥基金會無限期籌備中
#2321052
Penem 類抗生素會導致Valproic血中濃度下降60%以上，加重劑量一樣無效，所以必須搭配其他抗癲癇藥，至於機轉現在仍不明
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shallowline
#1397375
The serum concentration of valproic acid (VPA) in epilepsy patients decreased by the administration of carbapenem antibiotics, such as meropenem, panipenem or imipenem, to a sub-therapeutic level.
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蘇奕誌
#4914376
直接截自己的留言(複製貼上好麻煩ww
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cute_shiba
#6143129
自己會搞混的交互作用，順便複習一下
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資料來源：Micromedex
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Valproic acid－Penem類⮕減少VPA濃度，使癲癇發作風險增加
Valproic acid－Lamotrigine⮕增加Lamotrigine濃度，使Lamotrigine相關副作用增加(如rash)
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Interaction Effect:
Concurrent use of LAMOTRIGINE and VALPROIC ACID may result in increased lamoTRIgine exposure and increased risk of severe, potentially life-threatening rash.
Probable Mechanism:
inhibition of lamoTRIgine glucuronidation and decreased lamoTRIgine clearance
inhibition of lamoTRIgine glucuronidation and decreased lamoTRIgine clearance
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Interaction Effect:
Concurrent use of IMIPENEM and VALPROIC ACID may result in reduced valproic acid exposure and increased risk of seizures and status epilepticus.
Concurrent use of IMIPENEM and VALPROIC ACID may result in reduced valproic acid exposure and increased risk of seizures and status epilepticus.
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DGF
#5512141
carbapenem會降低valproic acid濃度且增加劑量無法改善
1.抑制valproate glucuronide在肝臟水解成valproate，而增加肝腎清除valproate glucuronide
2.抑制valproic acid經由胃腸道吸收
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